whooping cough
TRANSCRIPT
Whooping Cough
PERTUSSIS(Whooping Cough)
Understand about the whooping cough Explain the sign and symptom of whooping
cough Explain the complication of whooping cough Explain the risk factor of whooping cough Explain the pathophysiology of whooping
cough Explain the investigation of whooping cough Provide management for patient with whooping
cough List the nursing diagnosis of whooping cough
LEARNING OBJECTIVE
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DEFINTIONWhooping cough (pertussis) is an acute,highly contagious respiratory infection that is caused by the bacterium Bordetella pertussis.
Produces tenacious mucus with varying stages of the disease progressing with a characteristic cough and fever to chocking and fatalities.
There are three stages of the disease.
Stage one (lasts 1 - 2 weeks): Catarrhal Phase
Upper respiratory infection. Can be mistaken for the common cold
Slight fever (less than 100.4° F) Loss of appetite Very runny nose Sneezing Mild, occasional cough
SIGNS AND SYMPTOMS
Stage two (lasts 1 - 6 weeks): Paroxysmal Phase
Cough gets worse (2 - 50 times a day) and coughing spells last longer
Cough may end with a “whooping” sound as the person tries to draw a breath (however, not all people have the “whoop” sound)
Sudden intense bouts of coughing (paroxysms) can cause bulging and tearing eyes, tongue sticking out, and bluish discoloration
Vomiting or choking may follow coughing bouts Pneumonia may develop.
Stage three (lasts 2 weeks to several months): Convalescent Phase
Cough slowly goes away away
Complication
pneumonia convulsions
Seizure disorder (permanent)
Nose bleeds
Ear infections
Brain damage from lack of oxygen
Death
Slowed or stopped breathing (apnea)
Mental retardation
Bleeding in the brain (cerebral hemorrhage)
RISK FACTOR Predisposing Factors Bacteria Bordetella pertusssis (gram
negative) Transmission : Direct contact or droplet from
infected person ; indirect contact with freshly contaminated articles
Incubation period : 6-20 days, usually 7-10days Period of communicability: greatest during catarrhal
stage before onset of paraxysms
Precipitating Factors
Age Group: Infant(who are not
fully immunized)
The rod-shape Bordetta pertussis bacteria (shown above in green )lodge themselves in the cilia of the respiratory tract. They are spread in droplets from cough and sneezes. A person with pertussis is contagious from the cold symptoms appear. The contagious period lasts up 3 weeks after coughing spells begin.
PATHOPHYSIOLOGY
Bortella Pertussis attaches to and multiplies on the respiratory
epithelium
Spread in the nasopharynx and end primarily in the bronchi and
bronchioles
Bacteria attacks the cillia
Damage ciliated respiratory epithelium
Causes inflammation of the respiratory tract
Air moves to narrowed spaces
Mucus production
Coughing
Breathing Difficulties
Narrowing of the respiratory tract
Whooping sound
INVESTIGATION
Clinical history : Coughing for about 2 weeks with
whoop, paraxysms , posttusives vomitting Isolation of Bordetella pertussis from a clinical
specimen (culture positive), or Positive polymerase chain reaction (PCR) assay
for B. pertussis DNA.
Isolation during catarrhal stage : if hospitalized , institute respiratory precaution.
Maintain bed rest as long as fever present. Provide restful environment and reduce factor that
promote paraxysms e.g dust Encourage fluid ; offer small amount of fluid
frequently. Provide high humidity ; suction gently but often to
prevent choking on secretions. Observe for sign airway obstruction (increased
restlessness , cyanosis) Involved public health nurse if the child care at home.
NURSING MANAGEMENT
Antimicrobial therapy (e.g erythromycin) Administer of pertussis immune globulin Supportive treatment Hospitalization required for infant , children who
are dehydrated or those who have complications. Bed rest Adequate fluids Intubation possibly necessary Increase oxygen intake and humidity
MEDICAL MANAGEMENT
Whole cell pertussis vaccine (DTP) Pertussis can be prevented with the pertussis
vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization.This vaccine is 70-90% effective
DTaP immunizations are routinely given in five doses before a child's sixth birthday
The vaccination cannot be given to persons seven years of age or older
Immunity from the childhood vaccination series lasts for about ten years
PREVENTION
Immunity wears off the time
VACCINATION
Ineffective airway clearance r/t mucus production 2º pertussis
Ineffective breathing pattern r/t narrowing of respiratory tract
Imbalanced nutrition : less than body requirement r/t posttusive vomitting 2º pertussis
Altered body temperature : hyperthermia r/t invasion of Bordetella pertussis agent in the respiratory endothelium
NURSING DIAGNOSIS
Chaudhry R, Nagpaul-Chaudhry I, Buchta WG, Kircher KJ, Sampathkumar P. The prevention and treatment of pertussis.Manag Care Interface. 2007;20(2):43-6.
Raguckas SE, VandenBussche HL, Jacobs C, KlepserME. Pharmacotherapy. 2007;27(1): 41-52.
REFERRENCES