Nursing Care Plan (NCP) for Pertussis / Whooping Cough
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Lesson Objectives for Nursing Care Plan (NCP) for Pertussis/Whooping Cough
- Understanding Pertussis:
- Define Pertussis (Whooping Cough) as a highly contagious respiratory infection caused by the bacterium Bordetella pertussis.
- Recognize the characteristic symptoms, including paroxysmal coughing, inspiratory “whoop,” and post-tussive vomiting.
- Epidemiology and Transmission:
- Understand the epidemiology of Pertussis, including its incidence, prevalence, and populations at higher risk.
- Identify the modes of transmission, emphasizing the importance of vaccination for prevention.
- Clinical Presentation and Complications:
- Recognize the clinical presentation of Pertussis, ranging from mild cough to severe paroxysms, particularly in infants.
- Explore potential complications, such as pneumonia, seizures, and apnea, especially in vulnerable populations.
- Diagnostic Methods:
- Understand the diagnostic methods for Pertussis, including laboratory tests such as polymerase chain reaction (PCR) and culture.
- Discuss the importance of early and accurate diagnosis for prompt treatment and prevention of further transmission.
- Management and Prevention:
- Outline the principles of management for Pertussis, including antibiotic treatment, supportive care, and vaccination.
- Emphasize the role of vaccination in preventing Pertussis and reducing the severity of symptoms, especially in infants and pregnant women.
Pathophysiology of Pertussis (Whooping Cough)
- Attachment and Colonization:
- The bacteria attach to the cilia of the respiratory epithelial cells and produce toxins that interfere with the ciliary movement.
- This attachment and colonization disrupt the normal mucociliary clearance mechanism, leading to the accumulation of mucus and debris.
- Toxin Production:
- B. pertussis produces multiple toxins, including pertussis toxin, adenylate cyclase toxin, and tracheal cytotoxin.
- Pertussis toxin interferes with cellular signaling, affecting immune responses and contributing to the characteristic symptoms of Pertussis.
- Paroxysmal Coughing:
- The toxins and the inflammatory response lead to increased mucus production and severe inflammation of the airways.
- Paroxysmal coughing episodes result from attempts to clear the airways of accumulated mucus, often culminating in the characteristic “whooping” sound during inhalation.
- Complications and Spread:
- The severe coughing episodes may cause complications such as post-tussive vomiting, rib fractures, and exhaustion.
- The bacterium spreads through respiratory droplets during coughing, contributing to the highly contagious nature of Pertussis.
It’s important to note that the toxins produced by B. pertussis play a significant role in the pathogenesis of Pertussis, affecting both the respiratory epithelium and the host’s immune response. The disruption of normal respiratory function, coupled with the characteristic coughing spells, contributes to the clinical manifestations of Pertussis. Early diagnosis and appropriate treatment, along with vaccination for prevention, are crucial in managing this respiratory infection.
Etiology of Pertussis (Whooping Cough)
- Bacterial Cause:
- Pertussis is primarily caused by the bacterium Bordetella pertussis, which is highly contagious and spreads through respiratory droplets.
- Reservoir and Transmission:
- Humans are the primary reservoir for B. pertussis. The bacterium is transmitted from person to person through respiratory secretions, especially during coughing or sneezing.
- Vaccination Status:
- Unvaccinated or under-vaccinated individuals, particularly infants and young children, are more susceptible to Pertussis.
- The immunity provided by the pertussis vaccine (part of the DTP/DTaP series) may decrease over time, contributing to increased susceptibility in adolescents and adults.
- Waning Immunity:
- Immunity from natural infection or vaccination may wane over time, leaving individuals susceptible to reinfection or secondary infection.
- Waning immunity is a factor in the resurgence of Pertussis in various age groups, including adolescents and adults.
- Maternal Antibodies:
- Maternal antibodies acquired through vaccination or previous infection may provide some protection to infants during the first few months of life.
- However, these maternal antibodies gradually wane, and infants become more vulnerable to severe Pertussis infections.
Desired Outcomes of Nursing Care Plan (NCP) for Pertussis/Whooping Cough
- Resolution of Coughing Episodes:
- Attainment of a significant reduction in paroxysmal coughing episodes, leading to improved respiratory comfort and decreased severity of symptoms.
- Prevention of Complications:
- Absence or minimal occurrence of complications associated with Pertussis, such as post-tussive vomiting, rib fractures, or respiratory distress.
- Restoration of Adequate Oxygenation:
- Improvement in respiratory function and gas exchange, reflected in optimal oxygen saturation levels and the absence of signs of respiratory distress.
- Patient and Family Education:
- Enhanced understanding of Pertussis, its transmission, and the importance of completing the prescribed antibiotic regimen.
- Increased awareness of preventive measures, including vaccination, to reduce the risk of Pertussis in the individual and the community.
- Limitation of Transmission:
- Reduction in the spread of B. pertussis to others, contributing to community-wide prevention.
- Successful implementation of infection control measures to protect vulnerable populations, such as unvaccinated infants and individuals with compromised immune systems.
