Treatment. Laboratory research methods
Scarlet fever
Pathogen –
hemolytic
streptococcus
group A
Stable during
external environment
Highlights
exotoxin,
defiant
allergic
mood
body
Scarlet fever - acute infectious
a disease characterized
symptoms of intoxication, sore throat and
skin rashes
Scarlet fever
Epidemiology:Source of infection – patient or bacteria carrier
The transmission mechanism is airborne and
contact and household (toys, through “third parties”),
food
Entry gate – tonsils (97%), damaged skin
(1.5%) - extrabucal form (more often with burns)
Children aged 2-7 years are most often affected
Typical autumn-winter seasonality
Contagiousness index – 40%
Immunity is stable, but repeated cases are possible
Incubation period 2-7 days
Sudden onset
Expressed
intoxication
(temperature 3840°C, vomiting, headache
pain, general
weakness
Sore throat, sore throat,
"flaming throat" from 1
day of illness
"Raspberry Tongue"
Skin rash
Clinical signs of scarlet fever
Sore throat (follicular,lacunar)
Purulent plaque in lacunae
tonsils
“Burning throat” - bright
limited hyperemia
tonsils, uvula, arches.
There is no plaque on the tonsils
Clinical signs of scarlet fever
Specific changestongue - white coating on the tongue
Cleans from edges and tip
and in 2-3 days it becomes
"raspberry"
"Raspberry Tongue" - bright
pink with
hypertrophied
papillae
Clinical signs of scarlet fever
Pinpoint rash onhyperemic background
skin (from the end of 1 day of illness)
More saturated
on the side
surfaces
torso, below
belly, on
flexion
surfaces, in
places
natural
folds
White dermographism is characteristic in the first week of the disease.
Features of the rash with scarlet feverWhite dermographism is characteristic
first week of illness
Features of the rash with scarlet fever
Not available onface in the area
nasolabial
triangle
(pale
nasolabial
triangle
Filatova)
Features of the rash with scarlet fever
The rash disappearsin 3-7 days
Appears
pityriasis
peeling on
torso
Lamellar
peeling
palms and soles
A pinpoint rash on the palms and lamellar peeling of the skin of the palms is a specific symptom of scarlet fever
Real problems with scarlet fever: 1. Hyperthermia, headache, vomiting - due to intoxication; 2. Sore throat - due to sore throat; 3.Skin defect - me
The real problems withscarlet fever:
1.Hyperthermia, headache,
vomiting - due to intoxication;
2. Sore throat - due to sore throat;
3.Skin defect –
pinpoint rash;
4.Discomfort due to dryness,
peeling of the skin.
Potential problems
for scarlet fever:
Risk of complications
Complications of scarlet fever
Early (at 1 week) forbacterial count
factor
Otitis
Sinusitis
Purulent lymphadenitis
Late (2-3 weeks) for
allergic account
factor
Myocarditis
Nephritis
Rheumatism
Care and treatment of scarlet fever
Bed rest until normalizationtemperature, then until 10 days
semi-bed
Diet (follow for 3 weeks):
mechanically, thermally gentle, rich
potassium, with salt restriction, with exception
obligate allergens
Wet cleaning, ventilation 2 times per
day
Organize a chlorine regime
Care and treatment of scarlet fever
Maintain oral hygiene: rinsesoda solution, chamomile infusion,
calendula
Antibiotics for 7 days (penicillin series
or sumamed, suprax, cephalexin)
Antihistamines (suprastin, etc.)
