👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: barking cough · seal cough · laryngotracheobronchitis · LTB
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Use this quick-reference guide to spot, treat, and prevent Croup on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
⚠️ Causes
Viral (parainfluenza), 6mo–3yr
Subglottic airway swelling
🩺 Signs
Seal-bark cough, worse at night
Inspiratory stridor, hoarse voice
Low-grade fever, gradual onset
✅ Do
Cool mist / humidified air
Nebulized epi + dexamethasone
Keep child calm, sit upright
🚩 Report
Stridor at REST → airway risk
Cyanosis, retractions, ↓ sats
📚 Croup — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Croup (laryngotracheobronchitis) is a viral upper-airway infection, usually from parainfluenza virus, causing inflammation and edema of the larynx, trachea, and bronchi. It mainly affects children 6 months to 3 years and is marked by a classic barking, seal-like cough and inspiratory stridor that worsen at night. It is usually self-limiting, but airway swelling can compromise breathing in young children whose airways are already narrow.
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Key points
Understand these first
Hallmark signs are a harsh barking or seal-like cough, hoarseness, and inspiratory stridor.
Symptoms classically worsen at night and with crying or agitation.
Onset is gradual, often preceded by a low-grade fever and cold-like upper respiratory symptoms.
The child appears nontoxic and can usually still drink, swallow, and lie flat.
Steeple sign (subglottic narrowing) may appear on a neck X-ray.
Stridor at rest, retractions, and restlessness indicate worsening airway obstruction.
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Nursing priorities
What to do, in order
Keep the child calm and on the parent's lap; agitation worsens airway obstruction.
Provide cool humidified air or mist and encourage oral fluids to thin secretions.
Administer corticosteroids (dexamethasone) as ordered to reduce airway edema.
Give nebulized racemic epinephrine for moderate-to-severe stridor and monitor for rebound for at least 2-3 hours.
Continuously monitor respiratory status, oxygen saturation, and for increasing stridor or fatigue.
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Red flags — report now
Escalate immediately
Stridor at rest, increasing retractions, nasal flaring, or rising respiratory rate signal impending obstruction.
Cyanosis, drooling, lethargy, or decreasing level of consciousness require immediate escalation.
A child who becomes suddenly quiet with decreased breath sounds may be tiring and heading toward respiratory failure.
Never leave a child with worsening stridor unattended or delay airway support.
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Labs & values
Numbers to know
Oxygen saturation: normal 95-100%
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Patient teaching
What patients must know
Use cool night air or a cool-mist humidifier and sit with the child during episodes.
Keep the child calm; offer small frequent sips of fluid to stay hydrated.
Return to care immediately for stridor at rest, fast or labored breathing, drooling, or bluish color.
❓ Croup: NCLEX FAQs
What are the priority nursing interventions for Croup?
Keep the child calm and on the parent's lap; agitation worsens airway obstruction. Provide cool humidified air or mist and encourage oral fluids to thin secretions. Administer corticosteroids (dexamethasone) as ordered to reduce airway edema. Give nebulized racemic epinephrine for moderate-to-severe stridor and monitor for rebound for at least 2-3 hours.
What are the warning signs of Croup a nurse must report?
Stridor at rest, increasing retractions, nasal flaring, or rising respiratory rate signal impending obstruction. Cyanosis, drooling, lethargy, or decreasing level of consciousness require immediate escalation. A child who becomes suddenly quiet with decreased breath sounds may be tiring and heading toward respiratory failure. Never leave a child with worsening stridor unattended or delay airway support.
What do I need to know about Croup for the NCLEX?
Hallmark signs are a harsh barking or seal-like cough, hoarseness, and inspiratory stridor. Symptoms classically worsen at night and with crying or agitation. Onset is gradual, often preceded by a low-grade fever and cold-like upper respiratory symptoms. The child appears nontoxic and can usually still drink, swallow, and lie flat.
What patient teaching is important for Croup?
Use cool night air or a cool-mist humidifier and sit with the child during episodes. Keep the child calm; offer small frequent sips of fluid to stay hydrated. Return to care immediately for stridor at rest, fast or labored breathing, drooling, or bluish color.
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Quick Tip
Hallmark signs are a harsh barking or seal-like cough, hoarseness, and inspiratory stridor.