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This essay is written by a second year nursing student, who will be

discussing whooping cough. The author will begin by briefly summarising the

case study applicable to this assignment. The author will also define whooping

cough and state the manifestations, consequences, diagnosed and how whooping

cough is treated. This is followed by discussing immunisation for whooping

cough.

The Author will provide a description of the patients needs and will

provide a discussion and rational of the nursing management of the most vital

patient probems. This if followed by a summary and evaluation of the patient care

and a conclusion of the interventions and what the nursing student has learnt from

the assignment.

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 A five month old female has been administered into the emergency

department due to cyanosis and apnoea. Whooping cough (pertussis) has been

diagnosed via a post nasal aspiration. The child is able to tolerate nasal oxygen,

however is still suffering from paroxysms of coughing (severe attack of

coughing) and appears to be too tired to tolerate breast feeding. Therefore the

child is fed via a nasogastric tube. The child¶s parents choose not to have the

pertussis immunisation as they fear brain damage. The child is currently not

taking any medication however is on herbal immunisations which was prescribed

by a naturopath.

Pertussis is a very contagious and serious respiratory infection caused by

the bacterium bordetella pertussis (Department of health, 2010). Symptoms

include; severe coughing attack with a ³whooping´ sound on inhalation, vomiting

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at end of coughing bout, and apnoea (Department of health, 2010). Symptoms are

often accompanied by poor appetite, fatigue and dehydration (Department of

health, 2010). If whooping cough in young babies remains untreated the

following may occur; haemorrhage, apnoea, pneumonia, inflammation of the

brain, convulsions, coma, permanent brain damage and death (Department of

health, 2010). Pertussis is spread via air-borne droplets from the upper

respiratory tract and if released by an infected person coughing or sneezing

(Department of health, 2010). Diagnosis and treatment with the antibiotic

Erythromycin should commence immediately, especially if there is a

history/family history of the disease (Department of health, 2010).

Before immunisation, a doctor must be notified if the child has had a

serious reaction to any vaccination or whether they are unwell on the day of

immunisation, including a temperature of over 38.5 degrees Celsius (Department

of health, 2010). Possible side-effects of the pertussis vaccination include; a mild

temperature, irritability or crying, drowsiness or tiredness, soreness and swelling

in area where injection has been given (Department of health, 2010). Severe

reactions are rare and allergic reaction to any vaccine may occur, but the risks are

minor (Department of health, 2010). Therefore the patient is advised to remain

within the health care system 15 minutes post immunisation (Department of

health, 2010). Side-effects can be reduced by increasing fluid intake, applying a

wet cloth over injection site, paracetamol in cases of fever and avoid overdressing

the child (Department of health, 2010).

The child¶s health history is obtained from the parents or child¶s medical

file. Health history will tell if the child or the child¶s family has any history of

significant health issues which may be inheritable or cause a respiratory problem.

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The nurse must then perform a respiratory health assessment. On observation the

nurse notes any nasal flaring, tracheal tug, quality of respiration and rate,

intercostal recession or sternal recession. The nurse would then palpate for tender

areas, unusual lumps, symmetrical chest wall expansion, deviated nasal septum,

nasal cavity and the ability to smell. Auscultation of all lung fields are preformed

and wheezing, stridor, grunting or abnormal adventitious breathing sounds are

noted. These observations determine whether there are any other infections or

abnormalities within the lungs. Vital signs on the child are assessed four times

daily (QID), this will assist in determining whether the patient¶s health is

improving or declining. Vital signs assessment consists of blood pressure,

temperature, respiratory rate, pulse rate, and oxygen levels and arterial blood

gases (ABG¶s). Urine analysis and stool samples would also be beneficial as they

will indicate how dehydrated the child is and may give further clues of the child¶s

health.

The most important problems in this case study are; whooping cough,

cyanosis and apnoea, parental education about pertussis vaccination, risk of

aspirating, dehydration and malnutrition. The first priority for this child would be

to treat whooping cough by commencing intravenous antibiotics (erythromycin)

and immunisation for both parents and child. However as mentioned in the case

study the child¶s parents don¶t wish to immunise their child due to the fears of

brain damage, so the parents must first be educated on whooping cough,

importance of the pertussis immunisation and the consequences of not adequately

treating whooping cough. The child must be isolated in a single room, droplet

precautions, standard precautions and additional precautions are essential to

prevent infection of other patients (Department of health, 2010). To treat

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hydration and malnutrition the child is placed on a fluid balance chart and output

and input are monitored to ensure hydration. The child can be rehydrated by

intravenous fluids and maintaining nutrition is done by nasogastric feeds.

Cyanosis and apnea can be treated by administering oxygen by either a plastic

hood or a oxygen tent as the child has a nasogastric tube insitu so nasal prongs

would not fit correctly. Apnoea can also be treated by suctioning of excess

secretions and mucus. The child can be placed on their side to decrease aspiration

and vomiting.

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