These desired outcomes reflect the comprehensive goals of Pertussis management, encompassing both individual health and public health considerations. Regular monitoring, prompt intervention, and patient education contribute to achieving these outcomes in the management of Pertussis cases.
Pertussis/Whooping Cough Nursing Care Plan
Subjective Data:
- Poor appetite
- Irritability
- Fatigue / increased drowsiness
Objective Data:
- Fever
- Nasal congestion / discharge
- Cough
- Vomiting
- “Whooping” sound when breathing
Nursing Assessment of Nursing Care Plan (NCP) for Pertussis/Whooping Cough
- Respiratory Assessment:
- Monitor respiratory rate, depth, and effort, paying attention to signs of respiratory distress, such as increased work of breathing and use of accessory muscles.
- Assess for the presence of the characteristic “whooping” sound during inhalation.
- Cough Characteristics:
- Evaluate the nature of the cough, including its frequency, duration, and severity.
- Document any paroxysms of coughing and assess the impact on the individual’s ability to breathe and speak.
- Vital Signs:
- Regularly measure vital signs, including temperature, heart rate, and oxygen saturation.
- Document any signs of fever or hypoxia, as Pertussis can lead to respiratory compromise.
- Fluid Intake and Output:
- Monitor fluid intake and assess for signs of dehydration, especially in cases where post-tussive vomiting may affect oral intake.
- Evaluate urine output and other indicators of hydration status.
- Complications Assessment:
- Assess for complications associated with Pertussis, such as post-tussive vomiting, rib fractures, or respiratory distress.
- Document any signs of complications promptly for appropriate intervention.
- Immunization History:
- Inquire about the individual’s immunization history, especially the completion of the pertussis vaccine series (DTaP or Tdap).
- Consider the impact of waning immunity, particularly in adolescents and adults.
- Medication History:
- Document administration of any prescribed medications, including antibiotics and antipyretics.
- Ensure adherence to the prescribed antibiotic regimen for Pertussis.
- Patient and Family Education:
- Educate the patient and family about Pertussis, its transmission, and preventive measures.
- Provide guidance on infection control practices to limit the spread of the bacterium to others.
Nursing Interventions and Rationales
- Assess vitals and monitor for fever
Fever, usually low grade, is common in pertussis. Get a baseline to determine effectiveness of interventions.
- Perform physical assessment, note any signs of poor perfusion or oxygenation
Cyanosis and decreased capillary refill indicate inadequate oxygenation and tissue perfusion due to inability to breathe normally and constricted airways.
- Assess respiratory status. Note rate, rhythm, effort and presence of apneic episodes
Breathing is usually difficult due to cough. Infants may have periods of apnea and need to be carefully monitored.
Children may also experience retractions of respiratory muscles and use of accessory muscles with labored breathing.
- Position patient upright
The upright position can help improve lung expansion and provide for a more effective cough. Patients may also present in tripod position.
- Administer supplemental oxygen via mask
Give supplemental oxygen to improve perfusion and prevent brain damage.
Administer oxygen via mask or oxygen tent/hood as appropriate for patient and per facility protocol.
- Perform nasopharyngeal suction as appropriate per facility protocol
Excess secretions produced can further restrict air flow to the lungs. Perform suction carefully to remove secretions and clear airway. Avoid excessive suctioning as it may further increase inflammation.
- Initiate access and maintain IV fluids
Patients, especially infants, dehydrate quickly and require supplemental fluids. Medications may also be given via IV route.
- Monitor for and reduce risk of aspiration
- Place patient on their side when vomiting
- Keep patient upright while eating and drinking
- Make sure patient stays upright for 30-45 min after meals
Forceful and continuous coughing may cause vomiting. Positioning the patient upright uses the force of gravity to help reduce the risk of aspiration.
- Provide for safety. Initiate seizure precautions
Lack of oxygen and forceful continuous cough may cause seizures. Make sure patient is in crib or rails are raised to prevent injury. Place patient on the side and remove items from the bed that can cause suffocation
- Provide patient and parent education about the disease process and prevention
- Length and stages of disease
- Vaccination for all family members
- Cover that cough
Help parents be advocates to prevent further infection or spread of infection.
Vaccines are available and recommended to all ages, beginning as early as two months of age, but require a full series to be protected from the disease. Infants, who have not completed a full series of vaccine and adults whose immunity has faded are the most likely to develop whooping cough.
Nursing Evaluation of Nursing Care Plan (NCP) for Pertussis/Whooping Cough
- Resolution of Coughing Episodes:
- Assess the reduction in paroxysmal coughing episodes, focusing on improvements in respiratory comfort and the overall severity of symptoms.
- Prevention of Complications:
- Monitor for the absence or minimal occurrence of complications associated with Pertussis, such as post-tussive vomiting, rib fractures, or respiratory distress.
- Adequate Oxygenation:
- Evaluate the improvement in respiratory function and gas exchange, including optimal oxygen saturation levels and the absence of signs of respiratory distress.
- Patient and Family Education:
- Assess the understanding of Pertussis, its transmission, and the importance of completing the prescribed antibiotic regimen.
