QLexNursing

Irritability → Both

🦚 Irritability in pediatric clients is a non-specific sign but often the earliest clue of respiratory distress or systemic illness.

🦚 In acute laryngotracheobronchitis, irritability may occur from upper airway narrowing, which causes dyspnea, anxiety, and restlessness.

🦚 In pneumonia, it may be due to fever, hypoxia, or pleuritic chest pain.

🦚 Regardless of the source, changes in behavior, especially agitation or clinginess in toddlers, must be assessed in context with other clinical symptoms.

Cough findings at 0800 → Acute Laryngotracheobronchitis

🦚 A barking, non-productive cough (described as "seal-like") is pathognomonic for croup.

🦚 This occurs due to inflammation and edema of the subglottic region of the airway, particularly affecting the larynx and trachea.

🦚 It often presents suddenly at night or early morning, as noted in the time-stamped clinical notes (0800 onset).

🦚 The absence of productive sputum, as expected in pneumonia, also supports croup as the diagnosis.

Stridor → Acute Laryngotracheobronchitis

🦚 Stridor is a high-pitched inspiratory sound resulting from turbulent airflow through a narrowed upper airway.

🦚 It is characteristic of croup, especially during agitation or crying, as it reflects laryngeal or tracheal narrowing.

🦚 It is not a typical finding in pneumonia, which primarily affects the alveoli and lower airways.

🦚 The presence of audible inspiratory stridor on exam reinforces the diagnosis of upper airway obstruction rather than lower lung infection.

Temperature → Both

🦚 The child had a low-grade fever (38.1–38.2°C / 100.6°F), which is common in both croup and pneumonia.

🦚 In viral laryngotracheobronchitis, low-grade fevers are expected, especially in early stages.

🦚 Pneumonia may present with low- or high-grade fevers depending on the etiologic agent (e.g., viral pneumonia tends to have milder fever compared to bacterial pneumonia).

🦚 Therefore, temperature alone cannot differentiate the two, making it a shared finding.