Treatment. Laboratory research methods
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Post-vaccination immunity does not protect against disease. Whooping cough in these cases proceeds 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 high reactogenicity, due to the risk of complications, it is impossible to administer the second and subsequent revaccinates, which does not solve the problem of eliminating pertussis infection, post-vaccination immunity is short, the protective efficacy of various whole-cell DTP vaccines varies significantly (36-95%). The protective efficacy of whole cell vaccines depends on the level of maternal antibodies (in contrast to a cell-free vaccine).
The pertussis component of the DTP vaccine has sufficient reactogenicity; after vaccinations, both local and general reactions are observed. Registered reactions of a neurological nature, which are a direct consequence of vaccinations. These circumstances have led to the fact that pediatricians are very cautious about administering DTP vaccinations, this explains the large number of unreasonable medical exemptions.
Given the new concept, first in Japan and then in other developed countries, an acellular pertussis vaccine based on pertussis toxin and new protective factors was created and introduced. Currently, families of combined pediatric preparations based on 2-, 3- and 5-component pertussis vaccine are produced on an industrial scale. The following have been available in developed countries for several years now: four-component (AaDPT + inactivated polio vaccine (IPV) or Haemophilus influenzae vaccine (HIV)), five-component (AaDPT + IPV + Hib), six-component (AaDPT + 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 their vaccination history, who have been in contact with whooping cough patients, if they have a cough, are allowed into the children's team after receiving two negative results of bacteriological examination. Contact persons are placed under medical supervision for 7 days and a double bacteriological examination is carried out (two days in a row or with an interval of one day).
Activities aimed at interrupting transmission routes
Children in the first months of life and children from closed children's groups (children's homes, orphanages, etc.) are subject to isolation (hospitalization). All patients with whooping cough (children and adults) identified in nurseries, nursery-kindergartens, orphanages, 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. Bacteriocarriers are also subject to isolation until two negative results of bacteriological examination are obtained. In the focus of pertussis infection, the final disinfection is not carried out, daily wet cleaning and frequent airing are carried out.
Activities aimed at a susceptible organism
Unvaccinated children under the age of one year, children older than one year old, unvaccinated or with incomplete vaccinations, and also weakened by chronic or infectious diseases, it is advisable to administer antitoxic anti-pertussis immunoglobulin to those who have been in contact with whooping cough patients. Immunoglobulin is administered regardless of the time that has passed since the day of communication with the patient. Emergency vaccination in the outbreak is not carried out.
Neutralizationsourceinfections includes isolation as early as possible at the first suspicion of whooping cough, and even more so when this diagnosis is established. Isolate the child at home (in a separate room, behind a screen) or in the hospital for 30 days from the onset of the disease. After removing the patient, the room is ventilated.
Quarantine (separation) is subject to children under the age of 7 who were in contact with the patient, but did not have whooping cough. The quarantine period is 14 days in case of isolation of the patient.
All children under the age of 1 year, as well as young children who are not immunized against whooping cough for any reason, in case of contact with a patient, 7-globulin is administered (3-6 ml twice every 48 hours), it is better to use a specific anti-pertussis 7- globulin.
Hospitalization is subject to patients with severe, complicated forms of whooping cough, especially under the age of 2 years, and especially infants, patients living in adverse conditions. According to epidemiological indications (for isolation), patients are hospitalized from families in which there are infants, from hostels where there are children who did not have whooping cough.
Activeimmunization is the main link in the prevention of whooping cough. The DTP vaccine is currently being used. The pertussis vaccine in it is represented by a suspension of the first phase of pertussis bacilli adsorbed by phosphate or aluminum hydroxide. Immunization starts from 3 months, is carried out three times with an interval of 1.5 months, revaccination is carried out 1 1/2-2 years after the vaccination is completed.
Full coverage of vaccination and revaccination of children leads to a significant reduction in the incidence.
10. Nursing process for whooping cough
With whooping cough, the actions of a nurse 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 a child with physical assistance during a coughing fit (support the child, soothe);
- organization of walks in the fresh air;
- control over the mode of feeding (frequent, small portions);
- prevention of nosocomial infection (control of the isolation of the child);
- Providing emergency care for fainting, apnea, convulsions.
Actions nurses site:
- monitor compliance by the parents of the child with the isolation regime within 30 days from the moment of illness;
- inform the parents of other children about the case of whooping cough;
- to identify possible contacts of the child (especially in the first days of illness) with healthy children and ensure their observation within 14 days from the moment of contact;
- be able to provide emergency care 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 a sick child (early isolation of all children suspected of whooping cough; not to allow transfers of children to other groups, etc.).
The most common problem in 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 breaths, pulse per minute;
- control of body temperature;
- Strict compliance with medical prescriptions.
The most common laboratory confirmations of whooping cough are leukocytosis up to 30x10 9 /l with severe lymphocytosis and bacteriological examination of pharyngeal mucus.
Children in the first year of life and children with severe disease are usually hospitalized in DIB.
The period of isolation of patients with whooping cough is long - at least 30 days from the moment of illness.
