Nursing care for patients with whooping cough. Whooping cough is an acute infectious disease

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

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

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

Characteristically, the cough reflex is so fixed in the brain that even after the death of all bacteria, strong urges to cough continue to persist for several more weeks. Waste products of pertussis bacteria cause general intoxication of the body.

Warning: Humans have no innate immunity to this disease. Even a baby can get sick. Therefore, it is so important to protect him from contact with adults who have a strong persistent cough. It may well be a sign of whooping cough, which in an adult, as a rule, does not have other characteristic manifestations.

The susceptibility of a person is so great that if a baby gets sick, then the rest of the family will definitely get infected from it. Whooping cough lasts 3 months as long as the cough reflex exists. In this case, for about 2 weeks, the disease has practically no symptoms. If somehow it is possible to establish in the very first days that pertussis bacteria are present in the body, then the disease can be quickly suppressed, since the dangerous cough reflex has not yet had time to gain a foothold. Usually, the symptoms of whooping cough in children are detected already at a severe stage. Then the disease continues until the cough gradually disappears on its own.

Video: How to prevent coughing fits

How infection occurs

Most often, whooping cough infects children under the age of 6-7 years. Moreover, in babies younger than 2 years, the probability of infection is 2 times higher than in older children.

The incubation period for whooping cough is 1-2 weeks. Within 30 days, the child should not attend a childcare facility, contact with other children, since whooping cough is very contagious. Infection is possible only by airborne droplets in close contact with a sick person or a carrier when he sneezes or coughs.

Outbreaks of the disease occur more often in the autumn-winter period. This is due to the fact that whooping cough bacteria quickly die under the rays of the sun, and the duration of daylight hours in winter and autumn is minimal.

Whooping cough forms

When infected with whooping cough, the course of the disease is possible in one of the following forms:

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

This form is dangerous because other people can be infected, while the parents are sure that the baby is healthy. Most often, this form of whooping cough occurs in older children (after 7 years), if they have been vaccinated. The baby remains a carrier also after recovery from a typical whooping cough up to 30 days from the moment the infection enters his body. Often in such a latent form, whooping cough manifests itself in adults (for example, workers in child care facilities).

The first signs of whooping cough

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

Video: Whooping cough infection, symptoms, the importance of vaccination

Periods of illness and characteristic symptoms of whooping cough

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

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

Note: In infants, the excruciating attacks do not last so long, but after a few coughing movements, respiratory arrest may occur. Oxygen starvation of the brain causes diseases of the nervous system, developmental delays. Even death is possible.

Video: How to recognize whooping cough

Possible Complications

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

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

After whooping cough, due to cerebral hypoxia, tissue damage to individual centers sometimes occurs, as a result of which the child's hearing is impaired or epileptic seizures occur. Seizures are very dangerous, which also occur due to disruption of the brain and can lead to death.

Due to tension when coughing, damage to the eardrums, hemorrhage in the brain occurs.

Diagnosis of whooping cough in children

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

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

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

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

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

There is a method of express diagnostics. The smear is processed with a special composition and studied under a microscope, which uses the effect of the glow of antibodies when illuminated.

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

Signs of pneumonia

Inflammation of the lungs is one of the most common complications. Since parents know that whooping cough does not go away quickly, they do not always go to the doctor if the baby's condition changes. However, in some cases, delay is dangerous, so it is imperative to show the child to a specialist. Warning signs that require urgent treatment include:

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

Increased cough after the condition of the child has already begun to improve. Sudden increase in the duration and frequency of seizures.

Rapid breathing between attacks. General weakness.

Treatment of whooping cough in children

Whooping cough is mostly treated at home, unless it occurs in babies under the age of 1 year. Their complications develop rapidly, the baby can simply not have time to save. A child of any age is hospitalized if complications arise or respiratory arrest occurs during attacks.

First aid at home for whooping cough

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

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

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

How to alleviate the condition and speed up recovery

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

The patient should not be nervous.

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

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

In some cases, after consulting with your doctor first, you can use folk tips to alleviate the condition when you cough. For example, traditional healers recommend for children over 13 years of age to prepare a compress from a mixture of equal amounts of camphor and eucalyptus oils, as well as vinegar. He is advised to lay on the chest of the patient for the whole night. This helps make breathing easier.

Antibiotic treatment

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

At the stage of the appearance of harbingers of the disease, the baby is given only antipyretic medicine if there is a slight rise in temperature. It is impossible to give him expectorants when a dry paroxysmal cough appears on his own, since the movement of sputum will cause increased irritation of the respiratory tract.

Antibiotics (namely erythromycin, which has no harmful effect on the liver, intestines and kidneys) are used to treat children for whooping cough at a very early stage, while severe coughing fits have not yet appeared.

They are taken more often for preventive purposes. If someone in the family has whooping cough, then taking an antibiotic will protect children from the action of the bacterium. It kills the microbe before a cough develops. The antibiotic will also help not to get sick to adult family members caring for a sick baby.

Treatment in the hospital

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

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

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

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

In the treatment of children for whooping cough, antiallergic drugs are also used, and in severe cases, tranquilizers (seduxen, relanium).

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

In order to prevent complications, oxygen therapy is used, and sometimes artificial ventilation of the lungs.

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

Prevention

Since whooping cough is highly contagious, when cases of the disease are detected in a children's institution, all children and adults who have been in contact with the patient are examined and prophylactically treated. Erythromycin, which kills pertussis bacteria, is used, as well as injections of gamma globulin, which stimulates the production of antibodies.

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

Vaccination is the main preventive measure. It reduces the risk of infection. In the case of whooping cough, the course is much easier.

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.

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.

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.

whooping cough vaccine

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

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

Post-vaccination immunity does not protect against 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 hyposensitizingfacilities(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.

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 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 purpose 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.

Hosted on Allbest.ru

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 changes
tongue - 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 on
hyperemic 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 fever
Characterized by white dermographism in
first week of illness

Features of the rash with scarlet fever

Missing on
face in the area
nasolabial
triangle
(pale
nasolabial
triangle
Filatov)

Features of the rash with scarlet fever

The rash disappears
after 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 problems
scarlet 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) for
bacterial 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 normalization
temperature, 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: rinse
soda 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 patient
1. 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 - 1-2
weeks:
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 - 2-8
weeks 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 external
view 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 with
the 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, headboard
sublime
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 patient
1. 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 out
three 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!!!