U Assessment

HISTORY. The child usually has a history of an upper respiratory infection and a runny nose (rhinorrhea). After several days of respiratory symptoms, such as cough and increased respiratory rate, the child develops a barking, seal-like cough; a hoarse cry; and inspiratory stridor. The symptoms tend to occur in the late evening and improve during the day. A child may have LTB more than once but will outgrow it as the size of the airways increases. The course of the infection lasts several days to several weeks, and the child may have a lingering, barking cough.

PHYSICAL EXAMINATION. The initial sign of LTB is increasing respiratory distress. The child may develop flaring of the nares, a prolonged expiratory phase, and use of accessory muscles. When you auscultate the child's lungs, the breath sounds may be diminished and you may hear inspiratory stridor. The child may have a mild fever. Increasing respiratory obstruction is indicated by any of the following: increasing stridor, suprasternal and intercostal retractions, respiratory rate above 60, tachycardia, cyanosis, pallor, and restlessness. In addition, each type of croup can have particular symptoms, as shown in Table 1.

• TABLE 1 Forms of Laryngotracheobronchitis
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