With the advent of spasmodic cough, antibiotic therapy is indicated for 7-10 days (ampicillin, erythromycin, chloramphenicol, chloramphenicol, methicillin, gentomycin, etc.), oxygen therapy (the child's stay in an oxygen tent). Also apply hyposensitizingfunds(diphenhydramine, suprastin, diazolin, etc.), mukaltin and bronchodilators (mukaltin, bromhexine, eufillin, etc.), inhalation of aerosols with sputum thinning enzymes (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 applied DTP vaccine(adsorbed pertussis-diphtheria-tetanus vaccine).
Timingholdingvaccinationandrevaccination:
vaccination is carried out from 3 months three times with an interval of 30-45 days (0.5 ml IM) to healthy children who have not had whooping cough;
revaccination - at 18 months (0.5 ml / m, 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 are used (diphenhydramine, suprastin, tavegil), vitamins, inhalation aerosols of proteolytic enzymes (chymopsin, chymotrypsin), which facilitate the discharge of viscous sputum, mukaltin.
Mostly children of the first half of the year with a pronounced severity of the disease 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 epidemic 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.
Severely ill infants are advised to 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 disorders and encephalic syndrome) require resuscitation, as they can be life-threatening.
Erased forms of whooping cough do not require treatment. It is enough to eliminate external stimuli to ensure peace and longer sleep for whooping cough patients. In mild forms, prolonged exposure to fresh air and a small number of symptomatic measures at home can be limited. Walks should be daily and long. The room in which the patient is located should be systematically ventilated and its temperature should not exceed 20 degrees. During an attack of coughing, you need to take the child in your arms, slightly lowering his head.
With the accumulation of mucus in the oral cavity, it is necessary to free the child's mouth with a finger wrapped in clean gauze.
Diet. Serious attention should be paid to nutrition, since pre-existing or developed nutritional deficiencies can significantly increase the likelihood of an adverse outcome. Food is recommended to give fractional portions.
It is recommended to feed the patient little and often. Food should be complete and sufficiently high-calorie and fortified. With frequent vomiting, the child should be supplemented 20-30 minutes after vomiting.
The appointment 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. The best effect is provided by ampicillin, gentamicin, erythromycin. Antibacterial therapy is effective only in the early stages of uncomplicated whooping cough, in catarrhal and no later than 2-3 days of the convulsive period of the disease.
The appointment of antibiotics in the spasmodic period of whooping cough is indicated for the combination of whooping cough with acute respiratory viral diseases, bronchitis, bronchiolitis, 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 stops in breathing (apnea) with the development of cyanosis, the possible development of seizures and death.
3. Longer period of spasmodic cough (sometimes up to 3 months).
If any problems arise in a sick child goal nurses is their elimination (reduction).
The most responsible therapy for severe whooping cough in children of the first year of life. Oxygen therapy is necessary with the help of a systematic supply of oxygen, cleaning the airways from mucus and saliva. When breathing stops - suction of mucus from the respiratory tract, artificial ventilation of the lungs. With signs of brain disorders (tremor, short-term convulsions, increasing anxiety), seduxen is prescribed and, for the purpose of dehydration, lasix or magnesium sulfate. From 10 to 40 ml of a 20% glucose solution is injected intravenously with 1-4 ml of a 10% solution of calcium gluconate, to reduce pressure in the pulmonary circulation and to improve bronchial patency - eufillin, 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 outdoors).
Antitussives and sedatives. The efficacy of expectorant mixtures, cough suppressants, and mild sedatives is questionable; they should be used sparingly or not at all. Cough-provoking influences (mustard plasters, jars) should be avoided.
For the treatment of patients with severe forms of the disease - glucocorticosteroids and / or theophylline, salbutamol. With apnea attacks, chest massage, artificial respiration, oxygen.
Prevention in contact with the sick.
In unvaccinated children, human normal immunoglobulin is used. The drug is administered twice with an interval of 24 hours as soon as possible after contact.
Chemoprophylaxis with erythromycin at an age dosage for 2 weeks can also be carried out.
11. Activities in the focus of whooping cough
The room where the patient is located is thoroughly ventilated.
Children who were in contact with the patient and did not have whooping cough are subject to medical supervision within 14 days from the moment of separation from the patient. The appearance of catarrhal phenomena and cough raises the 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 sick person and who have not had whooping cough are quarantined for a period of 14 days from the moment of isolation of the patient, and in the absence of separation - within 40 days from the moment of illness or 30 days from the moment the patient develops convulsive cough.
Children over 10 years old and adults working in children's institutions are allowed to children's institutions, but within 14 days from the moment of separation from the patient, they are under medical supervision. With continued home contact with the patient, they are under medical supervision for 40 days from the onset of the disease.
All children who have not had whooping cough and are in contact with the patient are subject to examination for bacteriocarrier. If a bacteriocarrier is detected in non-coughing children, they are admitted to children's institutions after three negative bacteriological studies conducted at intervals of 3 days and with a certificate from the clinic stating that the child is healthy.
Contact children under the age of one year, who are not vaccinated against whooping cough and have not had whooping cough, are injected intramuscularly with gamma globulin 6 ml (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 pertussis monovaccine three times in 1 ml every 10 days.
In foci of whooping cough, according to epidemiological indications, children who have been in contact with a patient previously vaccinated against whooping cough, in 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 located is thoroughly ventilated.
