The role of the nurse in whooping cough in children. Treatment
In case of whooping cough, the nurse’s actions will depend on her profile (district nurse, hospital nurse, kindergarten nurse, etc.).
Actions of the hospital nurse:
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);
Organizing outdoor walks;
Control over feeding regimen (frequent, small portions);
Prevention of nosocomial infection (control of child isolation);
Providing emergency care for fainting, apnea, convulsions.
Actions of the site nurse:
Monitor the child’s parents’ compliance with the isolation regime for 30 days from the moment of illness;
Inform parents of other children about whooping cough;
Identify possible contacts of the child (especially in the first days of illness) with healthy children and ensure that they are monitored for 14 days from the date of contact;
Be able to provide emergency assistance for apnea, convulsions, fainting;
Promptly inform the doctor about the deterioration of the child’s condition.
The leading action of the preschool nurse 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.
The purpose of the nurse (site, hospital): prevent or reduce the risk of pneumonia.
Nurse actions:
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;
Body temperature control;
Strict compliance with 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 hyposensitizing agents(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).
Timing for vaccination and revaccination:
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.
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.
Features of whooping cough in children of the first year of life.
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 nurse's goal 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.
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.
Lecture No. 13
Topic: “Nursing care for tonsillitis, scarlet fever, whooping cough”
Sore throat (acute tonsillitis) -
This is an acute infectious disease primarily affecting the palatine tonsils.
Etiology : staphylococcus, B-hemolytic streptococcus of group A, but there may also be other pathogens (viruses, fungi).
Transmission routes:
1. Airborne
2. Nutritional.
3. Contact and household.
Source of infection :
1. Exogenous (i.e. from patients and bacteria carriers).
2. Endogenous (autoinfection - i.e. infection occurs from the oral cavity of the patient himself in the presence of chronic inflammation of the tonsils or carious teeth).
Predisposing factors : local or general hypothermia.
Clinic:
1. General intoxication syndrome : (fever up to 39-40, headache, chills, general malaise).
2. Sore throat when swallowing .
3. Local changes on the tonsils depend on the form of sore throat.
There are:
1. Catarrhal
2. Follicular
2. Lacunar
Catarrhal tonsillitis. The intoxication syndrome is not expressed, the temperature is subfebrile. When examining the pharynx, swelling and hyperemia of the palatine tonsils and arches are noted. Regional lymph nodes are enlarged and painful on palpation. Catarrhal tonsillitis can be the initial stage of another form of tonsillitis, and sometimes a manifestation of one or another infectious disease.
Angina follicular and lacunar. Characterized by more severe intoxication (headache, sore throat, temperature up to 39°, chills).
Examination of the pharynx for follicular sore throat: suppurating follicles in the form of white or yellowish peas are visible, visible through the mucous membrane. Sometimes the gaps contain yellow or grayish, dense plugs that have an unpleasant putrefactive odor.
Examination of the pharynx with lacunar angina: liquid yellowish-white purulent plaques form in the lacunae, which can merge, covering the entire surface of the tonsils. These deposits can be easily removed with a spatula. In both cases, the tonsils are hyperemic and swollen.
Complications of tonsillitis:
1. Local
Quinsy,
Peritonsillar abscess,
Swelling of the larynx (laryngitis),
Cervical lymphadenitis,
Otitis etc.
2. Infectious-allergic:
Rheumatism, glomerulonephritis
Treatment
- bed rest until temperature normalizes
Drink plenty of warm drinks
Antibiotics (cefuroxime, azithromycin, josamycin) - 5 days
Antihistamines
Rinsing the throat with saline solution, herbal decoctions (chamomile, calendula, eucalyptus)
Irrigation of the pharynx with the preparations ingalipt, bioparox, jox, hexoral and others.
Site observation:
If the child is not hospitalized, then on the first day, before antibiotics are prescribed at home, a swab is taken from the throat and nose for diphtheria (for BL). In the first three days, the patient is actively observed at home by a doctor and nurse. Home regime 10 days.
