Whooping cough. Etiology, symptoms, prevention, care for sick children

What is this disease?

Whooping cough is an extremely contagious respiratory tract infection. The disease is characterized by sudden attacks of spasmodic coughing, which usually end with a wheezing inhalation. The peak incidence occurs in early spring and late winter. Half of the cases are unvaccinated children under two years of age.

As a result of mass immunization and timely recognition of the disease, the number of deaths from whooping cough has sharply decreased. Children under one year old die from pneumonia and other complications; Whooping cough is also dangerous for very elderly people, but in children over one year old and in adults it is usually less severe.

What are the causes of the disease?

The causative agent of whooping cough is coccobacteria. The infection is usually transmitted by airborne droplets from a patient in the acute phase of the disease; much less often through bedding and other objects contaminated with secretions from the nasopharynx.

What are the symptoms of the disease?

7-10 days after infection, coccobacilli enter the respiratory tract, where they cause the formation of viscous mucus. Classic whooping cough lasts 6 weeks; during its course there are 3 periods; each duration is 2 weeks.

The catarrhal period is characterized by an irritating cough, night cough, loss of appetite, sneezing, restlessness and sometimes a slight increase in temperature. During this period, whooping cough is especially contagious.

The spasmodic period begins 7-14 days from the onset of the disease. It is characterized by paroxysmal convulsive cough with the release of viscous mucus. Each coughing attack usually ends with a noisy, convulsive breath, and choking on mucus can lead to vomiting. (Very young children may not have this typical gasping breath.)

In the intervals between breaths during a convulsive cough, complications such as increased pressure in the veins, nosebleeds, swelling around the eyes, hemorrhages under the conjunctiva, retinal detachment (and blindness), rectal prolapse, hernia, seizures and pneumonia are possible. In children, convulsive cough can cause periodic respiratory arrest, oxygen deficiency and metabolic disorders.

During this period, patients are very vulnerable to secondary bacterial or viral infections, which can be fatal. When a temperature appears, a secondary infection can be assumed.

Recovery period. At this time, coughing attacks and vomiting gradually subside. However, within a few months, even after a mild respiratory tract infection, the convulsive cough may begin again.

How is whooping cough diagnosed?

Classic symptoms - especially during the convulsive period of the disease - allow one to suspect whooping cough and order laboratory tests to confirm the diagnosis. Isolation of the bacilli carrier using a throat swab is possible only in the early stages of the disease. Typically, at the beginning of the convulsive period, leukocytosis increases, especially in children older than 6 months.

How is the disease treated?

Patients with severe attacks of convulsive cough should be hospitalized; They will receive fluids and electrolytes in the hospital. Treatment consists of proper nutrition, codeine and mild sedatives are prescribed to reduce cough; if the patient experiences periodic respiratory arrests, oxygen therapy is necessary; Antibiotics are used to prevent the development of secondary infections.

A patient with a spasmodic cough must be isolated. When caring for someone who has whooping cough, you should wear a mask. Care should be taken to create a calm environment so as not to provoke coughing attacks. It is better to feed patients in small portions, but more often.

Whooping cough vaccinations

Since infants are especially susceptible to whooping cough, immunization (diphtheria-tetanus-pertussis vaccine) is usually given at 2, 4 and 6 months. At 18 months and at 4-6 years, additional vaccinations are given.

The vaccine may harm the nervous system and cause other complications, but the risk of getting whooping cough is higher than the risk of developing complications.

Both adults and children can get whooping cough. Immunity against this respiratory infection is developed only after a person has been ill once. In children, the manifestations are more severe, and complications can be very serious, including death. The vaccine is given in the first months of life. It does not guarantee complete protection against infection, but in vaccinated children the disease occurs in a much milder form. Doctors recommend that parents, when caring for children with whooping cough, protect them as much as possible from any factors that provoke a suffocating cough.

The causative agent of this disease is whooping cough (a bacterium called Bordetella). The infection affects the trachea and bronchi.

The respiratory tract is covered with the so-called ciliated epithelium, the cells of which have “cilia” that ensure the movement of mucus and its removal to the outside. When they are irritated by toxic substances secreted by whooping cough pathogens, the nerve endings transmit a signal from the epithelium to the brain (to the area responsible for coughing). The response is a reflex cough, which should push the source of irritation out. Bacteria are firmly held on the epithelium due to the fact that they have special villi.

It is characteristic that the cough reflex is so entrenched in the brain that even after the death of all bacteria, a strong urge to cough continues to persist for several more weeks. The waste products of pertussis bacteria cause general intoxication of the body.

Warning: Humans do not have innate immunity to this disease. Even an infant can get sick. Therefore, it is so important to protect him from contact with adults who have a strong, persistent cough. It may well be a sign of whooping cough, which in an adult, as a rule, does not have other characteristic manifestations.

