Treatment. Laboratory research methods
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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 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 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 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.
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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Introduction……………………………………………………………………………….3
1. Etiology and pathogenesis…………………………………………………….4
2. Symptoms and course………………………………………………………...6
3. Nursing process for whooping cough……………………………………...8
Conclusion………………………………………………………………………………11
Literature……………………………………………………………………………….12
Introduction
Whooping cough is an acute infectious disease characterized by gradually increasing attacks of spasmodic cough. The pathogen is a rod with rounded ends. In the external environment, the microbe is not stable and quickly dies under the influence of disinfecting factors such as sunlight, and at a temperature of 56 degrees it dies in 10 - 15 minutes.
The source of the disease is a sick person. The infection is transmitted by airborne droplets during coughing, talking, and sneezing. The patient ceases to be contagious after 6 weeks. Children aged 5-8 years are most often affected.
With whooping cough, the mucous membrane of the upper respiratory tract is affected, where catarrhal inflammation is noted, causing specific irritation of the nerve endings. Frequent coughing attacks disrupt cerebral and pulmonary circulation, which leads to insufficient oxygen saturation of the blood and a shift in the oxygen-base balance towards acidosis. Increased excitability of the respiratory center persists for a long time after recovery.
The incubation period lasts from 2-15 days, usually 5-9 days. During whooping cough, the following periods are distinguished: catarrhal (3-14 days), spasmodic or convulsive (2-3 weeks), and the recovery period.
1. Etiology and pathogenesis
The causative agent of whooping cough is a short rod with rounded ends (0.2-1.2 microns), gram-negative, immobile, easily stained with aniline dyes. Antigenically heterogeneous. The antigen that causes the formation of agglutinins (agglutinogen) consists of several components. They are called factors and are designated by numbers from 1 to 14. Factor 7 is generic, factor 1 contains B. pertussis, 14 - B. parapertussis, the rest are found in different combinations; for the causative agent of whooping cough these are factors 2, 3, 4, 5, 6, for parawhooping cough - 8, 9, 10. The agglutination reaction with adsorbed factor sera makes it possible to differentiate Bordetella types and determine their antigenic variants. The causative agents of whooping cough and parapertussis are very unstable in the external environment, so seeding should be done immediately after taking the material. Bacteria quickly die when dried, ultraviolet irradiation, or under the influence of disinfectants. Sensitive to erythromycin, chloramphenicol, tetracycline antibiotics, streptomycin.
The gateway to infection is the mucous membrane of the respiratory tract. Pertussis microbes attach to ciliated epithelial cells, where they multiply on the surface of the mucous membrane without penetrating into the bloodstream. At the site of pathogen penetration, an inflammatory process develops, the activity of the ciliary apparatus of epithelial cells is inhibited and mucus secretion increases. Subsequently, ulceration of the respiratory tract epithelium and focal necrosis occurs. The pathological process is most pronounced in the bronchi and bronchioles, less pronounced changes develop in the trachea, larynx and nasopharynx. Mucopurulent plugs clog the lumen of the small bronchi, focal atelectasis and emphysema develop. Peribronchial infiltration is observed. In the genesis of convulsive attacks, sensitization of the body to the toxins of the pertussis bacillus is important. Constant irritation of the receptors of the respiratory tract causes coughing and leads to the formation of a focus of excitation of the dominant type in the respiratory center. As a result, typical attacks of spasmodic cough can also be caused by nonspecific irritants. From the dominant focus, excitation can radiate to other parts of the nervous system, for example, to the vasomotor (increased blood pressure, vasospasm). Irradiation of excitation also explains the appearance of convulsive contractions of the muscles of the face and torso, vomiting and other symptoms of whooping cough. Previous whooping cough (as well as anti-pertussis vaccinations) does not provide strong lifelong immunity, so repeated whooping cough infections are possible (about 5% of whooping cough cases occur in adults.
The source of infection is only humans (patients with typical and atypical forms of whooping cough, as well as healthy bacteria carriers). Patients in the initial stage of the disease (catarrhal period) are especially dangerous. Transmission of infection occurs by airborne droplets. Upon contact with sick people, susceptible people develop the disease with a frequency of up to 90%. Children of preschool age get sick more often. More than 50% of cases of whooping cough in young children are associated with insufficient maternal immunity and possibly the absence of transplacental transfer of protective specific antibodies. In countries where the number of vaccinated children decreases to 30% or lower, the level and dynamics of whooping cough incidence becomes the same as it was in the pre-vaccination period. Seasonality is not very pronounced; there is a slight increase in incidence in autumn and winter.
2. Symptoms and course
The disease lasts approximately 6 weeks and is divided into 3 stages: prodromal (catarrhal), paroxysmal and convalescent stage.
