NURSING MANAGEMENT

I. NURSING DIAGNOSIS

1. Ineffective Airway Clearance

• Related Factors:
• Excessive mucus production.
• Paroxysmal coughing spells.
• Inflammation and swelling of the airways.
• Fatigue and weakness from prolonged coughing. 

      Nursing Interventions:

• Monitor respiratory status regularly.
• Encourage fluid intake to thin secretions.
• Provide humidified oxygen or steam inhalation.
• Teach and assist with effective coughing techniques.

2. Impaired Gas Exchange

• Related Factors:
• Airway obstruction from mucus.
• Atelectasis due to ineffective coughing.
• Severe coughing leading to temporary cessation of breathing (apnea).

Nursing Interventions:

• Administer oxygen therapy as prescribed.
• Position patient to optimize lung expansion (e.g., semi-Fowler’s position).
• Monitor arterial blood gases (ABGs) and oxygen saturation levels.
• Encourage deep breathing exercises and use of incentive spirometry.
• Observe for signs of respiratory distress.

3. Ineffective Breathing Pattern

• Related Factors:
• Frequent, severe coughing fits.
• Anxiety or distress related to difficulty breathing.
• Inflammation of the airways.

Nursing Interventions:

• Assess respiratory rate, rhythm, and depth regularly.
• Encourage slow, deep breathing and relaxation techniques.
• Provide a calm environment to reduce anxiety.
• Administer bronchodilators or medications as prescribed.

4. Risk for Aspiration

• Related Factors:
• Excessive mucus production.
• Impaired gag reflex due to fatigue from coughing.
• Risk of vomiting after severe coughing fits.

Nursing Interventions:

• Position patient upright during and after meals.
• Provide small, frequent feedings to prevent over-distention.
• Monitor for signs of aspiration, such as sudden coughing during feeding.
• Teach and assist with safe swallowing techniques.
• Keep suction equipment available for immediate use.

5. Acute Pain (related to coughing and muscle strain)

• Related Factors:
• Intense and frequent coughing spells.
• Muscle strain or soreness from prolonged coughing.

Nursing Interventions:

• Assess pain level and characteristics regularly.
• Administer analgesics as prescribed to manage pain.
• Encourage and assist with splinting techniques during coughing.
• Provide comfort measures, such as warm compresses to sore muscles.
• Educate on proper body mechanics to reduce muscle strain.

 

6. Risk for Infection

• Related Factors:
• Impaired immune response.
• Prolonged illness and hospital stay.
• Inadequate hand hygiene and isolation precautions.

Nursing Interventions:

• Implement standard precautions and use personal protective equipment (PPE).
• Educate patient and family on the importance of hand hygiene.
• Ensure proper cleaning and disinfection of surfaces and equipment.
• Administer prophylactic antibiotics to close contacts if indicated.
• Monitor for signs of secondary infections, such as fever or increased mucus production.

II. NURSING CARE

Nursing care for pertussis involves a multifaceted approach to manage symptoms, support recovery, and prevent complications. This care is tailored to the patient’s age, severity of the disease, and specific symptoms. Below are key aspects of nursing care for patients with pertussis:

1. Respiratory Support and Airway Management

Assessment

• Monitor Respiratory Status: Regularly assess respiratory rate, depth, and effort. Look for signs of distress, such as retractions, nasal flaring, or use of accessory muscles.
• Auscultation: Listen to lung sounds to detect wheezing, crackles, or decreased breath sounds, indicating airway obstruction or atelectasis.

Interventions

• Airway Clearance: Encourage deep breathing and coughing to mobilize secretions. Use chest physiotherapy or postural drainage as necessary.
• Humidification: Provide humidified air or use a cool-mist humidifier to keep airways moist and help loosen mucus.
• Suctioning: Perform suctioning for infants or patients who are unable to clear secretions effectively.
• Positioning: Elevate the head of the bed or position the patient in a semi-Fowler’s position to facilitate breathing and lung expansion.

2. Nutrition and Hydration

Assessment

• Nutritional Status: Monitor weight and assess dietary intake to ensure adequate nutrition.
• Hydration: Check for signs of dehydration, such as dry mucous membranes or decreased urine output.

Interventions

• Small, Frequent Meals: Provide small, nutrient-dense meals to prevent vomiting and ensure adequate caloric intake.
• Oral Hydration: Encourage frequent sips of water or electrolyte solutions to maintain hydration.
• IV Fluids: Administer intravenous fluids if the patient is unable to maintain oral intake due to vomiting or severe coughing.

3. Pain and Comfort Management

Assessment

• Pain Levels: Regularly assess pain, particularly in the chest and abdomen, due to coughing.

Interventions

• Pain Relief: Administer analgesics as prescribed to relieve pain from coughing. Use non-pharmacological methods such as warm compresses to soothe sore muscles.
• Comfort Measures: Ensure a quiet and restful environment. Use pillows or other supports to help the patient find a comfortable position for rest and sleep.

4. Education and Support

Assessment

• Knowledge Deficit: Assess the patient’s and family’s understanding of the disease, its transmission, and care requirements.

Interventions

• Disease Education: Provide information on the nature of pertussis, its symptoms, and the importance of completing antibiotic therapy.
• Symptom Management: Teach techniques to manage symptoms, such as proper hand hygiene, safe coughing practices, and how to recognize signs of complications.
• Support Systems: Encourage the involvement of family and support networks. Provide emotional support to reduce anxiety and fear related to the illness.

