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*TOPIC: PERTUSSIS**1. DEFINITION*
- Acute infectious disease of the respiratory tract Caused by Bordetella pertussis bacillus Characterized by paroxysms of cough ending with a "whoop" sound Usually accompanied by vomiting.
*2. CAUSATIVE ORGANISM*
- _Bordetella pertussis_ bacillus
*3. INCUBATION PERIOD*@
- 5-21 days, average 14 days
*4. SIGNS AND SYMPTOMS* - 3 Stages:
*A. CATARRHAL STAGE* - _1 week, highly infectious_
- Low grade fever
- Coryza
- Conjunctivitis
- Progressive non-productive cough
*B. PAROXYSMAL STAGE*
- Paroxysms of cough ending with whoop
- Vomiting after cough
- Drooping of saliva
- Cyanosis due to hypoxia
- Distended jugular veins due to cough pressure
- Tearing from eyes
*C. CONVALESCENT STAGE*
- Child’s condition improves
- Cough paroxysms become less severe
- Whoop may continue for 4-8 weeks
*5. MEDICAL MANAGEMENT / INVESTIGATIONS*
- History to review the symptoms
- Sputum for M/C/S to isolate organism
- Chest X-ray: To rule out other respiratory infections
- FBC: Reveals lymphocytosis
*7. TREATMENT*
- *Antibiotics*: X-pen ¼ - 1 mega depending on age, q.i.d for 5/7
- *Analgesics/Antipyretics*: Panadol 50-200mg tds for 3/7
- *Antispasmodics*: Probanthine 2.5mg stat to reduce respiratory spasms
- *Steam inhalation*: To soothe throat
- *Oxygen therapy*: 2-5L/minute to relieve cyanosis
*8. NURSING CARE*
*AIMS*
- Promote quick recovery
- Relieve hypoxia
- Alleviate anxiety
- Prevent complications
*ENVIRONMENT*
- Isolate patient to prevent spread
- Well ventilated room
- Well lit room for observation + orientation
- Clean room to prevent nosocomial infections
- Humidified room to soothe respiratory tract + relieve cough
- Oxygen apparatus available due to dyspnea
- Cot bed to prevent falls
*POSITION*
- Position of comfort
- Fowler’s position for older children to promote lung expansion
- Change position 2 hourly to prevent pressure sores
- Allow any position of comfort as condition improves
*REST*
- Quiet room to promote rest
- Answer phone calls promptly to avoid disturbance
- Do procedures in blocks
- Administer prescribed analgesics
*OBSERVATIONS*
- Vitals, BP, weight: Baseline data
- Observe for cyanosis + give O2 if necessary
- Observe dyspnea: Prop up patient to promote lung expansion
- Observe pressure areas for pressure sores
- Observe cough for improvement/deterioration
- Observe sputum: color, amount, consistency → report hemoptysis
- Observe facial expressions for pain → give analgesics
- Observe feeding pattern → small frequent meals
- Observe respirations for tachypnea → report
*PSYCHOLOGICAL CARE*
- Explain disease process to mother to reduce anxiety
- Encourage questions + answer, or refer to physician
- Explain all procedures to patient + mother
- Involve successfully managed case to talk to mother
*NUTRITION*
- Encourage breastfeeding if applicable
- Energy-giving foods for metabolic needs
- Protein foods: fish, beans for tissue repair
- Vegetables + fruits to boost immunity + mucous membrane integrity
- Plenty oral fluids to prevent dehydration + help expectoration
- Small frequent meals to promote appetite
- Allow preferred foods from visitors
- Regular mouth washes to promote appetite
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