Conclusion
Whooping cough is widespread throughout the world. Every year, about 60 million people fall ill, of which about 600,000 die. Whooping cough also occurs in countries where pertussis vaccinations have been widely practiced for many years. Probably, among adults, whooping cough is more common, but not detected, as it occurs without characteristic convulsive seizures. When examining individuals with a persistent persistent cough, 20-26% are serologically diagnosed with pertussis infection. Mortality 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. Often develop atelectasis, acute pulmonary edema. Most often, patients are treated at home. Patients with a severe form of whooping cough and children under 2 years of age are hospitalized.
With the use of modern methods of treatment, mortality in whooping cough has decreased and occurs mainly among children 1 year old. Death can occur from asphyxia with complete closure of the glottis due to spasm of the muscles of the larynx during a coughing fit, as well as from respiratory arrest and convulsions.
Prevention consists in carrying out vaccination of children with pertussis - diphtheria-tetanus vaccine. The effectiveness of pertussis vaccine is 70-90%.
Vaccination is particularly good at protecting against severe forms of whooping cough. Studies have shown that the vaccine is 64% effective against mild whooping cough, 81% against paroxysmal and 95% against severe.
References
1. Veltishchev Yu.E. and Kobrinskaya B.A. Pediatric emergency care. Medicine, 2006 - 138s.
2. Pokrovsky V.I. Cherkassky B.L., Petrov V.L. Anti-epidemic
3. practice. - M.: - Perm, 2001 - 211s.
4. Sergeeva K.M., Moskvicheva O.K., Pediatrics: a guide for doctors and students K.M. - St. Petersburg: Peter, 2004 - 218s.
5. Tulchinskaya V.D., Sokolova N.G., Shekhovtseva N.M. Nursing in pediatrics. Rostov n / a: Phoenix, 2004 - 143s.
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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 bouts of spasmodic cough. The causative agent is a stick 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 after 10-15 minutes.
The source of the disease is a sick person. The infection is transmitted by airborne droplets during coughing, talking, sneezing. The patient ceases to be contagious after 6 weeks. Most often, children from 5-8 years old get sick.
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 bouts of coughing disrupt cerebral and pulmonary circulation, which leads to insufficient oxygen saturation of the blood, a shift in oxygen-base balance towards acidosis. The increased excitability of the respiratory center persists for a long time after recovery.
The incubation period lasts from 2-15 days, more often 5-9 days. During whooping cough, the following periods are distinguished, catarrhal (3-14 days), spasmodic, or convulsive (2-3 weeks), and a convalescent 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, well 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 various combinations; for the whooping cough pathogen, these are factors 2, 3, 4, 5, 6, for parapertussis - 8, 9, 10. The agglutination reaction with adsorbed factor sera makes it possible to differentiate bordetella species and determine their antigenic variants. The causative agents of whooping cough and parapertussis are very unstable in the external environment, so sowing should be done immediately after taking the material. Bacteria quickly die when dried, ultraviolet irradiation, under the influence of disinfectants. Sensitive to erythromycin, chloramphenicol, antibiotics of the tetracycline group, streptomycin.
The gateway of infection is the mucous membrane of the respiratory tract. Pertussis microbes attach to the cells of the ciliated epithelium, where they multiply on the surface of the mucous membrane without penetrating into the bloodstream. At the site of the introduction of the pathogen, an inflammatory process develops, the activity of the ciliary apparatus of epithelial cells is inhibited and the secretion of mucus increases. In the future, ulceration of the epithelium of the respiratory tract 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, developing focal atelectasis, emphysema. There is peribronchial infiltration. In the genesis of convulsive seizures, the sensitization of the body to the toxins of the whooping cough is important. Constant irritation of the respiratory tract receptors 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 non-specific stimuli. From the dominant focus, excitation can also 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 trunk, vomiting and other symptoms of whooping cough. Past whooping cough (as well as pertussis vaccinations) does not provide lifelong immunity, so recurrence of whooping cough is possible (about 5% of whooping cough cases occur in adults.
The source of infection is only a person (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. The infection is transmitted by airborne droplets. Upon contact with patients in susceptible people, the disease develops with a frequency of up to 90%. More often children of preschool age get sick. More than 50% of whooping cough cases in young children are associated with a lack of maternal immunity and possibly the absence of transplacental transmission of protective specific antibodies. In countries where the number of vaccinated children is reduced to 30% or less, the level and dynamics of the incidence of pertussis becomes the same as it was in the pre-vaccination period. Seasonality is not very pronounced, there is a slight increase in the 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.
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, subfebrile temperature. Gradually, the cough intensifies, the children become irritable, 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 fever (38-38.5) and a cough that does not decrease from antitussives. Gradually, the cough intensifies, becomes paroxysmal, especially at night. Bouts of convulsive coughing are manifested by a series of coughing shocks, followed by a deep whistling breath (reprise), followed by a series of short convulsive shocks. The number of such cycles during an attack ranges from 2 to 15. The attack ends with the release of viscous vitreous sputum, sometimes vomiting is noted 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, respiratory arrest may occur, followed by asphyxia. In young children, reprises are not expressed. Depending on the severity of the disease, the number of attacks can vary from 5 to 50 per day. The number of seizures increases over 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 the typical whooping cough attacks. Instead, after a few coughing shocks, they may experience short-term respiratory arrest, which can be life-threatening.
Mild and erased forms of the disease occur in previously vaccinated children and adults who fall ill again.