The incubation period lasts from 2 to 14 days (usually 5-7 days). The catarrhal period is characterized by general malaise, slight cough, runny nose, and low-grade fever. Gradually the cough intensifies, children become irritable and capricious.
At the end of the 2nd week of illness, a period of spasmodic cough begins. There is a runny nose, sneezing, occasionally a moderate increase in temperature (38-38.5) and a cough that does not decrease with antitussives. Gradually, the cough intensifies and becomes paroxysmal, especially at night. Attacks of convulsive cough are manifested by a series of coughing impulses, followed by a deep whistling breath (reprise), followed by a series of short convulsive impulses. The number of such cycles during an attack ranges from 2 to 15. The attack ends with the release of viscous glassy sputum, and sometimes vomiting is observed at the end of the attack. During an attack, the child is excited, the face is cyanotic, the veins of the neck are dilated, the tongue protrudes from the mouth, the frenulum of the tongue is often injured, and respiratory arrest followed by asphyxia may occur. In young children, repetitions are not pronounced. Depending on the severity of the disease, the number of attacks can vary from 5 to 50 per day. The number of attacks increases throughout the course of the disease. After the attack the child is tired. In severe cases, the general deterioration of the condition worsens.
Infants do not have typical attacks of whooping cough. Instead, after a few coughs, they may experience a short-term cessation of breathing, which can be life-threatening.
Mild and erased forms of the disease occur in previously vaccinated children and adults who become ill again.
Starting from the third week, a paroxysmal period begins, during which a typical spasmodic cough is observed: a series of 5-15 rapid coughing impulses, accompanied by a short wheezing inhalation. After several normal breaths, a new paroxysm may begin. During paroxysms, copious amounts of viscous, mucous, glassy sputum are released (usually infants and small children swallow it, but sometimes it is released in the form of large bubbles through the nostrils). Vomiting occurs at the end of an attack or during gagging caused by the discharge of thick sputum. During a coughing attack, the patient's face turns red or even blue; the tongue protrudes to the point of failure; its frenulum may be injured by the edge of the lower incisors; Sometimes hemorrhages occur under the mucous membrane of the conjunctiva of the eye.
The recovery stage begins in the fourth week; The period of convulsive cough lasts 3-4 weeks, then the attacks become less frequent and finally disappear, although the “normal” cough continues for another 2-3 weeks (period of resolution). In adults, the disease occurs without attacks of convulsive coughing and manifests itself as prolonged bronchitis with a persistent cough. The body temperature remains normal, paroxysms become less frequent and severe, less often end in vomiting, the patient feels better and looks better. The average duration of the disease is about 7 weeks (from 3 weeks to 3 months). Paroxysmal cough may reappear within several months; as a rule, it is provoked by ARVI.
3. Nursing process for whooping cough
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 using 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.
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.
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 pertussis 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
1. Veltishchev Yu.E. and Kobrinskaya B.A.. Emergency care in pediatrics. Medicine, 2006 – 138 p.
2. Pokrovsky V.I. Cherkassky B.L., Petrov V.L.. Anti-epidemic
practice. – M.:-Perm, 2001- 211 p.
3. Sergeeva K.M., Moskvicheva O.K., Pediatrics: a manual for doctors and students K.M. – St. Petersburg: Peter, 2004 – 218 p.
4. Tulchinskaya V.D., Sokolova N.G., Shekhovtseva N.M. Nursing in pediatrics. Rostov n/a: Phoenix, 2004 –143 p.
Laboratory research methods.
Nursing process for whooping cough.
Definition:
Whooping cough is an acute infectious disease caused by the pertussis bacillus, characterized by primary damage to the nervous system, respiratory tract and peculiar attacks of spasmodic cough.
General information:
The causative agent is the gram-negative bacillus Bordetella pertussis (Bordet-Zhangou bacillus). This is a stationary, small, short rod with a length of 0.502 microns. On nutrient media it grows slowly (3-4 days), 20-60 units of penicillin are usually added to them to suppress other flora, which easily suppresses the whooping cough bacillus; She is not sensitive to penicillin. The pertussis bacillus quickly dies in the external environment and is very sensitive to the effects of elevated temperature, sunlight, drying, and disinfectants.
Source of infection- a sick person.
Carriage is rare and short-lived.
Transmission path- airborne.
Receptivity - almost absolute and, moreover, from birth.
Immunity- persistent, lifelong.
Age aspect- the greatest number of diseases occurs between the ages of 1 and 5 years.
Reference features:
- bedside onset of whitening with general malaise, low-grade fever, slight runny nose and obsessive cough (1-2 weeks)
- a characteristic cough at the height of the disease with the presence of reprisal and redness of the face against the background of mild symptoms of intoxication;
- attacks of apnea with the release of thick viscous sputum and vomiting;
- hemorrhages in the sclera of the eyes and the appearance of ulcers on the frenulum of the tongue due to trauma to it from the incisors of the teeth;
- the occurrence of spasmodic coughing attacks when pressing on the root of the tongue and tragus of the ears;
- lack of effect from symptomatic therapy for 5-7 days.
