Pertussis – Whooping Cough
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Pertussis (Image)
Pertussis Pathochart (Cheatsheet)
Immunization Schedule (Cheatsheet)
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Outline
Overview
- Highly contagious respiratory infection caused by the Bordetella pertussis bacteria that is easily prevented with vaccine.
Nursing Points
General
- Spread via direct contact with droplets
- The time between exposure and the development of symptoms is on average 7–14 days
- Prevention
- Immunization:
- DTaP: for infants and young kids – given at 2, 4, 6, 15 months and 4-6 years
- Tdap: for adolescents and adults
- Booster recommended for adolescents
- Recommended for pregnant women in 3rd trimester to help protect newborns
- Immunization:
Assessment
- Catarrhal stage – upper respiratory infection
- Runny nose
- Fever
- Mild cough
- Paroxysmal stage
- Cough progresses
- Worse at night
- Short rapid coughs followed by high-pitched “whoop sound” as patient tries to breathe in.
- Coughing can be so forceful that patients vomit, break ribs and become exhausted.
- Lasts 4-6 weeks
- Cough progresses
Therapeutic Management
- Isolate patient
- Initiate droplet precautions
- Dx- nasopharyngeal swab for culture
- Position patient on side during coughing spells to reduce risk of aspiration
- Encourage fluids
- Humidified oxygen
- Antibiotic therapy
- Erythromycin
- Clarithromycin
- Azithromycin
- Monitor for complications
- Respiratory distress and cyanosis
- Rib fractures
- Pneumonia
Nursing Concepts
- Immunity
- Infection Control
- Oxygenation
Patient Education
- Isolate child from other children
- Pain relievers may help alleviate discomfort
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Transcript
Hey guys, glad you are joining me here! In this lesson we are going to talk about pertussis, which is also known as whooping cough.
Whooping cough is a highly contagious respiratory infection caused by the organism bordetella pertussis, which you can see in the photo here. What happens during pertussis is that the bacteria attach to the cilia which are the tiny little hairlike things that line the upper respiratory system. The bacteria causes damage and inflammation in the airway.
The crazy thing with whooping cough is that it symptoms can actually last up to 6 weeks.
It can be prevented with the DTaP (Diphtheria, Tetanus and Pertussis) vaccine which is given at 2, 4, 6, 15 months and again between 4-6 years. You may be thinking wait- I thought it was called the Tdap. Well, the Tdap is what’s used for adolescents and adults, whereas the DTaP is given to infants and kids.
In your assessment there are two different stages to look for. The first is the catarrhal stage. Catarrh is just a fancy word for inflammation in the airways. During this stage you’ll see fever, increased nasal secretions, and a mild cough. The second stage is the paroxysmal stage and this is when the cough really progresses. Patients experience these coughing spells – where they have a bunch of short rapid coughs followed by a high-pitched whooping sound. These spells tend to be worse at night and can be so bad that they cause vomiting and may be fracture ribs.
Like I mentioned symptoms can last up to 6 weeks- so it can be pretty exhausting.
Just a quite note- The patients we are most worried about are our infants. They may develop pneumonia and their airways are actually still pretty soft so the intense coughing can cause a lot of damage. Apneic episodes are common in infants and for them whooping cough can be life threatening. So be extra vigilant with your assessment- looking out for signs of respiratory distress.
These patients need to be on droplet precautions. Our nursing care is focused on supporting respiratory effort. These patients may benefit from humidified O2 and elevating the head of bed.
Antibiotics are given as well. The most common one give is azithromycin.
Patient education is important because we need to make sure caregivers know that symptoms can last a long time.
Your priority nursing concepts for a pediatric patient with pertussis are immunity, infection control and oxygenation.
Pertussis is a respiratory infection that is very contagious and caused by bordetella pertussis.
It is preventable with the DTaP immunization, which is given at 2, 4, 6, 15 mo and 4-6 years.
There are 2 stages to the disease, the first pretty much just looks like an upper respiratory tract infection and the second is when the cough progresses to the classic “whooping cough”.
Treatment is supportive and antibiotics.
Patient education should focus on preparing caregivers for the length of the illness and also making people aware of the importance of immunizing against it!
That’s it for our lesson on Pertussis or Whooping cough. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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