Starting from the third week, a paroxysmal period begins, during which a typical spasmodic cough is observed: a series of 5-15 quick cough shocks, accompanied by a short wheezing breath. After a few normal breaths, a new paroxysm may begin. During paroxysms, a copious amount of viscous mucous vitreous sputum is secreted (usually infants and young children swallow it, but sometimes its separation in the form of large blisters through the nostrils is noted). Characterized by vomiting that occurs at the end of an attack or with vomiting caused by the discharge of thick sputum. During a coughing fit, the patient's face turns red or even blue; the tongue protrudes to failure, trauma to its frenulum on the edge of the lower incisors is possible; sometimes there are hemorrhages under the mucous membrane of the conjunctiva of the eye.
The recovery stage starts from 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 (resolution period). In adults, the disease proceeds without bouts of convulsive coughing, manifested by prolonged bronchitis with a persistent cough. Body temperature remains normal, paroxysms become less frequent and severe, rarely 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 a few months; as a rule, it provokes SARS.
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 are used (diphenhydramine, suprastin, tavegil), vitamins, inhalation aerosols of proteolytic enzymes (chymopsin, chymotrypsin), which facilitate the discharge of viscous sputum, mukaltin.
Mostly children of the first half of the year with a pronounced severity of the disease 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 epidemic 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.
Severely ill infants are advised to 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 disorders and encephalic syndrome) require resuscitation, as they can be life-threatening.
Erased forms of whooping cough do not require treatment. It is enough to eliminate external stimuli to ensure peace and longer sleep for patients with whooping cough. In mild forms, prolonged exposure to fresh air and a small number of symptomatic measures at home can be limited. Walks should be daily and long. The room in which the patient is located should be systematically ventilated and its temperature should not exceed 20 degrees. During an attack of coughing, you should take the child in your arms, slightly lowering his head.
With the accumulation of mucus in the oral cavity, it is necessary to free the child's mouth with a finger wrapped in clean gauze ...
Diet. Serious attention should be paid to nutrition, since pre-existing or developed nutritional deficiencies can significantly increase the likelihood of an adverse outcome. Food is recommended to give fractional portions.
It is recommended to feed the patient little and often. Food should be complete and sufficiently high-calorie and fortified. With frequent vomiting, the child should be supplemented 20-30 minutes after vomiting.
The appointment 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. The best effect is provided by ampicillin, gentamicin, erythromycin. Antibacterial therapy is effective only in the early stages of uncomplicated whooping cough, in catarrhal and no later than 2-3 days of the convulsive period of the disease.
The appointment of antibiotics in the spasmodic period of whooping cough is indicated for the combination of whooping cough with acute respiratory viral diseases, bronchitis, bronchiolitis, in the presence of chronic pneumonia. One of the main tasks is the fight against respiratory failure.
The most responsible therapy for severe whooping cough in children of the first year of life. Oxygen therapy is necessary with the help of a systematic supply of oxygen, cleaning the airways from mucus and saliva. When breathing stops - suction of mucus from the respiratory tract, artificial ventilation of the lungs. With signs of brain disorders (tremor, short-term convulsions, increasing anxiety), seduxen is prescribed and, for the purpose of dehydration, 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 injected intravenously, to reduce pressure in the pulmonary circulation and to improve bronchial patency - eufillin, 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 outdoors).
Antitussives and sedatives. The efficacy of expectorant mixtures, cough suppressants, and mild sedatives is questionable; they should be used sparingly or not at all. Cough-provoking influences (mustard plasters, jars) should be avoided.
For the treatment of patients with severe forms of the disease - glucocorticosteroids and / or theophylline, salbutamol. With apnea attacks - chest massage, artificial respiration, oxygen.
Prevention in contact with the sick
In unvaccinated children, human normal immunoglobulin is used. The drug is administered twice with an interval of 24 hours as soon as possible after contact.
Chemoprophylaxis with erythromycin at an age dosage for 2 weeks can also be carried out.
Conclusion
Whooping cough is widespread throughout the world. Every year, about 60 million people fall ill, of which about 600,000 die. Whooping cough also occurs in countries where pertussis vaccinations have been widely practiced for many years. Probably, among adults, whooping cough is more common, but not detected, as it occurs without characteristic convulsive seizures. When examining individuals with a persistent persistent cough, 20-26% are serologically diagnosed with pertussis infection. Mortality 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. Often develop atelectasis, acute pulmonary edema. Most often, patients are treated at home. Patients with a severe form of whooping cough and children under 2 years of age are hospitalized.
With the use of modern methods of treatment, mortality in whooping cough has decreased and occurs mainly among children 1 year old. Death can occur from asphyxia with complete closure of the glottis due to spasm of the muscles of the larynx during a coughing fit, as well as from respiratory arrest and convulsions.
Prevention consists in carrying out vaccination of children with pertussis-diphtheria-tetanus vaccine. The effectiveness of pertussis vaccine is 70-90%.
Vaccination is particularly good at protecting against severe forms of whooping cough. Studies have shown that the vaccine is 64% effective against mild whooping cough, 81% against paroxysmal and 95% against severe.
Literature
1. Veltishchev Yu.E. and Kobrinskaya B.A. Pediatric emergency care. Medicine, 2006 - 138s.
2. Pokrovsky V.I. Cherkassky B.L., Petrov V.L. Anti-epidemic
practice. - M.: - Perm, 2001 - 211s.