- Verify increased awareness of preventive measures, including vaccination, to reduce the risk of Pertussis in the individual and the community.
- Limitation of Transmission:
- Monitor for a reduction in the spread of B. pertussis to others, as evidenced by successful implementation of infection control measures.
- Evaluate the effectiveness of education and measures to protect vulnerable populations, such as unvaccinated infants and individuals with compromised immune systems.
References
- https://www.medicinenet.com/pertussis/article.htm
- https://emedicine.medscape.com/article/967268-overview#a4
- https://www.mayoclinic.org/diseases-conditions/whooping-cough/symptoms-causes/syc-20378973
- https://www.cdc.gov/pertussis/about/diagnosis-treatment.html
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Transcript
Let’s dive into the nursing care plan for pertussis, also known as whooping cough. So the pathophysiology of pertussis or whooping cough is a highly contagious bacterial respiratory infection. It can affect people of all ages, but it’s most severe in infants and intolerance for adults. It pretty much presents as a mild cough or cold, but in young children, there is a hacking cough that is so severe that they are actually unable to breathe. Some nursing considerations that we want to take into consideration is that we want to manage that cough. It is very important that we keep the cough at bay. We want to monitor the vital signs. We want to do a really good respiratory assessment and administer any medications as ordered. And we want to give some vaccine education. The desired outcome for these patients is that the patient will maintain adequate respiration and a clear airway.
The patient is going to maintain optimal hydration and nutrition status, and the patient is going to be free from infection. So a patient with whooping cough. So this patient has a hacking hacking cough. What are some things that the patient might complain of? What do you think some things are that the patient might complain of? Well, when they come to see us, some of us have some subjective things that they’re going to talk about if they’re going to say that there is a poor appetite. They’re just not hungry. They have to decide, are they going to finish this cough? Or they’re going to be very irritable. And if you notice, this is something that happens with infants a lot when they’re sick; they tend to become very, very irritable and finally fatigue or increased drowsiness. Now, when they come to us, we’re going to have some objective data that we’re going to collect from our assessment.
We’re going to see that this patient has a fever. So remember that’s anything, 100.4 or higher. They’re going to have nasal congestion and discharge. They’re going to have a cough, vomiting, and it’s going to have that distinct whooping sound. So it’s going to be a very distinct whooping sound when they are breathing. So nursing considerations and nursing intervention, we want to perform a physical assessment. We want a head to toe physical assessment. And the goal of this is we want to assess the patient for any cyanosis or bluing of the skin. We want to see a capillary refill. If it’s decreased, these things can indicate added inadequate oxygenation and inadequate tissue perfusion. And that’s most likely due to the inability of the patient to breathe normally. And they’re constricted airways.
Next, We’re going to follow up with that and do a detailed respiratory assessment. We’re going to, uh, assess their respiratory status and we are going to, um, let’s see. So we are going to respiratory status as this is a respiratory condition. Breathing is usually very difficult due to the cough. They may have periods of apnea; do you remember what apnea is? Apnea is just an absence of breathing. So they may have periods of apnea. So we need to be diligent about monitoring these patients carefully. The child may also experience retractions of the respiratory accessory muscles, and they may also use those accessory muscles with labored breathing.
We’re going to monitor for and reduce the risk of aspiration because of the forceful and continuous coughing that comes from pertussis. It may cause vomiting. Then, we want to position the patient upright and use the force of gravity to help reduce the risk of aspiration. Okay? So these patients are at risk for aspiration. The next thing that we want to do is we want to initiate access. So these patients need an IV and we want to add fluids. They need lots of IV fluids, especially if they do hydrate fast and they need supplemental fluids. Medications may also be given via the IV route. Always important to have any patient that comes in and needs at least one good IV. Uh, with these patients, their O2 saturations may decrease. So let’s add that here. So they may have, um, decreased O2 saturations. So that’s anything less than 90%. So if their O2 sat is less than 90%. We want to administer any supplemental O2. We can give oxygen to improve perfusion and prevent any type of brand damage. So let’s take a look at the completed care plan next to the key points. The pathophysiology, one thing you want to remember is that pertussis is very contagious. It’s a contagious respiratory infection caused by a bacteria that causes a very dangerous hacking cough. Some of
The subjective things that the patient is going to present with, what they’re going to complain of at home is poor appetite, irritability, fatigue, drowsiness. Some things that we’re going to observe from this patient is we’re going to see a fever, cough, vomiting, and we’re going to hear that classic whooping sound. When they’re breathing, the inspiration is going to have a flipping sound. So the things that we want to do, the first thing we want to do is we want to do a really good respiratory assessment. WE want to administer O2. We want to watch for aspiration. We want to give them cough suppressants. We want to suction any secretions. Finally, we would like to give the patient and the family some vaccine education. Vaccines for pertussis are available and recommended for all ages beginning as early as two months; this does require a full series to be fully protected from the disease. So they are still susceptible until that course has been given, but this is the easiest way to prevent the spread of professors. We love you guys; go out and be your best self today, and, as always, happy nursing.
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