Antipyretics (paracetomol)
Irrigate the throat with dioxidin, hexoral
Monitoring diuresis, pulse, blood pressure
Provide information and directions to parents
on OBC, OAM (10 and 20 days of illness), ECG
Bacteriological examination - take a smear
from tonsils to streptococcus
Working in a scarlet fever outbreak
Activities with the patient1. Hospitalization is not necessary
2. Submit the IES (notify the Center for State Sanitary and Epidemiological Surveys about
disease)
3. Isolate the patient for 10 days
(children under 8 years + 12 days
"home quarantine")
4. Current disinfection is carried out
systematically (dishes, toys,
personal hygiene items),
organize mask, chlorine
patient care regimen,
quartz
5. Final disinfection in
not carried out in foci
(Sanitary and epidemiological
rules SP 3.1.2.1203-03
"Prevention
streptococcal infection")
With contact
1. Identify all contacts
2. Quarantine for 7 days
(only in DDU) from the moment
isolation of the last patient
3. Establish surveillance
(thermometry, examination of the pharynx,
skin). Children who have had acute respiratory infections
are inspected until the 15th day from
onset of illness for the presence
cutaneous lamellar
peeling palms
4. Family contacts who have not been ill
scarlet fever are not allowed in
Preschool and 1st-2nd grade school for 7
days (during hospitalization
patient) or 17 days (if
the patient is being treated at home) Whooping cough
Pathogen –
BordeJangu stick
Unstable during
external environment
Highlights
exotoxin,
defiant
irritation
receptors
respiratory
ways
Whooping cough is an acute infectious disease
a disease with a cyclical course,
characterized by long-term
persistent paroxysmal cough.
Whooping cough
Epidemiology:Whooping cough
Source of infection - patient up to 25-30 days from onset
illnesses
The transmission mechanism is airborne. Contact
must be tight and long
Entry gate – upper respiratory tract
Children from 1 month to 6 years get sick more often; they also get sick
newborns
Typical autumn-winter seasonality (peak December)
Contagiousness index – up to 70%
Immunity is strong and lifelong
Mortality – 0.1-0.9%
Incubation period 3 - 15 days
Clinical signs of whooping cough
Catarrhal period - 1-2weeks:
Dry cough at night
before bed
Temperature
normal or
low-grade fever
Behavior,
well-being, appetite
not violated
Cough does not respond
therapy and intensifies
Clinical signs of whooping cough
Convulsive period - 2-8weeks or more:
The cough becomes
paroxysmal
Reprises are noted -
whistling convulsive
breaths
The attack ends
viscous discharge
phlegm, mucus or
vomiting
In children under one year of age - often
apnea cessation of breathing
View of a patient with whooping cough during a coughing attack
Clinical signs of whooping cough
Characteristic externalappearance during an attack
– the face turns red,
then the veins turn blue
swell out of the eyes
tears are flowing
Tongue sticking out of mouth
to the limit
Ulcer
on the bridle
language
The real problems with whooping cough are:
Breathing disorders –paroxysmal cough due to
irritation of the cough center
Vomiting – due to severe cough
Ineffective drainage
sputum
Stopping breathing due to apnea
Potential problems
for whooping cough:
Risk of complications
Complications of whooping cough
Group 1 – associated withby the action of a toxin or
the whooping cough stick itself
Emphysema
Atelectasis
Encephalopathy
The appearance of the umbilical and
inguinal hernia
Hemorrhages in
conjunctiva, into the brain
Rectal prolapse
Group 2 – joining
secondary infection
Bronchitis
Pneumonia
Treatment and care for whooping cough
General mode, walks in the fresh air, headboardsublime
Nutrition according to age, exclude foods (seeds,
nuts), because aspiration may occur when coughing
Supplement after vomiting
Organize leisure and security regime, not
leaving the child alone (possibly apnea)
During an attack, sit or pick up, after
remove sticky mucus from the mouth with a tissue
Mask mode when in contact with a patient
Wet cleaning, airing 2 times a day,
humidify the air, temperature up to +22
Antibiotics (rulid, ampiox, etc.), expectorants
drugs and antitussives (libexin, tusuprex)
Give humidified oxygen
Working in a whooping cough outbreak
Activities with the patient1. Hospitalization is subject to
children with severe forms,
children under 2 years old, not vaccinated
from whooping cough, from closed
outbreaks
2. Submit IES (report to
TsGSEN about the disease)
3. Isolate the patient for 30
days from the onset of the disease
4. Organize a mask
mode, regular
ventilation, damp
cleaning, quartzing
5. Final disinfection
not carried out
With contact
1. Identify everyone who is coughing
contact up to 14 years old,
suspend from visiting
children's group up to
receiving 2 negative
results
tank examination for whooping cough
2. Set observation to 14
days (only in kindergartens, boarding schools, orphanages)
3. Find out the vaccination
medical history: unvaccinated up to 1
years and older, weakened
children - appropriate
administer antipertussis
immunoglobulin
Specific prevention of whooping cough
Vaccination is being carried outthree times at intervals
45 days DPT vaccine
V₁ - 3 months,
V₂ - 4.5 months,
V₃ - 6 months,
Revaccination
R – 18 months.