3. Sergeeva K.M., Moskvicheva O.K., Pediatrics: a guide for doctors and students K.M. - St. Petersburg: Peter, 2004 - 218s.
4. Tulchinskaya V.D., Sokolova N.G., Shekhovtseva N.M. Nursing in pediatrics. Rostov n / a: Phoenix, 2004 -143s.
Laboratory research methods.
Nursing process in whooping cough.
Definition:
Whooping cough is an acute infectious disease caused by pertussis bacillus, characterized by a predominant lesion of the nervous system, respiratory tract and peculiar bouts of spasmodic cough.
General information:
The causative agent is the gram-negative bacillus Bordetella pertussis (Borde-Jangu bacillus). This is a fixed, small, short stick 0.502 microns long. It grows slowly on nutrient media (3-4 days), they usually add 20-60 IU of penicillin to inhibit other flora, which easily drowns out whooping cough; she is not sensitive to penicillin. The pertussis bacillus quickly dies in the external environment, it is very sensitive to the effects of elevated temperature, sunlight, drying, and disinfectants.
Source of infection- a sick person.
Carriage is observed rarely, for a short time.
Transmission route- airborne.
Susceptibility - almost absolute and, moreover, from birth.
Immunity- persistent, lifelong.
Age aspect- the greatest number of diseases falls on the age from 1 year to 5 years.
Reference features:
- bed onset of whitening with general malaise, subfebrile temperature, slight runny nose and obsessive cough (1-2 weeks)
- characteristic cough at the height of the disease with the presence of reprise and reddening of the face against the background of mild symptoms of intoxication;
- apnea attacks with the release of thick viscous sputum and the occurrence of vomiting;
- hemorrhages in the sclera of the eyes and the appearance of an ulcer on the frenulum of the tongue due to trauma to it on the incisors of the teeth;
- the occurrence of attacks of spasmodic cough with pressure on the root of the tongue and tragus of the ears;
- lack of effect from ongoing symptomatic therapy for 5-7 days.
- Complete blood count (leukocytosis, lymphocytosis against the background of normal or delayed ESR);
- Bacteriological research method;
- Serological examination (agglutination test, RSK, RPGA);
- Immunofluorescent method (as an express diagnostic).
Complications:
- nosebleeds;
- hemorrhages in the conjunctiva, retina;
- cerebral hemorrhage with subsequent development of central paralysis;
- emphysema, lung atelectasis, pneumothorax;
- cerebrovascular accident, cerebral edema;
- accession of a secondary infection with the development of pneumonia, bronchitis, otitis media, sinusitis.
Treatment is more often 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 regimen (traumatic procedures contribute to the appearance of coughing fits).
24-hour maternal or nursing supervision (due to the risk of respiratory arrest and aspiration of vomit).
Sufficient oxygenation (sleeping in the fresh air, long walks, good ventilation of rooms and wards)
Medical therapy:
- antibiotics (ampicillin, erythromycin, gentamicin, levomycetin) in the catarrhal period and the first two weeks of the spasmodic cough period;
- 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 SES;
- isolation of the patient is terminated after 25 days from the onset of the disease;
- identification of contacts;
- imposition of quarantine on contacts (children under 7 years of age) for 14 days;
- bacteriological examination of contacts.
Disinfection is not carried out.
Specific prevention:
Vaccination is carried out with the DTP vaccine three times with an interval of 45 days, starting from the age of 3 months, intramuscularly. Revaccination at 18 months once.
Graph-logical structure.
Whooping cough.
Etiology Pertussis stick (Borde-Jangu stick)
Source whooping cough
Transmission routes airborne
Development mechanism causative agent→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
sick periods:
| Period of illness | incubation | catarrhal | spasmodic | permission | |
| duration | 14 days | 14 days | 4-6 weeks | 2-3 weeks | |
| signs | No | runny nose, dry cough (more often at night) | aura, spasmodic coughing fits, reprises | Lessening of attacks, cough loses its paroxysmal character | |
| temperature | No | normal or subfebrile | normal | ||
| sputum | No | Small mucous discharge | Viscous transparent | ||
| Appearance of the patient | ordinary | Manifestations of rhinopharyngitis | vomiting after a bout of coughing, flushing of the face, injection of the sclera, lacrimation, sore on the frenulum of the tongue, voluntary urination and defecation, puffiness of the face | A rare cough, it is possible to return a paroxysmal cough with the addition of SARS | |
Complications:
- accession of a secondary infection,
- lesion of C.N.S. (encephalopathy),
- hemorrhage,
- emphysema,
- hernia,
- cardiovascular disorders
Diagnostics:
- bacteriological examination (smear from the pharynx on Borde-Zhangu),
- serological method (RSK),
- immunofluorescent method
Principle of treatment:
- 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 - DTP vaccine from 3 months, three times with an interval of 1 month;
revaccination at 18 months
Activities in the outbreak:
- registration in SES; isolation of the patient for 25 days from the beginning
- imposition of quarantine on contacts for 14 days from the moment of isolation of the patient
- bacteriological examination of contacts (smear from the pharynx on Borde-Zhangu).
test questions
1. Define the disease
2. Name the cause of the disease
3. Name the main clinical manifestations of this infection
4. Describe the principles of treatment and nursing process in patient care.
5. Name the stages of anti-epidemic measures.
6. Name the methods of prevention.
Lecture No. 13
Topic: "Nursing care for tonsillitis, scarlet fever, whooping cough"
Angina (acute tonsillitis) -
This is an acute infectious disease with a predominant lesion of the palatine tonsils.