A person’s susceptibility is so great that if a baby gets sick, the rest of the family will definitely become infected from him. Whooping cough lasts 3 months while the cough reflex exists. In this case, the disease has virtually no symptoms for about 2 weeks. If you somehow manage to establish in the very first days that the pertussis bacterium is present in the body, then you can quickly suppress the disease, since the dangerous cough reflex has not yet had time to take hold. Usually, symptoms of whooping cough in children are detected already at a severe stage. Then the disease continues until the cough gradually goes away on its own.

Video: How to prevent coughing attacks

How does infection occur?

Most often, children under the age of 6-7 years become infected with whooping cough. Moreover, in children under 2 years of age, the likelihood of infection is 2 times higher than in older children.

The incubation period for whooping cough is 1-2 weeks. For 30 days, the child should not visit a child care facility or have contact with other children, as whooping cough is highly contagious. Infection is only possible through airborne droplets during close contact with a sick person or bacteria carrier when he sneezes or coughs.

Outbreaks of the disease occur more often in the autumn-winter period. This is explained by the fact that whooping cough bacteria quickly die in the sun, and the length of daylight in winter and autumn is minimal.

Forms of whooping cough

When infected with whooping cough, the disease may occur in one of the following forms:

Typical - the disease develops consistently with all its inherent signs.
Atypical (erased) - the patient coughs only slightly, but there are no severe attacks. For some time, the cough may disappear altogether.
In the form of bacterial carriage, when there are no signs of the disease, but the child is a carrier of bacteria.

This form is dangerous because it can infect other people, while parents are confident that the baby is healthy. Most often, this form of whooping cough occurs in older children (after 7 years) if they have been vaccinated. The baby also remains a bacteria carrier after recovery from typical whooping cough until 30 days after the infection entered his body. Whooping cough often manifests itself in such a latent form in adults (for example, workers in child care institutions).

The first signs of whooping cough

At the initial stage, the disease does not cause much concern for parents, since the first signs of whooping cough resemble a common cold. The baby develops severe chills due to rising temperature, headache, and weakness. Snot appears, and then an intensifying dry cough. Moreover, ordinary cough remedies do not help. And only after a few days symptoms of typical whooping cough may appear, which gradually intensify.

Video: Whooping cough infection, symptoms, importance of vaccination

Periods of illness and characteristic symptoms of whooping cough

There are the following periods for the development of whooping cough symptoms in a child:

Incubation. The infection has already occurred, but there are no first signs of the disease. They appear only 6-14 days after the bacteria enter the body.
Premonitory. This is a period associated with the appearance of precursors of whooping cough: a dry, gradually increasing (especially at night) cough, a slight increase in temperature. At the same time, the child feels well. But this condition lasts 1-2 weeks without change.
Spasmodic. There are attacks of convulsive cough associated with an attempt to push out what is irritating the respiratory tract, and it is difficult to inhale air. After several coughing exhalations, a deep breath follows with a characteristic whistling sound (reprise), which occurs due to a spasm of the larynx in the vocal cords. After this, the baby shudders convulsively several times. The attack ends with the release of mucus or vomiting. Coughing attacks with whooping cough can be repeated from 5 to 40 times a day. The frequency of their appearance is a characteristic of the severity of the disease. During an attack, the child's tongue sticks out and his face is red-blue. The eyes turn red because the blood vessels burst due to tension. Breathing may stop for 30-60 seconds. This period of illness lasts approximately 2 weeks.
Reverse development (resolution). The cough gradually weakens, attacks appear for another 10 days, the pauses between them increase. Then severe symptoms disappear. The child coughs a little for another 2-3 weeks, but the cough is normal.

Note: In infants, painful attacks do not last so long, but after several coughing movements, breathing may stop. Oxygen starvation of the brain causes diseases of the nervous system and developmental delays. Even death is possible.

Video: How to recognize whooping cough

Possible complications

Complications of whooping cough can include inflammation of the respiratory system: lungs (pneumonia), bronchi (bronchitis), larynx (laryngitis), trachea (tracheitis). As a result of narrowing of the lumen of the respiratory passages, as well as spasms and swelling of tissues, death can occur. Bronchopneumonia develops especially quickly in children under 1 year of age.

Complications such as emphysema (bloating) and pneumothorax (damage to the lung wall and air leaking into the surrounding cavity) are possible. Severe tension during an attack can cause umbilical and inguinal hernias and nosebleeds.

After whooping cough, due to cerebral hypoxia, tissue damage to individual centers sometimes occurs, resulting in hearing impairment or epileptic seizures in the child. Seizures, which also occur due to disruption of brain function, are very dangerous and can lead to death.

Due to strain when coughing, damage to the eardrums and bleeding in the brain occurs.

Diagnosis of whooping cough in children

If a child's whooping cough occurs in a mild and atypical form, diagnosis is very difficult. The doctor can assume that the malaise is caused by this particular disease in the following cases:

the child’s cough does not go away for a long time, the symptom only intensifies, while the runny nose and fever stopped after 3 days;
expectorants do not have any effect; on the contrary, the state of health worsens after taking them;
Between coughing attacks, the baby seems healthy and has a normal appetite.

