Nursing Care Plan (NCP) for Pertussis / Whooping Cough

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Outline

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

  • Assess vitals and monitor for fever

 

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

 

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

 

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

 

  • Assess respiratory status. Note rate, rhythm, effort and presence of apneic episodes

 

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.

 

  • Position patient upright

 

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

 

  • Administer supplemental oxygen via mask

 

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.

 

  • Perform nasopharyngeal suction as appropriate per facility protocol

 

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.

 

  • Initiate access and maintain IV fluids

 

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

 

  • 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

 

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

 

  • Provide for safety. Initiate seizure precautions

 

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

 

  • Provide patient and parent education about the disease process and prevention
    • Length and stages of disease
    • Vaccination for all family members
    • Cover that cough

 

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.

Writing a Nursing Care Plan (NCP) for Pertussis / Whooping Cough

A Nursing Care Plan (NCP) for Pertussis / Whooping Cough starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Let’s dive into the nursing care plan for pertussis, also known as whooping cough. So the pathophysiology of pertussis or whooping cough is a highly contagious bacterial respiratory infection. It can affect people of all ages, but it’s most severe in infants and intolerance for adults. It pretty much presents as a mild cough or cold, but in young children, there is a hacking cough that is so severe that they are actually unable to breathe. Some nursing considerations that we want to take into consideration is that we want to manage that cough. It is very important that we keep the cough at bay. We want to monitor the vital signs. We want to do a really good respiratory assessment and administer any medications as ordered. And we want to give some vaccine education. The desired outcome for these patients is that the patient will maintain adequate respiration and a clear airway. 

The patient is going to maintain optimal hydration and nutrition status, and the patient is going to be free from infection. So a patient with whooping cough. So this patient has a hacking hacking cough. What are some things that the patient might complain of? What do you think some things are that the patient might complain of? Well, when they come to see us, some of us have some subjective things that they’re going to talk about if they’re going to say that there is a poor appetite. They’re just not hungry. They have to decide, are they going to finish this cough? Or they’re going to be very irritable. And if you notice, this is something that happens with infants a lot when they’re sick; they tend to become very, very irritable and finally fatigue or increased drowsiness. Now, when they come to us, we’re going to have some objective data that we’re going to collect from our assessment. 

We’re going to see that this patient has a fever. So remember that’s anything, 100.4 or higher. They’re going to have nasal congestion and discharge. They’re going to have a cough, vomiting, and it’s going to have that distinct whooping sound. So it’s going to be a very distinct whooping sound when they are breathing. So nursing considerations and nursing intervention, we want to perform a physical assessment. We want a head to toe physical assessment. And the goal of this is we want to assess the patient for any cyanosis or bluing of the skin. We want to see a capillary refill. If it’s decreased, these things can indicate added inadequate oxygenation and inadequate tissue perfusion. And that’s most likely due to the inability of the patient to breathe normally. And they’re constricted airways. 

Next, We’re going to follow up with that and do a detailed respiratory assessment. We’re going to, uh, assess their respiratory status and we are going to, um, let’s see. So we are going to respiratory status as this is a respiratory condition. Breathing is usually very difficult due to the cough. They may have periods of apnea; do you remember what apnea is? Apnea is just an absence of breathing. So they may have periods of apnea. So we need to be diligent about monitoring these patients carefully. The child may also experience retractions of the respiratory accessory muscles, and they may also use those accessory muscles with labored breathing. 

We’re going to monitor for and reduce the risk of aspiration because of the forceful and continuous coughing that comes from pertussis. It may cause vomiting. Then, we want to position the patient upright and use the force of gravity to help reduce the risk of aspiration. Okay? So these patients are at risk for aspiration. The next thing that we want to do is we want to initiate access. So these patients need an IV and we want to add fluids. They need lots of IV fluids, especially if they do hydrate fast and they need supplemental fluids. Medications may also be given via the IV route. Always important to have any patient that comes in and needs at least one good IV. Uh, with these patients, their O2 saturations may decrease. So let’s add that here. So they may have, um, decreased O2 saturations. So that’s anything less than 90%. So if their O2 sat is less than 90%. We want to administer any supplemental O2. We can give oxygen to improve perfusion and prevent any type of brand damage. So let’s take a look at the completed care plan next to the key points. The pathophysiology, one thing you want to remember is that pertussis is very contagious. It’s a contagious respiratory infection caused by a bacteria that causes a very dangerous hacking cough. Some of 

The subjective things that the patient is going to present with, what they’re going to complain of at home is poor appetite, irritability, fatigue, drowsiness. Some things that we’re going to observe from this patient is we’re going to see a fever, cough, vomiting, and we’re going to hear that classic whooping sound. When they’re breathing, the inspiration is going to have a flipping sound. So the things that we want to do, the first thing we want to do is we want to do a really good respiratory assessment. WE want to administer O2. We want to watch for aspiration. We want to give them cough suppressants. We want to suction any secretions. Finally, we would like to give the patient and the family some vaccine education. Vaccines for pertussis are available and recommended for all ages beginning as early as two months; this does require a full series to be fully protected from the disease. So they are still susceptible until that course has been given, but this is the easiest way to prevent the spread of professors. We love you guys; go out and be your best self today, and, as always, happy nursing.

 

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