Etiology : staphylococcus, B-hemolytic streptococcus of group A, but there may be other pathogens (viruses, fungi).
Transmission routes:
1. Airborne
2. Alimentary.
3. Contact household.
Source of infection :
1. Exogenous (i.e. from patients and bacteria carriers).
2. Endogenous (autoinfection - that is, infection occurs from the oral cavity of the patient himself in the presence of chronic inflammation of the palatine tonsils or carious teeth).
Predisposing factors : local or general hypothermia.
Clinic:
1. Syndrome of general intoxication : (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 angina.
Distinguish:
1. Catarrhal
2. Follicular
2. Lacunar
Angina catarrhal. The syndrome of intoxication 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 angina can be the initial stage for another form of angina, and sometimes a manifestation of a particular infectious disease.
Angina follicular and lacunar. They are characterized by more pronounced intoxication (headache, sore throat, temperature up to 39 °, chills).
Inspection of the pharynx with follicular angina: festering follicles are visible in the form of white or yellowish peas, translucent through the mucous membrane. Sometimes there are yellow or grayish, dense plugs in the lacunae, which have an unpleasant putrefactive odor.
Examination of the pharynx with lacunar angina: liquid yellowish-white purulent deposits are formed in the lacunae, which can merge, covering the entire surface of the tonsils. These raids are easily removed with a spatula. In both cases, the tonsils are hyperemic, edematous.
Complications of angina:
1. Local
Quinsy,
paratonsillar abscess,
Swelling of the larynx (laryngitis),
cervical lymphadenitis,
Otitis, etc.
2. Infectious-allergic:
Rheumatism, glomerulonephritis
Treatment
- bed rest until temperature returns to normal
Plentiful warm drink
Antibiotics (cefuroxime, azithromycin, josamycin) - 5 days
Antihistamines
Rinsing the throat with saline, decoctions of herbs (chamomile, calendula, eucalyptus)
Irrigation of the pharynx with preparations of ingalipt, bioparox, joks, hexoral and others.
Site supervision:
If the child is not hospitalized, then on the first day, before prescribing antibiotics at home, a swab is taken from the throat and nose for diphtheria (on BL). In the first three days, the patient is actively monitored at home by a doctor and nurse. Home mode 10 days.
After recovery:
The patient is administered intramuscularly bicillin-3 once for the prevention of rheumatism and nephritis,
General blood and urine tests are done. A month later, 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, tonsillitis, punctate rash, 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 angina.
Transmission way:
Airborne and contact-household, very rarely food.
Incubation period 2-7 days.
By the end of the 1st day, 3 main signs of the disease are formed:
1. Syndrome intoxication
2. inflammation at the entrance gate (angina)
3. small rash on the skin.
Intoxication manifested by an increase in temperature to high numbers of 38.5-39, a violation of well-being, headache, often vomiting.
Angina- complaints of sore throat. When examining the pharynx, there is a bright hyperemia and swelling of the tonsils, arches, and soft palate. Angina can be catarrhal, lacunar, follicular and even necrotic.
Regional l/nodes increase.
A characteristic appearance in scarlet fever is the tongue - in the first 2-3 days it is lined in the center with a white coating, dryish. The tip of the tongue is crimson, from 2-3 days the tongue begins to clear, becomes crimson, with pronounced papillae. " Crimson" language - Lasts 1-2 weeks.
By the end of the first, the beginning of the second day, at the same time, all over the body appears small, thick rash on hyperemic background of the skin. The skin feels hot, dry, rough (shagreen skin). A favorite place for localization of the rash is in the inguinal folds, elbows, lower abdomen, in the armpits, in the popliteal fossae. The nasolabial triangle always remains free from the rash.
All symptoms reach a maximum by day 3, and then gradually fade away.
When the rash subsides, most patients develop large-lamellar peeling of the skin especially pronounced on the fingers and toes.
- infectious- otitis media, sinusitis, laryngitis, bronchitis, pneumonia, paratonsillar abscess.
- allergic- glomerulonephritis, rheumatism, infectious - allergic myocarditis.
Treatment:
At home, hospitalization is subject to children from closed institutions, severe
and complicated forms, children under 3 years old.
-mode bed for the entire acute period.
-BUT/ b penicilline row(amoxicillin, augmentin, flemoxin solutab), macrolides(erythromycin, azithromycin), or cephalosporins 1 generation (cephalexin, cefazolin and others).
Antihistamines (tavegil, fenkarol) - according to indications
Symptomatic (antipyretic, gargling).
-specific No;
- nonspecific - consists in isolating patients for 10 days, if recovery has not occurred by day 10, then the period increases.
Those who have recovered are discharged to kindergartens and schools after 21 days (to avoid complications such as myocarditis, glomerulonephritis). Children who have been in contact with a patient with scarlet fever at home and in kindergartens are observed for 7 days (temperature, skin, pharynx).