In this case, to make sure that the patient has whooping cough, a bacteriological culture of a throat smear is done. The difficulty is that the bacterium is held quite firmly by the ciliated epithelium and is not removed outside. The likelihood that even in the presence of whooping cough pathogens they can be detected using this method is reduced to zero if the child has eaten or brushed his teeth before the procedure. They will be completely absent from the sample if the baby was given even an insignificant dose of antibiotic.

A general blood test is also done, which reveals a characteristic increase in the content of leukocytes and lymphocytes.

Methods for diagnosing whooping cough bacillus are used using a blood test for antibodies (ELISA, PCR, RA).

There is a rapid diagnostic method. The smear is treated with a special compound and examined under a microscope, which uses the effect of antibodies glowing when illuminated.

Warning: If there are characteristic symptoms of whooping cough, the child must be isolated to avoid infecting other people. In addition, his situation may worsen after communicating with people with colds or flu. Even after recovery, the body is weakened, the slightest hypothermia or infection causes severe complications of whooping cough.

Signs of pneumonia

Pneumonia is one of the most common complications. Since parents know that whooping cough does not go away quickly, they do not always consult a doctor if there is a change in the baby’s condition. However, in some cases, delay is dangerous, so it is necessary to show the child to a specialist. Warning signs that require immediate treatment include:

Temperature increase. If this happens 2-3 weeks after the onset of whooping cough attacks, the baby does not develop a runny nose.

Increased cough after the child’s condition had already begun to improve. A sudden increase in the duration and frequency of attacks.

Rapid breathing between attacks. General weakness.

Treatment of whooping cough in children

Whooping cough is treated mainly at home, except when it affects babies under 1 year of age. Their complications develop rapidly, and the baby may simply not have time to save. A child of any age is hospitalized if complications arise or respiratory arrest occurs during attacks.

First aid at home for whooping cough

During a coughing attack, the baby should not lie down. He needs to be planted immediately. The room temperature should be no more than 16 degrees. You should turn off the heating completely and use a sprinkler to humidify the air.

It is important to calm and distract the baby with the help of toys and cartoons. Since the cause of cough is stimulation of the nerve center of the brain, fear and excitement provoke increased coughing and spasm in the respiratory tract. At the slightest deterioration of the condition, it is necessary to urgently call an ambulance.

Note: As doctors emphasize, any means are good to stop and prevent an attack, as long as they evoke positive emotions in the baby. Watching children's TV shows, buying a dog or new toys, or going to the zoo force the brain to switch to the perception of new impressions and reduce sensitivity to irritation of the cough center.

How to alleviate the condition and speed up recovery

A sick baby needs to walk every day to prevent brain hypoxia and improve breathing. At the same time, we must remember that it can infect other children. Walking along the banks of a river or lake, where the air is cooler and more humid, is especially beneficial. It is not recommended to walk a lot; it is better to sit on a bench.

The patient should not be nervous.

An attack can be triggered by improperly organized nutrition. It is necessary to feed the baby often and little by little, mainly with liquid food, since the chewing movement also causes coughing and vomiting. As Dr. E. Komarovsky explains, in a child frightened by a previous attack while eating, even an invitation to the table often reflexively causes a whooping cough.

Warning: Under no circumstances is it recommended to self-medicate or use “grandmother’s remedies” to get rid of a cough. The nature of the cough in this case is such that heating and infusions do not get rid of it, and an allergic reaction to plants can lead to a state of shock.

In some cases, after consulting with your doctor first, you can use folk tips to relieve coughing. For example, traditional healers recommend preparing a compress for children over 13 years old from a mixture of equal amounts of camphor and eucalyptus oils, as well as vinegar. It is recommended to place it on the patient’s chest overnight. This helps make breathing easier.

Treatment with antibiotics

Whooping cough is usually detected at a stage when the cough reflex, which represents the main danger, has already developed. In this case, antibiotics do not help.

At the stage of the appearance of precursors of the disease, the baby is given only an antipyretic medicine if there is a slight rise in temperature. You cannot give him expectorants when a dry paroxysmal cough appears on your own, since the movement of sputum will cause increased irritation of the respiratory tract.

Antibiotics (namely erythromycin, which does not have a harmful effect on the liver, intestines and kidneys) are used to treat children from whooping cough at a very early stage, before severe coughing attacks have yet appeared.

They are taken more often for preventive purposes. If one of your family members gets whooping cough, taking an antibiotic will protect the children from the action of the bacterium. It kills the germ before a cough develops. An antibiotic will also help adult family members caring for a sick baby not to get sick.

Treatment in hospital

In cases of increased severity, a patient with whooping cough is hospitalized. The hospital uses drugs to eliminate respiratory failure and oxygen starvation of the brain.