5. Monitoring and Managing Complications

Assessment

• Identify Early Signs: Monitor for early signs of complications such as pneumonia, dehydration, or respiratory failure.

Interventions

• Prompt Treatment: Initiate timely interventions for complications. Administer antibiotics as prescribed and ensure follow-up care.
• Hospitalization: Arrange for hospitalization if the patient shows signs of severe respiratory distress, dehydration, or other serious complications.

6. Family Education and Discharge Planning

Assessment

• Readiness for Discharge: Assess the patient’s and family’s readiness to manage care at home, including understanding of medication regimens and follow-up requirements.

Interventions

• Discharge Instructions: Provide detailed discharge instructions, including signs to watch for that would require medical attention.
• Follow-Up Care: Arrange for follow-up appointments and community resources to support ongoing care and recovery.

 

III. HEALTH TEACHINGS

        Health teachings for pertussis are critical for preventing the spread of the infection, managing symptoms, and ensuring proper recovery. Educating patients and caregivers about the disease, its management, and preventive measures is essential. Here’s a comprehensive guide to health

1. Symptom Management

Cough Management

• Coughing Spells: Inform that coughing fits can be severe and may lead to vomiting or breathlessness.
• Positioning: Encourage sitting upright during coughing episodes to ease breathing.

Hydration and Nutrition

• Hydration: Emphasize the importance of drinking plenty of fluids to prevent dehydration and help thin mucus.
• Nutrition: Recommend small, frequent meals to avoid triggering cough-induced vomiting and ensure adequate nutrition.

3. Medication Adherence

Antibiotics

• Importance of Completing the Course: Stress that completing the entire course of prescribed antibiotics is crucial, even if symptoms improve, to ensure the bacteria are fully eradicated and to reduce transmission risk.
• Potential Side Effects: Discuss common side effects such as gastrointestinal upset and the importance of reporting any severe reactions to the healthcare provider.

• Pain Management: Over-the-counter pain relievers like acetaminophen or ibuprofen can help alleviate discomfort from coughing.

4. Preventing Transmission

Hygiene Practices

• Hand Hygiene: Teach proper hand-washing techniques using soap and water for at least 20 seconds, especially after coughing or sneezing.
• Respiratory Etiquette: Encourage covering the mouth and nose with a tissue or elbow when coughing or sneezing and disposing of tissues immediately.

5. Importance of Vaccination

Vaccination Schedule

• Infants and Children: Explain the importance of the DTaP vaccine, which is given in multiple doses starting at 2 months of age.
• Adolescents and Adults: Highlight the need for booster shots (Tdap) during adolescence, adulthood, and pregnancy to maintain immunity.
• Herd Immunity: Emphasize that widespread vaccination helps protect those who cannot be vaccinated, such as infants and individuals with certain medical conditions.

6. Recognizing and Managing Complications

Signs of Complications

• Monitoring Infants: Stress that infants with pertussis are at higher risk for complications and should be monitored closely for signs of apnea (pauses in breathing).

Follow-Up Care

• Regular Check-Ups: Encourage follow-up visits to monitor recovery and check for any potential complications.

7. Long-Term Care and Recovery

Recovery Timeline

• Expectations: Explain that the recovery period can be prolonged, with cough lasting for several weeks to months even after the infection has been treated.
• Patience and Support: Encourage patience and provide emotional support, as the prolonged cough can be exhausting and stressful for both the patient and caregivers.

8. Emotional Support and Counseling

Psychosocial Impact

• Anxiety and Fear: Address any anxiety or fear related to severe coughing spells and potential complications. Provide reassurance and clear information about the disease and its management.
• Support Networks: Encourage seeking support from family, friends, or support groups to cope with the stress and emotional impact of the illness.

9. Community Resources

Educational Materials

• Online Resources: Direct to reliable online resources for further information and support.

Support Services

• Healthcare Provider Follow-Up: Ensure patients have contact information for follow-up care and access to community health services.
• Vaccination Clinics: Inform about local vaccination clinics and services that offer immunizations and support.

Sample Health Teaching Plan for Pertussis

Objective: To educate the patient and family on pertussis management, symptom control, and prevention of transmission.

Teaching Points:

1. Understanding Pertussis:
• Explain what pertussis is and how it affects the respiratory system.
• Discuss the stages of the disease and what to expect at each stage.
2. Symptom Management:
• Teach methods to manage and reduce coughing fits, such as using a humidifier.
• Emphasize the importance of staying hydrated and maintaining nutrition.
3. Medication Adherence:
• Instruct on the correct use of prescribed antibiotics and the importance of completing the course.
• Explain potential side effects and when to contact a healthcare provider.
4. Preventing Transmission:
• Discuss proper hand hygiene and respiratory etiquette.
• Highlight the importance of isolation until no longer contagious.
5. Vaccination Importance:
• Educate on the importance of vaccination and the recommended schedules for DTaP and Tdap.
6. Recognizing Complications:
• Provide information on signs of complications and when to seek medical help.
7. Long-Term Care and Support:
• Discuss the expected duration of recovery and how to manage prolonged symptoms.
• Offer emotional support and information on support groups.