Anti-epidemic measures riiya in remote control(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:
whooping cough is a gram-negative bacillus Bordetellapertussis). 4 serotypes are known, which in the process of growth and development form exo- and endotoxins. The CNS (respiratory and vasomotor centers) is most sensitive to toxins. In the external environment, the rod is unstable and quickly dies because. sensitive to heat, sunlight, drying, exposure to disinfectants.
Source of infection - Patients with typical and atypical forms of whooping cough.
Transmission route - airborne, infection occurs with close and sufficiently long contact (the radius of dispersion of the pathogen is 2-2.5 meters). Whooping cough affects children of all ages, including newborns.
The 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
subfebrile. The cough is dry, obsessive, gradually increasing, there may be a runny nose.
3. Period of spasmodic cough from 2-3 weeks to 2 months.
A coughing fit is a coughing shock following one after another on exhalation, interrupted by a whistling, convulsive breath - reprise. The attack ends with the discharge of thick, viscous vitreous sputum or vomiting. With a typical attack of coughing, the appearance of the patient is characteristic: the face turns red, then turns blue, becomes purple-red, the veins of the neck, face, head swell, lacrimation is noted. The tongue protrudes from the mouth to the limit. As a result of friction of the frenulum of the tongue against the teeth, an anguish or sore formation occurs. Outside the attack, puffiness of the face, swelling of the eyelids, and pallor of the skin persist. Hemorrhages in the sclera and petechial rash on the face and neck are possible.
4. Permission period from 2 to 3 weeks -
cough loses its typical character, occurs less and less often, but attacks can be provoked by emotional stress or physical exertion. Within 2-6 months, the increased excitability of the child remains, trace reactions are possible (return of a paroxysmal, convulsive cough with the addition of SARS).
Features of modern whooping cough- the predominance of mild and atypical forms due to mass pertussis immunization.
Features of whooping cough in young children:
Shortened periods 1 and 2, 3 - extended to 50-60 days;
Coughing fits can be without reprises, but are often accompanied by respiratory arrest, there may be convulsions;
Complications occur more often: (diarrheal syndrome, encephalopathy, emphysema, pertussis pneumonia, atelectasis, cerebrovascular accident, bleeding and hemorrhages in the brain, retina, umbilical or inguinal hernia, rectal prolapse, and others).
Laboratory diagnostics:
1) the "cough plate" method
2) a smear from the posterior pharyngeal wall - a tank of sowing on Borde-Gangu medium (potato-glycerol agar with the addition of blood and penicillin) or AMC (casein-coal agar).
3) RPHA - for the diagnosis of 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:
Hospitalizations are subject children with severe forms, with complications, with a non-smooth course, an unfavorable premorbid background, with an exacerbation of chronic diseases and young children. According to epidemic indications - children from closed institutions.
Mode- sparing, with obligatory individual walks.
Diet- in severe forms, feed more often and in small portions,
supplement after vomiting.
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, broncholithin, libexin, tusuprex, sinekod);
Antihistamines (claritin, suprastin);
Vitamins with trace elements;
In severe forms - prednisolone;
Oxygen therapy, with apnea - mechanical ventilation;
Eufillin (with bronchoabstruction 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.
-non-specific
Isolation of 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 hearth when treating a patient with whooping cough at home. Contact children of the first year of life and unvaccinated children up to 2 years of age should be given antitoxic antipertussis immunoglobulin.
Scarlet fever
Pathogen -
hemolytic
streptococcus
group A
Resistant during
external environment
Highlights
exotoxin,
defiant
allergic
mood
organism
Scarlet fever is an acute infectious
a disease characterized
symptoms of intoxication, tonsillitis and
skin rashes
Scarlet fever
Epidemiology:Source of infection - patient or carrier
The transmission mechanism is airborne and
contact-household (toys, through "third parties"),
food
Entry gate - tonsils (97%), damaged skin
(1.5%) - extrabuccal form (more often with burns)
Most often sick children 2-7 years old
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 maw" with 1
day of illness
"Crimson Tongue"
Rash on the skin
Clinical signs of scarlet fever
Angina (follicular,lacunar)
Purulent plaque in lacunae
tonsils
"Flaming pharynx" - 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
Cleaned from edges and tip
and for 2-3 days it becomes
"crimson"
"Raspberry tongue" - bright
pink s
hypertrophied
papillae
Clinical signs of scarlet fever
Small rash onhyperemic background
skin (from the end of the 1st day of illness)
More saturated
on the side
surfaces
torso, below
belly, on
flexion
surface, in
places
natural
folds
Characterized by white dermographism in the first week of the disease
Features of the rash with scarlet feverCharacterized by white dermographism in
first week of illness
Features of the rash with scarlet fever
Missing onface in the area
nasolabial
triangle
(pale
nasolabial
triangle
Filatov)
Features of the rash with scarlet fever
The rash disappearsafter 3-7 days
Appears
pityriasis
peeling on
torso
lamellar
peeling
palms and soles
Pitted rash on the palms and lamellar peeling of the skin of the palms - a specific symptom of scarlet fever
Real problems with scarlet fever: 1. Hyperthermia, headache, vomiting - due to intoxication; 2. Sore throat - due to angina; 3. Skin defect - me
The real problemsscarlet fever:
1. Hyperthermia, headache,
vomiting - due to intoxication;
2. Sore throat - due to angina;
3. Skin defect -
punctate rash;
4. Discomfort due to dryness,
peeling of the skin.