If a child is admitted to the hospital at the first stage of the disease, then the task is to destroy microbes, stop attacks of apnea (stopping breathing), relieve seizures, and eliminate spasms in the bronchi and lungs.

To enhance the body's resistance to pertussis infection, gamma globulin is administered at an early stage. Vitamins C, A, and group B are prescribed. Sedatives are used (infusions of valerian, motherwort). To relieve spasms and convulsions, treatment with antispasmodics is used: calcium gluconate, belladonna extract.

Antitussive drugs do not have sufficient effect against whooping cough, however, during painful attacks, under the supervision of a doctor, they are given to children to facilitate the discharge of sputum. Among the drugs used are ambroxol, ambrobene, lazolvan (to thin sputum), bromhexine (stimulator of mucus excretion), aminophylline (relieves spasms in the respiratory organs).

When treating children for whooping cough, antiallergic drugs are also used, and in severe cases, tranquilizers (Seduxen, Relanium).

To reduce the frequency of attacks and reduce the likelihood of apnea, psychotropic drugs (aminazine), which also have an antiemetic effect, are used. Respiratory arrest is prevented by the administration of hormonal drugs. At the end of the spasmodic period, massage and breathing exercises are prescribed.

To prevent complications, oxygen therapy and sometimes artificial ventilation are used.

Video: Use of erythromycin for whooping cough, the importance of vaccination, cough prevention

Prevention

Since whooping cough is very contagious, when cases of the disease are detected in a children's institution, examination and preventive treatment of all children and adults who were in contact with the patient are carried out. Erythromycin is used, which kills whooping cough bacteria, as well as injections of gamma globulin, which stimulates the production of antibodies.

Infection of whooping cough in infants is especially dangerous. Therefore, it is necessary to limit the child’s stay in crowded places and communication with unfamiliar children and adults. If a child is brought from the maternity hospital, and one of the family members is sick, it is necessary to completely exclude his contact with the baby.

The main preventative measure is vaccination. It reduces the risk of infection. In case of illness, whooping cough is much easier.

Forecast.

The prognosis of whooping cough largely depends on the age of the child, the severity of the course and the presence of complications. For older children, whooping cough is not very dangerous.

The prognosis remains serious in young children when complications occur (pneumonia, asphyxia, encephalopathy).

Mortality among children under one year of age reaches 0.1-0.9%.

Basic principles of treatment.

Young children with severe whooping cough, complications or concomitant diseases are subject to hospitalization.

It is necessary to create a protective regime, to eliminate as much as possible all irritants (mental, physical, pain, etc.).

The main task of pathogenetic therapy in severe forms is to combat hypoxia; oxygen therapy is carried out in oxygen tents, while the oxygen concentration should not be higher than 40%; in mild and moderate forms, aerotherapy (long stay in the fresh air) is indicated; in case of respiratory arrest, mechanical ventilation is indicated.

To improve bronchial patency, aminophylline is prescribed orally or parenterally (especially in case of signs of cerebrovascular accident, obstructive syndrome, pulmonary edema).

To liquefy viscous sputum: mucaltin, mucopront, potassium iodide solution; antitussive drugs for children over 2 years of age - glaucine hydrochloride, glauvent, etc.

Inhalation with a solution of sodium bicarbonate, aminophylline, novocaine, ascorbic acid.

Carrying out postural drainages, suctioning mucus.

Diet food.

Sedatives: seduxen, phenobarbital (reduce the frequency of attacks).

Immunomodulators.

Antibacterial therapy: erythromycin, rulide, vilprafen, summed (prevent the colonization of pertussis bacteria, but their effectiveness is limited to the early stages of illness; in addition, they are indicated when a secondary bacterial infection is attached) the course of treatment is 8-10 days.

Anti-pertussis immunoglobulin (children under 2 years old).

Vitamin therapy.

Preventive and anti-epidemic measures for whooping cough:

In conditions of incomplete and late diagnosis, the patient is isolated for 30 days from the onset of the disease at home, and in severe forms and for epidemic indications, hospitalization is carried out.

The outbreak is quarantined for 14 days from the moment of separation from the sick person, contacts are identified, registered and monitored daily (identifying those who are coughing) with 2-fold bacteriological examination, with an interval of 7-17 days (until receiving 2- x negative tests).

Only children 7 years old are subject to separation.

Carrying out routine disinfection during quarantine.

Specific prevention: routine active immunization of children under one year of age with DTP (associated pertussis-diphtheria-tetanus vaccine).

DTP vaccination: from 3 months three times with an interval of 30 days.

I revaccination with DPT - 1.5-2 years after vaccination.

Vaccinations against whooping cough are not given to children over 3 years of age.

Children under one year of age who have not been vaccinated against whooping cough are given immunoglobulin according to indications.

Nursing process for whooping cough.

Timely identify real and potential problems, violated needs of the patient and his family members.

Possible patient problems:

sleep disturbance;

loss of appetite;

persistent, obsessive cough;

breathing problems;

disturbance of physiological functions (loose stools);
impairment of motor activity;
change in appearance;
the child’s inability to independently cope with difficulties arising as a result of the disease;
psycho-emotional stress;
complication of the disease.

