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

•

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