Potential Issues
with scarlet fever:
Risk of complications
Complications of scarlet fever
Early (at 1 week) forbacterial count
factor a
Otitis
Sinusitis
Purulent lymphadenitis
Late (at 2-3 weeks) for
allergic account
factor a
Myocarditis
Nephritis
Rheumatism
Care and treatment of scarlet fever
Bed rest until normalizationtemperature, then up to 10 days
semi-bed
Diet (follow for 3 weeks):
mechanically, thermally gentle, rich
potassium, with salt restriction, with exception
obligate allergens
Wet cleaning, airing 2 times a day
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, supraks, cephalexin)
Antihistamines (suprastin, etc.)
Antipyretics (paracetomol)
Irrigate the throat with dioxidine, hexoral
Control of diuresis, pulse, blood pressure
Give information to parents and referrals
on KLA, OAM (10 and 20 days of illness), ECG
Bacteriological examination - take a smear
from tonsils to streptococcus
Work in the hearth of scarlet fever
Activities with the patient1. Hospitalization is not required
2. Submit to IES (notify the Central State Sanitary and Epidemiological Service about
disease)
3. Isolate the patient for 10 days
(children up to 8 years old + 12 days
"home quarantine"
4. Current disinfection is carried out
systematically (dishes, toys,
personal hygiene items),
organize mask, chlorine
patient care routine,
quartz
5. Final disinfection in
foci is not carried out
(Sanitary and epidemiological
rules SP 3.1.2.1203-03
"Prevention
streptococcal infection)
With contact
1. Reveal all contacts
2. Quarantine for 7 days
(only in DDU) from the moment
isolation of the last patient
3. Set surveillance
(thermometry, throat examination,
skin). Children with ARI
inspected up to 15 days from
the onset of the disease for the presence
skin lamellar
peeling of the palms
4. Contacts in the family who were not ill
scarlet fever are not allowed in
Kindergarten and 1-2 grade school for 7
days (when hospitalized
patient) or 17 days (if
patient is treated at home Whooping cough
Pathogen -
wand bordezhangu
Unstable during
external environment
Highlights
exotoxin,
defiant
irritation
receptors
respiratory
ways
Whooping cough is an acute infectious
cyclic disease,
characterized by a long
persistent paroxysmal cough.
Whooping cough
Epidemiology:Whooping cough
The source of infection is the patient up to 25-30 days from the onset
disease
The transmission mechanism is airborne. Contact
should be tight and long
Entrance gate - upper respiratory tract
Children from 1 month to 6 years of age get sick more often, get sick and
newborns
Typical autumn-winter seasonality (peak December)
Contagiousness index - up to 70%
Immunity is stable, lifelong
Lethality - 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
subfebrile
Behavior,
health, appetite
not violated
Cough is unrelenting
therapy and enhanced
Clinical signs of whooping cough
Convulsive period - 2-8weeks or more:
The cough becomes
paroxysmal
Reprises are noted -
wheezing convulsive
breaths
The attack ends
viscous discharge
sputum, mucus or
vomiting
In children under one year old - often
apnea
View of a patient with whooping cough during a coughing fit
Clinical signs of whooping cough
Characteristic externalview during attack
- face turns red
then turns blue, veins
swell out of the eyes
tears flow
tongue sticking out of mouth
to the limit
sore
on the bridle
language
The real problems with whooping cough:
Respiratory failure -paroxysmal cough due to
irritation of the cough center
Vomiting - due to severe coughing
Ineffective discharge
sputum
Stopping breathing due to apnea
Potential Issues
for whooping cough:
Risk of complications
Whooping cough complications
Group 1 - associated withthe action of a toxin or
the whooping cough
Emphysema
Atelectasis
Encephalopathy
The appearance of the umbilical
inguinal hernia
Hemorrhages in
conjunctiva, brain
rectal prolapse
2 group - accession
secondary infection
Bronchitis
Pneumonia
Treatment and care for whooping cough
General mode, outdoor walks, headboardsublime
Nutrition by age, exclude foods (seeds,
nuts), because may be aspirated when coughing
Supplement after vomiting
Organize leisure and protective regime, not
leaving the child alone (possibly apnea)
During an attack, sit down or pick up, after
remove mucus from the mouth with a tissue
Wearing a mask when in contact with a sick person
Wet cleaning, airing 2 times a day,
humidify the air, temperature up to +22
Antibiotics (rulid, ampioks, etc.), expectorants
drugs and antitussives (libexin, tusuprex)
Give humidified oxygen
Work in the focus of whooping cough
Activities with the patient1. Hospitalizations are subject
children with severe forms,
children under 2 years of age, not vaccinated
from whooping cough, from closed
foci
2. Submit IES (report to
TsGSEN about the disease)
3. Isolate the patient for 30
days from onset of illness
4. Organize a mask
routine, regular
ventilation, damp
cleaning, quartzing
5. Final disinfection
not carried out
With contact
1. Identify all coughing
contact up to 14 years old,
remove from visit
children's team to
getting 2 negative
results
whooping cough test tank
2. Set watch to 14
days (only in kindergartens, boarding schools, orphanages)
3. Find out vaccination
history: unvaccinated up to 1
years and older, weakened
children - appropriate
administer pertussis
immunoglobulin
Specific prophylaxis for whooping cough
Vaccination is 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!!!