Possible problems for parents:

family maladaptation due to the child’s illness;

fear for the child;

uncertainty about the successful outcome of the disease;

lack of knowledge about the disease and care;

inadequate assessment of the child’s condition;

chronic fatigue syndrome.

Nursing intervention.

Inform parents about the causes of development, features of the course of whooping cough, principles of treatment and care, preventive measures, and prognosis.

Limit as much as possible the interaction of a sick child with other children.

Ensure that the patient is isolated at home until 2 negative bacteriological examination results are obtained, and in severe forms, assist in arranging hospitalization.

Ensure sufficient aeration of the room where the sick child is located. It is optimal if the windows are constantly open; the child needs this, especially at night, when the most severe coughing attacks occur (in the fresh air they settle down, are less pronounced and complications arise much less frequently).

Teach parents to provide first aid in case of vomiting and convulsions. Follow all doctor's orders in a timely manner.

Create a calm, comfortable environment around the child, protect him from unnecessary worries and painful manipulations. Involve parents in the process of caring for the child, teach them how to properly sanitize the respiratory tract, carry out inhalations with a 2% sodium bicarbonate solution, and vibration massage.

Provide the child with nutrition adequate to his condition and age; it should be complete, enriched with vitamins (especially vitamin C, which promotes better absorption of oxygen). Easily digestible liquid and semi-liquid foods are recommended: dairy cereals or vegetable pureed vegetarian soups, rice, semolina porridge, mashed potatoes, low-fat cottage cheese; the consumption of bread, animal fats, cabbage, extractive and spicy foods should be limited. In severe forms of the disease, give liquid and semi-liquid food (not containing crumbs, lumps), often and in small portions. If vomiting occurs frequently, it is necessary to supplement the child's feeding after an attack and vomiting.

The amount of liquid consumed should be increased to 1.5-2 liters, introduce rosehip decoction, tea with lemon, fruit drinks, warm degassed mineral alkaline waters (Borjomi, Narzan, Smirnovskaya) or a 2% solution of soda in half with warm milk.

Advise parents to organize interesting leisure time for the child: diversify it with new toys, books, decals and other calm age-appropriate games (since attacks of whooping cough intensify with excitement and increased physical activity).

Protect the patient from communicating with patients with ARVI, since the addition of secondary viral-bacterial infections creates a threat of developing pneumonia and increasing the severity of whooping cough.

Organize routine disinfection at home (disinfect dishes, toys, care items, furnishings, carry out wet cleaning with soap and soda solution 2 times a day).

During the period of convalescence, it is recommended that the child undergo nonspecific disease prevention (nutritious nutrition enriched with vitamins, sleep in the fresh air, hardening, dosed physical activity, exercise therapy, physiotherapy, massage).

Create an expert nursing process map

for whooping cough

Questions for self-study:

Define whooping cough.

What properties does the whooping cough pathogen have?

What are the sources of infection?

What are the mechanisms and routes of transmission of infection?

What is the mechanism of whooping cough development?

What are the main clinical manifestations of whooping cough during the catarrhal period?

What are the main clinical manifestations of whooping cough during the spasmodic period?

What are the characteristics of whooping cough in children under one year of age?

What are the basic principles of treating whooping cough?

What preventive and anti-epidemic measures are taken for whooping cough?

What complications can develop with whooping cough?

MAP OF THE NURSING PROCESS

MAP OF THE NURSING PROCESS

(result of disease dynamics)

date

Stage 1

Collection of information

Stage 2

Patient problems

Stage 3

Care plan

Stage 4

Implementation of the care plan

Stage 5

Assessing the effectiveness of care

Used but not reflected in daily monitoring

The examination can be subjective (questioning)

Objective (examination, anthropometry,

percussion, auscultation, etc.)

Study of medical documentation (history of development,

survey data)

Real

Primary (priority) and secondary

Priority

Potential

Short term goals (less than a week)

Long-term goals (more than a week)

Independent interventions (does not require doctor's orders)

Dependent interventions (based on doctor's orders or instructions)

Interdependent interventions (carried out jointly with another health worker)

Effect achieved:

fully

not completely

partially

not achieved

NURSING PROCESS IN TUBERCULOSIS

Send your good work in the knowledge base is simple. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Post-vaccination immunity does not protect against the disease. Whooping cough in these cases occurs in the form of mild and erased forms of infection. Over the years of specific prevention, their number has increased to 95% of cases. The disadvantages of the whole-cell vaccine are its high reactogenicity; due to the risk of complications, the second and subsequent booster vaccinations cannot be administered, which does not solve the issue of eliminating pertussis infection; post-vaccination immunity is short-lived; the protective effectiveness of various whole-cell DPT vaccines varies significantly (36-95%). The protective effectiveness of whole cell vaccines depends on the level of maternal antibodies (unlike acellular vaccines).

