Pertussis Nursing Care Plans Diagnosis and Interventions
Pertussis NCLEX Review and Nursing Care Plans
Pertussis is a highly contagious medical condition that involves the infection of the respiratory tract infection. It is also known as whooping cough due to the high-pitched inhalation with a “whoop” sound after a hacking cough. The disease may last for 6 to 10 weeks.
Pertussis was a common childhood disease until the vaccine against it was developed in 1914. It was then combined with other vaccines against tetanus and diphtheria in the 1940s, forming the DPT vaccine.
Due to the development of the pertussis vaccine, the disease is now only prevalent in developing countries where the vaccination coverage is low. Despite the rigorous vaccination program, the World Health Organization (WHO) reports that about 60 million cases of pertussis happens every year around the globe.
The pertussis vaccine is highly recommended to be given in pregnant women, as mortality is highest with infants. It can only be given to teens and adults with faded immunity against pertussis.
Signs and Symptoms of Pertussis
Pertussis has 3 stages: catarrhal, paroxysmal, and convalescent.
Stage 1: Catarrhal
A patient infected with pertussis may not show any symptoms until about 7 to 10 days later (incubation period), or even longer. The signs and symptoms are flu-like, which include:
- Generalized malaise or feeling unwell
- Rhinorrhea – runny nose
- Nasal congestion
- Red, watery eyes
- Fever – usually low-grade
- Cough – may be more severe at night
Stage 2: Paroxysmal
In this stage, a “paroxysm” or an episode consist of rapid series of coughs that have increasing intensity. The signs and symptoms worsen 1 to 2 weeks after their initial appearance, and may show:
- Fatigue or extreme tiredness
- Reddish cheeks or bluish discoloration of the lips
- Persistent hacking cough, which may or may not be followed by a high-pitched “whoop” sound when inhaling air
- Thick mucus
- Post-pertussis emesis or vomiting
It is important to note that in infants, cough may not be observed. The clinical manifestation of pertussis in infants is difficulty of breathing, which may turn to temporary apnea or cessation of breathing.
Stage 3: Convalescent
In this stage, the patient may have less episodes of coughing, and the other symptoms also improve. It usually occurs 4 weeks after the initial appearance of the symptoms.
Causes and Risk Factors of Pertussis
Pertussis is caused by the bacterium Bordetella pertussis, a gram-negative coccobacillus that can be transmitted through air droplets from the infected person’s respiratory tract. The transmission occurs when the infected person sneezes, coughs, or talks closely to a non-infected individual.
The risk factors that may increase the likelihood of pertussis include:
- Age – infants younger than 12 months are not eligible to receive the vaccine yet
- Unvaccinated young children and vulnerable adults
- Impaired immune response to vaccination
- Intrauterine exposure to HIV in newborns
- Household crowding or suboptimal living
- Epidemic exposure
- Contact with an infected individual
Complications of Pertussis
The complications of pertussis can be life threatening, especially for infants aged 6 months and below.
- Pneumonia in infants
- Bradypnea (slow breathing) or apnea (cessation of breathing) in infants
- Dehydration or weight loss in infants
- Epistaxis or nose bleeds
- Scleral hemorrhage – the appearance of red blood vessels in the white area of the eyes
- Atelectasis – collapsed lung
- Subcutaneous emphysema – the entrance of air in the soft tissues surrounding the lungs
- Bronchiectasis – the destruction of the bronchi and bronchial tubes
- Abdominal or inguinal hernia
- Bacterial superinfection
- Encephalitis – acute inflammation of the brain (rare)
Diagnosis of Pertussis
- History taking – to check for details of exposure, medical history, and any allergy to antibiotics
- Physical examination – many doctors rely on the characteristic whoop sound and cough to come up with the initial diagnosis of pertussis
- Sputum culture – a cotton swab is inserted into the nasopharyngeal airway to obtain a sample for culture
- Chest X-ray – to check for any inflammation or collapse in the lungs
Prevention of Pertussis
- According to the Center for Disease Control and Prevention (CDC), infants need 3 shots of DTP vaccine at age 2 months, 4 months, and 6 months. Then, 2 booster shots should be given at age 15 to 18 months, and 5 to 6 years in order to maintain the level of immunity against the 3 diseases.
- Adolescents are strongly recommended to receive 1 booster shot of DPT vaccine preferably at age 11 to 12 years, as the immunity against these diseases has likely to have faded.
- Pregnant women are encouraged to receive the pertussis vaccine between 27 and 36 weeks of pregnancy to provide some level of immunity to the infant in the first few months of life.
Treatment for Pertussis
Medications. The following medications are given in patients with whooping cough:
- Antibiotic therapy – pertussis is mainly treated with the administration of an antibiotic drug for 3 to 5 days. The patient is no longer contagious by at least the 4th day of treatment. The antibiotic drug may also be given to people who have been in close contact with the infected person.