After recovery:
The patient is given intramuscular bicillin-3 once to prevent rheumatism and nephritis,
General blood and urine tests are done. After a month, the patient should be examined by a doctor again (so as not to miss complications). If necessary, repeat blood and urine tests.
Scarlet fever
This is one of the forms of streptococcal infection, accompanied by fever, sore throat, pinpoint rash, and prone to complications.
Etiology: Caused by group A beta-hemolytic streptococcus.
sources of infection:
1-patient with scarlet fever up to 7-8 days from the onset of the disease;
2 - patients with tonsillitis.
Transmission path:
Airborne and household contact, very rarely food.
Incubation period 2-7 days.
By the end of 1 day, 3 main signs of the disease are formed:
1. Intoxication syndrome
2. inflammation at the entrance gate (angina)
3. pinpoint rash on the skin.
Intoxication manifested by an increase in temperature to high numbers of 38.5-39, poor health, headache, often vomiting.
Angina- complaints of sore throat. When examining the pharynx, there is bright hyperemia and swelling of the tonsils, arches, and soft palate. Sore throat can be catarrhal, lacunar, follicular and even necrotic.
Regional lymph nodes are enlarged.
The tongue has a characteristic appearance during scarlet fever - in the first 2-3 days it is coated in the center with a white coating and is rather dry. The tip of the tongue is crimson in color, from 2-3 days the tongue begins to clear, becomes crimson, with pronounced papillae. " Raspberry" tongue – lasts 1-2 weeks.
By the end of the first, beginning of the second day, it appears simultaneously throughout the body. pinpoint, thick rash on a hyperemic skin background. The skin feels hot, dry, rough (shagreen skin). The favorite place for localization of the rash is in the groin folds, elbow bends, lower abdomen, armpits, and popliteal fossae. The nasolabial triangle always remains free of rash.
All symptoms reach a maximum by day 3 and then gradually fade away.
When the rash fades, most patients develop large-lamellar peeling skin , especially pronounced on the fingers and toes.
- Infectious– otitis media, sinusitis, laryngitis, bronchitis, pneumonia, peritonsillar abscess.
- Allergic– glomerulonephritis, rheumatism, infectious-allergic myocarditis.
Treatment:
At home, children from closed institutions, severe cases, are subject to hospitalization
and complicated forms, children under 3 years of age.
-mode bed rest for the entire acute period.
-A/ b penicillinear row(amoxicillin, augmentin, flemoxin solutab), macrolides(erythromycin, azithromycin), or cephalosporins 1st generation (cephalexin, cefazolin and others).
Antihistamines (tavegil, fenkarol) - according to indications
Symptomatic (antipyretics, gargling).
-specific No;
- nonspecific - consists of isolating patients for 10 days; if recovery has not occurred by the 10th day, then the period is increased.
Those who have recovered are discharged to kindergarten and school after 21 days (to avoid complications such as myocarditis, glomerulonephritis). Children who have been in contact with a person with scarlet fever are observed at home and in preschools for 7 days (temperature, skin, pharynx).
Anti-epidemic measures rallies in DU(children's institution)
1. quarantine for 7 days, final disinfection is carried out in the group, contacts are examined daily (skin, pharynx, thermometry).
Whooping cough
Etiology:
the causative agent of whooping cough is a gram-negative rod ( Bordetellapertussis). There are 4 known serotypes that produce exo- and endotoxins during growth and development. The central nervous system (respiratory and vasomotor centers) is most sensitive to toxins. In the external environment, the rod is unstable and quickly dies because sensitive to high temperature, sunlight, drying, and disinfectants.
Source of infection – patients with typical and atypical forms of whooping cough.
Transmission path – airborne, infection occurs through close and sufficiently long contact (dispersion radius of the pathogen is 2-2.5 meters). Whooping cough affects children of all ages, including newborns.