The pertussis component of the DTP vaccine is sufficiently reactogenic; After vaccinations, both local and general reactions are observed. Neurological reactions have been recorded that are a direct consequence of vaccinations. These circumstances have led to the fact that pediatricians approach vaccinations with the DPT vaccine with great caution, which explains the large number of unfounded medical exemptions.

Taking into account the new concept, first in Japan and then in other developed countries, an acellular pertussis vaccine was created and introduced, based on pertussis toxin and new protective factors. Currently, families of combined pediatric drugs based on 2-, 3- and 5-component pertussis vaccines are produced on an industrial scale. In developed countries, the following have been available for several years: four-component (DaDT + inactivated polio vaccine (IPV) or Haemophilus influenzae vaccine (HIB)), five-component (DaDPT + IPV + Hib), six-component (DaDTP + IPV + Hib + hepatitis B) vaccines.

Anti-epidemic measures

Activities aimed at early detection of patients

Identification of patients with whooping cough is carried out according to clinical criteria in accordance with the standard case definition with further mandatory laboratory confirmation. Children under the age of 14 years who have not had whooping cough, regardless of vaccination history, who have communicated with someone who has whooping cough, if they have a cough, are allowed into the children's group after receiving two negative results of a bacteriological examination. Contact persons are placed under medical observation for 7 days and undergo a double bacteriological examination (two days in a row or with an interval of one day).

Measures aimed at interrupting transmission routes

Children in the first months of life and children from closed children's groups (orphanages, orphanages, etc.) are subject to isolation (hospitalization). All patients with whooping cough (children and adults) identified in nurseries, kindergartens, children's homes, maternity hospitals, children's departments of hospitals and other children's organized groups are subject to isolation for a period of 14 days from the onset of the disease. Bacteria carriers are also subject to isolation until two negative bacteriological test results are obtained. In the source of pertussis infection, final disinfection is not carried out; daily wet cleaning and frequent ventilation are carried out.

Measures aimed at susceptible organisms

It is advisable to administer antitoxic pertussis immunoglobulin to unvaccinated children under the age of one year, children over one year old, unvaccinated or with incomplete vaccinations, as well as those weakened by chronic or infectious diseases who have communicated with whooping cough patients. Immunoglobulin is administered regardless of the time that has passed since the date of contact with the patient. Emergency vaccination is not carried out in the outbreak.

Neutralizationsourceinfections includes the earliest possible isolation at the first suspicion of whooping cough, and even more so when this diagnosis is established. The child is isolated at home (in a separate room, behind a screen) or in a hospital for 30 days from the onset of the disease. After removing the patient, the room is ventilated.

Children under 7 years of age who have been in contact with a sick person but have not had whooping cough are subject to quarantine (separation). The quarantine period is 14 days when the patient is isolated.

All children under the age of one year, as well as young children who, for any reason, are not immunized against whooping cough, in case of contact with a patient, are administered 7-globulin (3-6 ml twice every 48 hours); it is better to use a specific anti-pertussis 7-globulin. globulin.

Patients with severe, complicated forms of whooping cough are subject to hospitalization, especially those under the age of 2 years and especially infants and patients living in unfavorable conditions. According to epidemiological indications (for isolation), patients from families with infants and from hostels where there are children who have not had whooping cough are hospitalized.

Activeimmunization is the main link in the prevention of whooping cough. Currently, the DTP vaccine is used. The pertussis vaccine in it is represented by a suspension of the first phase of pertussis bacilli adsorbed with phosphate or aluminum hydroxide. Immunization begins at 3 months, is carried out three times with an interval of 1.5 months, revaccination is carried out 1 1/2-2 years after completed vaccination.

Full coverage of vaccination and revaccination of children leads to a significant reduction in morbidity.

10. Nursing process for whooping cough

In case of whooping cough, the nurse’s actions will depend on her profile (district nurse, hospital nurse, kindergarten nurse, etc.).

Actions nurses hospital:

- creation of a protective regime in the ward, department;

- providing physical assistance to the child during a coughing attack (support the child, calm him down);

- organization of walks in the fresh air;

- control over the feeding regimen (frequent, small portions);

- prevention of nosocomial infection (control of child isolation);

- provision of emergency care for fainting, apnea, convulsions.

Actions nurses plot:

- monitor the child’s parents’ compliance with the isolation regime for 30 days from the moment of illness;

- inform the parents of other children about the case of whooping cough;

- identify possible contacts of the child (especially in the first days of illness) with healthy children and ensure monitoring of them for 14 days from the moment of contact;

- be able to provide emergency assistance for apnea, convulsions, fainting;

- promptly inform the doctor about the deterioration of the child’s condition.

Leading action nurses DDU in case of whooping cough, quarantine measures will be carried out within 14 days from the moment of isolation of the sick child (early isolation of all children suspected of having whooping cough; not allowing children to be transferred to other groups, etc.).