DPT vaccine, Infanrix
enter only
intramuscularly!!!
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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 DTP 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 (DTP + inactivated polio vaccine (IPV) or Haemophilus influenzae vaccine (HIB)), five-component (DPT + IPV + Hib), six-component (DPT + 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 of age, 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 2 years of age 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 DPT 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 regime (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; do not allow 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 hyposensitizingfunds(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, bronchitis, bronchiolitis, and in the presence of chronic pneumonia. One of the main tasks is the fight against respiratory failure.
Peculiaritieswhooping coughatchildrenfirstyearlife.
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 children's institutions are allowed into children's 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.
Literature used
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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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; do not allow 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, 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.
Whooping cough - an acute infectious disease, the main manifestation of which is a paroxysmal cough.
Etiology
The causative agent is the Bordet-Giangu bacterium. The source of infection is a sick person within 25–30 days from the onset of the disease. The route of transmission is airborne. The incubation period is 3–15 days.
Clinical manifestations
During the course of the disease, there are 3 periods: catarrhal, spasmodic and the period of resolution.
Catarrhal period. Duration - 10–14 days. There is a short-term increase in body temperature to subfebrile, a slight runny nose, and an increasing cough.
Spasmodic period. Duration - 2–3 weeks. The main symptom is a typical paroxysmal cough. A coughing attack begins unexpectedly and consists of repeated cough impulses (reprises), which are interrupted by a prolonged wheezing inhalation associated with a narrowing of the glottis. In infants, after a series of coughing impulses, breathing may stop (apnea). During a coughing attack, the skin on the child’s face becomes cyanotic with a purple tint, and swelling of the neck veins is observed. When coughing, the child sticks out his tongue and drools. At the end of the attack, a small amount of viscous sputum may be released. The frequency of attacks is from 10 to 60 times a day, depending on the severity of the disease.
Resolution period. Duration - 1–3 weeks. Attacks occur less frequently, are shorter in duration, and the cough loses its specificity. All symptoms of the disease gradually disappear. The total duration of the disease is 5–12 weeks.
Complications
Emphysema, atelectasis, pneumonia, bronchitis, encephalopathy.
Diagnostics
1. Accounting for epidemiological data.
3. Bacteriological examination of mucus taken from the back wall of the pharynx.
4. Immunoluminescent rapid diagnostics.
5. Serological study.
Treatment
1. Treatment regimen.
2. Balanced nutrition.
3. Drug therapy: antibiotics, antispasmodics, expectorants, including proteolytic enzymes.
Prevention
1. Active immunization - DTP vaccination (pertussis-diphtheria-tetanus vaccine). The course begins at the age of 3 months. The course consists of 3 injections with an interval of 30–40 days. Revaccination - after 1.5–2 years.
2. Isolation of patients for 25–30 days from the onset of the disease.
3. Contact children under 7 years of age are subject to quarantine for 14 days.
Nursing care
1. Patient care is carried out in accordance with the general principles of care for childhood infections.
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, Rulid, 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 results of bacteriological examination are obtained, and in severe forms, assist in organizing 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, train them 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: milk 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 |