Main clinical manifestations of whooping cough
1. Incubation period from 3 to 14 days.
2. Catarrhal period 1-2 weeks-
the patient's condition is satisfactory, the temperature is normal or
low-grade fever. The cough is dry, obsessive, gradually increasing, and there may be a runny nose.
3. Period of spasmodic cough from 2-3 weeks to 2 months.
A coughing attack consists of coughing impulses following each other on exhalation, interrupted by a whistling, convulsive inhalation - reprise. The attack ends with the discharge of thick, viscous glassy sputum or vomiting. In a typical coughing attack, the patient’s appearance is characteristic: the face turns red, then turns blue, becomes purple-red, the veins of the neck, face, and head swell, and lacrimation is noted. The tongue protrudes from the mouth to the limit. As a result of friction of the frenulum of the tongue on the teeth, a tear or ulcer forms. Outside of an attack, puffiness of the face, swelling of the eyelids, and pale skin persist. Hemorrhages in the sclera and petechial rash on the face and neck are possible.
4. Permission period from 2 to 3 weeks -
The cough loses its typical character and occurs less and less frequently, but attacks can be provoked by emotional stress or physical exertion. For 2-6 months, the child’s increased excitability remains, trace reactions are possible (return of paroxysmal, convulsive cough when ARVI is added).
Features of modern whooping cough– the predominance of mild and atypical forms due to mass pertussis immunization.
Features of whooping cough in young children:
Periods 1 and 2 were shortened, period 3 was extended to 50-60 days;
Coughing attacks may not occur repeatedly, but are often accompanied by cessation of breathing, and there may be convulsions;
More often complications occur: (diarrhea syndrome, encephalopathy, pulmonary emphysema, pertussis pneumonia, atelectasis, cerebrovascular accident, bleeding and hemorrhages in the brain, retina, umbilical or inguinal hernia, rectal prolapse and others).
Laboratory diagnostics:
1) “cough patch” method
2) a smear from the back of the throat - a tank inoculated on Bordet-Giangou medium (potato-glycerin agar with the addition of blood and penicillin) or KUA (casein-charcoal agar).
3) RPGA - for diagnosing whooping cough in the later stages or when examining the focus. Diagnostic titer 1:80.
4) molecular method - PCR (polymer chain reaction).
5) OAK – leukocytosis with lymphocytosis (or isolated lymphocytosis) with normal ESR.
Treatment:
Subject to hospitalization children with severe forms, with complications, with an unsmooth course, unfavorable premorbid background, with exacerbation of chronic diseases and young children. According to epidemic indications - children from closed institutions.
Mode- gentle, with mandatory individual walks.
Diet– in severe forms, feed more often and in small portions,
after vomiting, supplement feeding.
Etiotropic therapy: antibiotics-– erythromycin, roxithromycin (rulid), azithromycin (sumamed) for 5-7-10 days, effective in the early stages of the disease.
Pathogenetic therapy:
P/convulsive (phenobarbital, chlorpromazine);
Calming (valerian);
Dehydration therapy (diacarb or furosemide);
Mucolytics and antitussives (tussin plus, broncholitin, libexin, tusuprex, sinekod);
Antihistamines (claritin, suprastin);
Vitamins with microelements;
For severe forms - prednisolone;
Oxygen therapy, for apnea - mechanical ventilation;
Eufillin (for bronchoobstruction and cerebrovascular accidents);
Physiotherapy, chest massage, exercise therapy;
P/pertussis immunoglobulin (children under 2 years old).
Prevention
-specific- DTP (tetracoccus) from 3 months 3 times, with an interval of 45 days, revaccination at 18 months.
-nonspecific
Isolate the patient for 14 days. Children who have been in contact with the patient are observed for 7 days, a double bacteriological examination is carried out for children from the family when treating a patient with whooping cough at home. Contact children of the first year of life and unvaccinated children under 2 years of age are given antitoxic anti-pertussis immunoglobulin.
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:
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.
sleep disturbance;
loss of appetite;
persistent, obsessive cough;
breathing problems;
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
(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 |
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.
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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 (supporting the child, calming 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 previously been 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.
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