The most common problem for all children with whooping cough is the risk of developing pneumonia.

Target nurses (plot, hospital): prevent or reduce the risk of pneumonia.

Actions nurses:

- careful monitoring of the child’s condition (timely notice changes in behavior, changes in skin color, the appearance of shortness of breath);

- counting the number of respirations and pulse per minute;

- control of body temperature;

- strict adherence to medical prescriptions.

The most common laboratory confirmations of whooping cough are leukocytosis up to 30x10 9 /l with pronounced lymphocytosis and bacteriological examination of pharyngeal mucus.

Children of the first year of life and children with severe disease are usually hospitalized in the DIB.

The period of isolation of patients with whooping cough is long - at least 30 days from the moment of illness.

With the appearance of a spasmodic cough, antibiotic therapy is indicated for 7-10 days (ampicillin, erythromycin, chloramphenicol, chloramphenicol, methicillin, gentomycin, etc.), oxygen therapy (the child stays in an oxygen tent). Also used hyposensitizingfacilities(diphenhydramine, suprastin, diazolin, etc.), mucaltin and bronchodilators (mucaltin, bromhexine, aminophylline, etc.), inhalation of aerosols with enzymes that dilute sputum (trypsin, chymopsin).

Since the problem of all children is the risk of whooping cough, and the main goal of the nurse is to prevent the disease, her actions should be aimed at developing specific immunity in children.

For this purpose it can be used DPT vaccine(adsorbed pertussis-diphtheria-tetanus vaccine).

Deadlinescarrying outvaccinationsAndrevaccination:

vaccination is carried out from 3 months three times with an interval of 30-45 days (0.5 ml IM) for healthy children who have not had whooping cough;

revaccination - at 18 months (0.5 ml intramuscularly, once).

At all times, when treating patients with whooping cough, doctors paid great attention to general hygiene rules - regimen, care and nutrition.

In the treatment of whooping cough, antihistamines (diphenhydramine, suprastin, tavegil), vitamins, inhalation aerosols of proteolytic enzymes (chymopsin, chymotrypsin), which facilitate the discharge of viscous sputum, and mucaltin are used.

Mostly children in the first half of the year with severe illness are subject to hospitalization due to the risk of developing apnea and serious complications. Hospitalization of older children is carried out in accordance with the severity of the disease and for epidemiological reasons. In the presence of complications, indications for hospitalization are determined by their severity, regardless of age. It is necessary to protect patients from infection.

It is recommended that seriously ill infants be placed in a darkened, quiet room and disturbed as little as possible, since exposure to external stimuli can cause severe paroxysm with anoxia. For older children with mild forms of the disease, bed rest is not required.

Severe manifestations of pertussis infection (profound respiratory rhythm disturbances and encephalic syndrome) require resuscitation measures as they can be life-threatening.

Erased forms of whooping cough do not require treatment. It is enough to eliminate external irritants to ensure peace and longer sleep for those with whooping cough. In mild forms, you can limit yourself to long stays in the fresh air and a small number of symptomatic measures at home. Walks should be daily and long. The room in which the patient is located must be systematically ventilated and its temperature should not exceed 20 degrees. During a coughing attack, you need to take the child in your arms, slightly lowering his head.

If mucus accumulates in the oral cavity, you need to empty the child's mouth with a finger wrapped in clean gauze.

Diet. Careful attention should be paid to nutrition, as pre-existing or developing nutritional deficiencies can significantly increase the likelihood of an adverse outcome. It is recommended to give food in fractional portions.

It is recommended to feed the patient little and often. Food should be complete and sufficiently high in calories and fortified. If the child vomits frequently, additional feeding should be done 20-30 minutes after vomiting.

The prescription of antibiotics is indicated in young children, with severe and complicated forms of whooping cough, in the presence of concomitant diseases in therapeutic doses for 7-10 days. Ampicillin, gentamicin, and erythromycin have the best effect. Antibacterial therapy is effective only in the early stages of uncomplicated whooping cough, in catarrhal whooping cough and no later than the 2-3rd day of the convulsive period of the disease.

The prescription of antibiotics during the spasmodic period of whooping cough is indicated when whooping cough is combined with acute respiratory viral diseases, with bronchitis, bronchiolitis, and in the presence of chronic pneumonia. One of the main tasks is the fight against respiratory failure.

Peculiaritieswhooping coughatchildrenfirstof the yearlife.

1. Shortening of the catarrhal period and even its absence.

2. The absence of reprises and the appearance of their analogues - temporary cessation of breathing (apnea) with the development of cyanosis, the possible development of convulsions and death.

3. A longer period of spasmodic cough (sometimes up to 3 months).

If any problems arise in a sick child purpose nurses is their elimination (reduction).

