Chapter 23: Infectious Conditions: Pertussis

Question 1

What is Pertussis?

Answer 1

“whooping cough”

• highly contagious
• bacterial infection of the respiratory tract that causes paroxysmal cough
• a “whooping” sound is produced as the child tries to take a breath

Question 2

Causative Agent

Answer 2

-Bordetella pertussis
>B pertussis attaches to and multiplies on the respiratory epithelium, starting in the nasopharynx and ending primarily in the bronchi and bronchioles
-a tracheal cytotoxin is produced that is responsible for the local epithelial damage that produces the respiratory symptom

Question 3

How does this disease spread?

Answer 3

via droplet infection and direct contact with discharges from respiratory mucous membranes of the infected child

Question 4

Signs + Symptoms: 3 stages

Answer 4

divided into 3 stages: catarrhal, paroxysmal, and convalescent
>classic cough lasts from 6 to 10 weeks
>each stage lasts for 2 to 4 weeks
>incubation period ranges from 6 to 21 days

Question 5

Signs+ Symptoms

Answer 5

> Catarrhal:

• lasts 1 to 2 weeks
• upper respiratory infection similar to common cold
• mild cough, coryza, and sneezing
• low grade fever less than 101 Degrees F

> Paroxysmal:

• lasts 2 to 4 weeks
• fever absent or minimal
• persistent staccato, paroxysmal cough ending with an inspiratory whoop
• cyanosis, sweating, prostration, and exhaustion from coughing
• coughing accompanied by red face and protruding tongue
• conjunctival hemorrhage and facial petechiae may occur r/t force of cough
• saliva, mucus, and tears may flow from nose, eyes, and mouth during cough
• vomiting may accompany coughing

> Convalescent:

• last 3 weeks to 6 months
• symptoms diminish over that period of time
• coughing becomes less severe and paroxysms and whoops slowly disappear
• cough may persist for months and is aggravated by physical stress and respiratory irritants

Question 6

Diagnosis

Answer 6

• based on a history of severe coughing, with or without a whoop, reddening of the face during coughing, and incomplete or absent pertussis vaccination
• when blood testing performed: profound lymphocytosis
• chest radiography may show focal atelectasis and/ or peribronchial cuffing
• isolation of B pertussis in a culture from a swab taken from nasopharyngeal secretions
• polymerase chain reaction (PCR) testing to detect DNA

Question 7

Prevention

Answer 7

-vaccination with DTaP; combination of diphtheria, pertussis, and tetanus toxoids
>recommended at 2,4,6, and between 15 and 18 months with a booster at 4 to 6 years
>booster also between 11 and 12 years

Question 8

Nursing Care

Answer 8

• goal= limiting the number of paroxysms; observing the severity of cough; and maximizing nutrition, hydration, rest, and recovery
• droplet precautions
• monitor vital signs and oxygen saturation
• centers on hydration and nutritional status; if unable to drink, IV infusion given
• records coughing, feeding, vomiting, and weight changes

Question 9

Medical Care

Answer 9

-antibiotic therapy (Erythromycin) is given to eradicate the infection, reduce morbidity, and prevent complications
>if allergic to erythromycin, Trimethoprim sulfamethoxazole (Bactrim) is given
-corticosteroids may be sued to reduce the severity of the illness although it increases the risk of masking a superinfection

Question 10

Education/ Discharge

Answer 10

• no special diet; fed according to what is tolerated
• as long as the child can tolerate, he or she can participate in regular activities and play
• follow-up checks