- Antipyretics – over-the counter fever reducers may be given to manage the body temperature
- Intravenous fluid therapy – excessive loss of water and salt due to vomiting and fever require immediate replacement through the administration of parenteral fluids
- Oxygen therapy – oxygen supplementation may be needed for patients with severe difficulty of breathing
- Cough suppressants are found to have little effect on whooping cough and are therefore not recommended
Isolation. A patient with pertussis should be isolated until they finish the 5-day course of antibiotic treatment.
Hospitalization. Seriously ill infants infected with pertussis may need hospitalization. They need to be placed in a dark and quiet room with little disturbance to reduce the episodes of severe cough. Suctioning of thick mucus secretions may also be needed to clear the airway.
Nutritional support. The nutritional status of infants and young children with pertussis should be closely monitored as studies show that poor nutrition contributes to the development of serious complications. Small meals are encouraged to be given as often as possible.
Nursing Diagnosis for Pertussis
Nursing Care Plan for Pertussis 1
Ineffective Airway Clearance related to nasal congestion and excessive mucus production secondary to pertussis as evidenced by whooping cough, thick mucus, shortness of breath, and SpO2 level of 89%
Desired Outcome: The patient will be able to maintain airway patency and to improve airway clearance as evidenced by being able to expectorate phlegm effectively, respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and verbalize ease of breathing.
|Pertussis Nursing Interventions||Rationales|
|Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. Assess breath sounds via auscultation.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds are important signs of complications of severe pertussis such as pneumonia and bronchiectasis in infants.|
|Suction secretions if needed.||To help clear any phlegm that the patient is unable to expectorate.|
|Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is within the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value within the target.|
|Administer the prescribed medications (e.g., antibiotics and antipyretics).||To help treat pertussis and resolve high temperature. Pertussis is mainly treated with the administration of an antibiotic drug for 3 to 5 days.|
|Avoid cough suppressants and explain the rationale to the parent of the infant or child.||Cough suppressants are found to have little effect on whooping cough and are therefore not recommended.|
|Elevate the head of the bed and assist the patient to assume semi-Fowler’s position.||Head elevation and proper positioning help improve the expansion of the lungs, enabling the patient to breathe more effectively.|
Nursing Care Plan for Pertussis 2
Nursing Diagnosis: Ineffective Breathing Pattern related to nasal congestion and thick mucus production secondary to pertussis as evidenced by shortness of breath, SpO2 level of 89%, and persistent whooping cough
Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and verbalize ease of breathing.
|Pertussis Nursing Interventions||Rationales|
|Assess the patient’s vital signs and characteristics of respirations at least every 4 hours.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.|
|Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is within the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value within the target range.|
|Administer the prescribed medications (e.g. antibiotics and antipyretics).||To help treat pertussis and resolve temperature.|
|Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position. Encourage plenty of rest and adequate hydration.||Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.|
|Perform chest physiotherapy such as percussion and vibration, if not contraindicated. Nebulization using sodium chloride (NaCl) may also be done, as ordered by the physician. Steam inhalation may also be performed.||To facilitate clearance of any thick airway secretions.|
Nursing Care Plan for Pertussis 3
Nursing Diagnosis: Activity intolerance related to difficulty of breathing secondary to pertussis, as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, headache, and shortness of breath upon exertion
Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
|Pertussis Nursing Interventions||Rationales|
|Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels and mental status related to fatigue and activity intolerance.|
|Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.||To gradually increase the patient’s tolerance to physical activity. To allow the patient to pace activity versus rest.|
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.|
Nursing Care Plan for Pertussis 4
Nursing Diagnosis: Risk for Infection (Cross-contamination)
Desired Outcome: The patient will be able to avoid the cross-contamination of pertussis.
|Pertussis Nursing Interventions||Rationales|
|Assess vital signs and observe for any signs of infection as well as for any signs of respiratory distress.||To establish patient’s baseline and monitor for any changes in vital signs and flu-like symptoms.|
|Place the patient in isolation and provide adequate ventilation in the room.||Isolation: To reduce the risk of infecting other patients, staff, family, and visitors in the hospital ward, care facility, or at home. A patient with pertussis should be isolated until they finish the 5-day course of antibiotic treatment. Ventilation: To allow enough oxygenation in the room.|
|Consider giving antibiotics to people who had recent close contact with the patient.||The antibiotic drug may also be given to people who have been in close contact with the infected person. This will reduce the likelihood of symptoms to appear as well as the spread of infection to others.|
|Teach the patient how to perform proper hand hygiene, covering the mouth when coughing, and oral care.||To maintain patient’s safety. To prevent spreading airborne pathogens and reduce the risk of cross-contamination.|
Pertussis Nursing Considerations
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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