The most important treatment for severe whooping cough in children of the first year of life. Oxygen therapy is necessary using systematic oxygen supply, cleaning the airways from mucus and saliva. If breathing stops - suction of mucus from the respiratory tract, artificial ventilation of the lungs. For signs of brain disorders (tremors, short-term convulsions, increasing anxiety), seduxen is prescribed and, for dehydration purposes, lasix or magnesium sulfate. From 10 to 40 ml of a 20% glucose solution with 1-4 ml of a 10% calcium gluconate solution is administered intravenously, to reduce pressure in the pulmonary circulation and to improve bronchial patency - aminophylline, for children with neurotic disorders - bromine preparations, luminal, valerian. With frequent severe vomiting, parenteral fluid administration is necessary.

It is recommended that the patient stay in the fresh air (children practically do not cough outside).

Antitussives and sedatives. The effectiveness of expectorants, cough suppressants and mild sedatives is questionable; they should be used with caution or not at all. Exposures that provoke cough should be avoided (mustard plasters, cups)

For the treatment of patients with severe forms of the disease - glucocorticosteroids and/or theophylline, salbutamol. During attacks of apnea, chest massage, artificial respiration, oxygen.

Prevention upon contact with a sick person.

In unvaccinated children, normal human immunoglobulin is used. The drug is administered twice with an interval of 24 hours as early as possible after contact.

Chemoprophylaxis with erythromycin can also be carried out at an age-specific dosage for 2 weeks.

11. Measures in the outbreak of whooping cough

The room where the patient is located is thoroughly ventilated.

Children who have been in contact with the patient and have not had whooping cough are subject to medical supervision for 14 days from the moment of separation from the patient. The appearance of catarrhal symptoms and cough raises suspicion of whooping cough and requires isolation of the child from healthy children until the diagnosis is clarified.

Children under 10 years of age who have been in contact with a patient and have not had whooping cough are subject to quarantine for a period of 14 days from the moment the patient is isolated, and in the absence of separation - for 40 days from the moment of illness or 30 days from the moment the patient develops a convulsive disorder. cough.

Children over 10 years of age and adults working in child care institutions are allowed into child care institutions, but are under medical supervision for 14 days from the moment of separation from the patient. If contact with the patient continues at home, they are under medical supervision for 40 days from the onset of the disease.

All children who have not had whooping cough and who are in contact with the patient are subject to examination for bacterial carriage. If bacterial carriage is detected in children who do not cough, they are allowed into children's institutions after three times negative bacteriological tests, carried out at intervals of 3 days and upon presentation of a certificate from the clinic stating that the child is healthy.

Contact children under one year of age who have not been vaccinated against whooping cough and who have not had whooping cough are given intramuscular injections of 6 ml of gamma globulin (3 ml every other day).

Contact children aged 1 to 6 years who have not had whooping cough and have not been vaccinated against whooping cough are given accelerated immunization with the pertussis monovaccine three times, 1 ml each, every 10 days.

In areas of whooping cough, according to epidemiological indications, children who have come into contact with a patient who has been previously vaccinated against whooping cough, and for whom more than 2 years have passed since the last vaccination, are revaccinated once at a dose of 1 ml. The room where the patient is is thoroughly ventilated.

Conclusion

Whooping cough is widespread throughout the world. Every year, about 60 million people get sick, of whom about 600,000 die. Whooping cough also occurs in countries where pertussis vaccinations have been widely administered for many years. It is likely that whooping cough is more common among adults, but is not detected, since it occurs without characteristic convulsive attacks. When examining people with persistent, prolonged cough, pertussis infection is serologically detected in 20-26%. The mortality rate from whooping cough and its complications reaches 0.04%.

The most common complication of whooping cough, especially in children under 1 year of age, is pneumonia. Atelectasis and acute pulmonary edema often develop. Most often, patients are treated at home. Patients with severe whooping cough and children under 2 years of age are hospitalized.

With the use of modern treatment methods, mortality from whooping cough has decreased and occurs mainly among children 1 year of age. Death can occur from asphyxia when the glottis is completely closed due to spasm of the laryngeal muscles during a coughing attack, as well as from respiratory arrest and convulsions.

Prevention consists of vaccinating children with pertussis-diphtheria-tetanus vaccine. The effectiveness of the whooping cough vaccine is 70-90%.

The vaccine protects particularly well against severe forms of whooping cough. Studies have shown that the vaccine is 64% effective against mild forms of whooping cough, 81% against paroxysmal and 95% effective against severe.

References

1. Veltishchev Yu.E. and Kobrinskaya B.A. Pediatric emergency care. Medicine, 2006 - 138 p.

2. Pokrovsky V.I. Cherkassky B.L., Petrov V.L. Anti-epidemic

3. practice. - M.: - Perm, 2001 - 211 p.

4. Sergeeva K.M., Moskvicheva O.K., Pediatrics: a manual for doctors and students K.M. - St. Petersburg: Peter, 2004 - 218 p.

5. Tulchinskaya V.D., Sokolova N.G., Shekhovtseva N.M. Nursing in pediatrics. Rostov n/d: Phoenix, 2004 - 143 p.

Posted on Allbest.ru