Nursing Care Plan for Pertussis / Whooping Cough

Pathophysiology

Pertussis, commonly known as whooping cough, is a highly contagious bacterial respiratory infection that can affect people of all ages, but is most severe in infants and toddlers. For adults, it presents as a mild cold or cough, but in young children the hacking cough can be so severe that they are unable to breathe. Pertussis presents in three distinct phases that each last approximately two weeks: catarrhal phase may be mistaken for a mild cold or allergies, paroxysmal stage is the most noticeable with severe cough and difficulty breathing and the convalescent stage is a lingering, chronic cough that may last longer than two weeks.  

Etiology

Pertussis is caused by the Bordetella pertussis bacteria that is transmitted through respiratory droplets. When an infected person coughs or sneezes, the droplets that are sprayed into the air may be breathed in by others. Often, adults do not realize they are infected and kiss infants, transmitting the disease through saliva. Inflammation and swelling leads to production of secretions that further narrow the airways. As the lungs attempt to rid themselves of the extra secretions, the inflammation increases and the airways narrow even more causing the “whooping” sound between coughs as the air attempts to pass through the constricted airways.  

Desired Outcome

Patient will maintain adequate respiration and clear airway. Patient will maintain optimal hydration and nutrition status. Patient will be free from infection.

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 Interventions and Rationales

  1. Assess vitals and monitor for fever

  2. Fever, usually low grade, is common in pertussis. Get a baseline to determine effectiveness of interventions.

  3. Perform physical assessment, note any signs of poor perfusion or oxygenation

  4. Cyanosis and decreased  capillary refill indicate inadequate oxygenation and tissue perfusion due to inability to breathe normally and constricted airways.

  5. Assess respiratory status. 

    Note rate, rhythm, effort and presence of apneic episodes

  6. Breathing is usually difficult due to cough. Infants may have periods of apnea and need to be carefully monitored.

    Child may also experience retractions of respiratory muscles and use of accessory muscles with labored breathing.

  7. Position patient upright

  8. The upright position can help improve lung expansion and provide for a more effective cough.  Patients may also present in tripod position.

  9. Administer supplemental oxygen via mask

  10. 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.

  11. Perform nasopharyngeal suction as appropriate per facility protocol

  12. 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.

  13. Initiate access and maintain IV fluids

  14. Patients, especially infants, dehydrate quickly and require supplemental fluids.  Medications may also be given via IV route.

  15. 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
  16. Forceful and continuous coughing may cause vomiting. Positioning the patient upright uses the force of gravity to help reduce the risk of aspiration.

  17. Provide for safety. Initiate seizure precautions

  18. 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

  19. Provide patient and parent education about the disease process and  prevention

    • Length and stages of disease
    • Vaccination for all family members
    • Cover that cough
  20. 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.


References

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