PERTUSSIS FOR CHILDREN

DISEASE DESCRIPTION
AGENT - BORDETELLA PERTUSSIS, a small gram negative coccobacillus is responsible for the majority of attacks of whooping cough.

INCUBATION PERIOD - 7 to 21 days.
COMMUNICABLE PERIOD - greatest during the catarrhal stage.
SOURCE - discharge from the respiratory tract of the infected person.

TRANSMISSION :
Direct contact or droplet spread from infected person. Indirect contact with freshly contaminated articles. Whooping cough spreads readily in the home among unvaccinated infant and young children.

STAGES

1. CATARRHAL STAGE
2. PAROXYSMAL STAGE
3. CONVALESCENT STAGE

Signs and symptoms of catarrhal stage

1. Last 1 to 2 weeks
2. Common cold with running nose.
3. Sneezing
4. Dry cough
5. Slight fever or no fever

Signs and symptoms of paroxysmal stage.

1. Last 2 to 4 weeks or larger.
2. Frequent severe violent coughing attacks occuring in clusters leading tovomiting, cyanosis and exhausion.

Signs and symptoms of convalescent stage.

1. Last 2 weeks to several months.
2. Coughing attacks disease, but many return with each respiratory infection.

TREATMENT
Whooping cough in infant , or when complicated by respiratory tract demands skilled treatment in a unit possessing all the necessary facilities. In case of apnoe attack the nurse should remain with the patient by giving O2. A child may turn blue, vomit or exhausted during a coughing attack, the air way shpuld be cleared. Patient feeding and refeeding after vomiting is a fundamental tenet of nursing care. Failure to refeeding results loss of weight and diminished power of resistance. It is wise to give small frequent feeds. Iv therapy and anti mocrobial therapy as prescribed.

NURSING CONSIDERATION

1. Isolate the child during catarrhal stage.
2. Institute respiratory isolation and precautions.
3. Maintain bed rest.
4. Gentle suctioning.
5. Increase fluid intake.
6. Oxygen as prescribed.
7. Reduce environmental factors that promote paroxysmes of coughing such as dust , smoke and sudden changes in temperature.

DIAGNOSTIC TEST
Bordetella pertussis may be isolated from culture of nasopharyngeal mucus.The organism is mostly found in brachial secretions the per nasal swab should only be taken immadiatelly after paroxysm , with this method there is air 80 to 90% chance of isolating the organism in the first 10 days of the ilness.


RESPIRATORY COMPLICATION :

• Pneumonia
• Emphysema
• Aspiration pneumonia
• Pneumothorax

CNS

• Convulsions
• Encephalopathy
• Coma

NURSING ALERT
The nurse should remain with the xchild while giving nebulization. Child should be held with head elevated while feeding. While suctioning , gently rotate and with draw catheter , apply suction 5 to 10 seconds only. Choose correct size of catheter for suctioning. Change the suction tube each time after suctioning.

COMPARISON OF SIGNS AND SYMPTOMPS OF PATIENT WITH BOOK PICTURE.

1. Productive cough with thick secretion related to whoop.
2. Cyanosis
3. Fever
4. Difficulty in breathing
5. Vomiting
6. Loss of appetite
7. Broncheopneumonia.

1. But my patient present ( see E- LEARNING for bed side clinic on pertussis) the following symptomps such as : 1. Productive cough with thick secretion related to whoop.
2. Cyanosis
3. Fever
4. Difficulty in breathing.

In Comparison my patients does have vomiting, loss of appetite and bronchopneumonia as shown in the book picture.

HEALTH TEACHING

1. Advised mother to give vaccination in time and explained about vaccination schedule.
2. Explained about medication and to give in proper time.
3. Instruction given to the mother about cleanliness hand hygiene, to wash hand before and after giving feed, personal hygiene, importance of sterilization of feeding others etc.
4. Explained the motrher how to take care of baby. Child should be held with head elevated while feeding. Dont place infant in prone position. Place the child in a comfortable position to promote easier ventilation. Dont allow to contact with other children. Dont give cold items of food. Give small amount frequent feeds. While vomiting , keep the child on side line position to prevent aspiration.

REFERENCE
Paediatric Infectious diseases
Hal B. Jensen and Robert S.BALTIMORE 1995

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