- Complete blood count (leukocytosis, lymphocytosis against the background of normal or slow ESR);
- Bacteriological research method;
- Serological examination (agglutination reaction, RSK, RPGA);
- Immunofluorescent method (as a rapid diagnostic method).
Complications:
- Nosebleeds;
- hemorrhages in the conjunctiva, retina;
- cerebral hemorrhage with subsequent development of central paralysis;
- emphysema, pulmonary atelectasis, pneumothorax;
- cerebrovascular accident, cerebral edema;
- the addition of a secondary infection with the development of pneumonia, bronchitis, otitis media, sinusitis.
Treatment is often done at home,
indications for hospitalization are:
epidemic (children from closed children's groups),
age (first two years of life),
clinical (severe course of the disease and complicated forms of the disease).
Therapeutic and protective regime (traumatic procedures contribute to the appearance of coughing attacks).
24-hour maternal or nursing supervision (due to the risk of respiratory arrest and aspiration of vomit).
Sufficient oxygenation (sleeping in the fresh air, walking for many hours, good ventilation of rooms and wards)
Drug therapy:
- antibiotics (ampicillin, erythromycin, gentamicin, chloramphenicol) in the catarrhal period and the first two weeks of the period of spasmodic cough;
- neuroleptic drugs (aminosine, seduxen);
- drugs that thin sputum;
- inhalations with proteolytic enzymes;
- drugs that suppress the cough reflex.
Anti-epidemic measures:
- early detection of the patient;
- registration of the patient in the SES;
- isolation of the patient stops 25 days from the onset of the disease;
- identification of contacts;
- imposing quarantine on contacts (children under 7 years of age) for 14 days;
- bacteriological examination of contacts.
No disinfection is carried out.
Specific prevention:
Vaccination is carried out with DTP vaccine three times with an interval of 45 days, starting from 3 months of age, intramuscularly. Revaccination at 18 months. once.
Graph-logical structure.
Whooping cough.
Etiology Whooping cough bacillus (Borde-Gengou bacillus)
Source whooping cough patient
Transmission routes airborne
Development mechanism pathogen→upper respiratory tract→
respiratory catarrh
trachea→C.N.S.→ hyperexcitation of C.N.S.→spasm of bronchi, bronchioles, respiratory muscles, diaphragm, tonic convulsions of striated muscles
Clinic
periods of illness:
| Period of illness | incubatory | catarrhal | spasmodic | permission | |
| duration | 14 days | 14 days | 4-6 weeks | 2-3 weeks | |
| signs | No | runny nose, dry cough (usually at night) | aura, spasmodic coughing attacks, reprises | Reduction of attacks, cough loses paroxysmal character | |
| temperature | No | normal or subfebrile | normal | ||
| sputum | No | Small mucous discharge | Viscous transparent | ||
| Patient's appearance | ordinary | Manifestations of nasopharyngitis | vomiting after a coughing attack, facial hyperemia, scleral injection, lacrimation, ulcer on the frenulum of the tongue, random urination and defecation, puffiness of the face | Rare cough, possible return of paroxysmal cough when ARVI is added | |
Complications:
- addition of a secondary infection,
- defeat of the central nervous system (encephalopathy),
- hemorrhages,
- emphysema,
- hernias,
- cardiovascular disorders
Diagnostics:
- bacteriological examination (throat swab on Borde-Gangu),
- serological method (RSK),
- immunofluorescent method
Treatment principle:
- protective regime
- fresh air, oxygen therapy,
- mechanically pureed food,
- intensively organized leisure
- drug treatment: antibiotics (macrolides), antipsychotics, antispasmodics, antihistamines, vitamins A, C, K; antitussives
Specific prevention:
vaccination - with DTP vaccine from 3 months, three times with an interval of 1 month;
revaccination at 18 months
Activities in the outbreak:
- registration with the SES; isolation of the patient for 25 days from the beginning
- quarantine of contacts for 14 days from the moment of isolation of the patient
- bacteriological examination of contacts (throat swab on Borde-Gangu).
Control questions
1. Define the disease
2. State the cause of the disease
3. Name the main clinical manifestations of this infection
4. Describe the principles of treatment and the nursing process when caring for a patient.
5. Name the stages of anti-epidemic measures.
6. Name methods of prevention.
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.
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"
"Crimson 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 a
Otitis
Sinusitis
Purulent lymphadenitis
Late (2-3 weeks) for
allergic account
factor a
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 outbreaks
(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 bedtime
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 convulsions
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 from 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 outlet
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.
DTP vaccine, Infanrix
enter only
intramuscularly!!!
