Pertussis
Key Points
- Pertussis is caused by Bordetella pertussis/parapertussis and spreads by respiratory droplets.
- Classic illness features paroxysmal cough followed by an inspiratory “whoop.”
- Infants can present atypically with apnea, cyanosis, tachypnea, or bradycardia.
- PCR is usually more reliable than culture, though access can vary by setting.
- Antibiotics mainly reduce transmission and are also recommended for close contacts.
- Isolation usually continues until about 5 days after effective antibiotic therapy starts.
Pathophysiology
Inhaled Bordetella organisms adhere to respiratory mucosa and trigger local inflammation. Disease progression moves from nonspecific catarrhal symptoms to paroxysmal cough episodes with high physiologic stress.
Repeated forceful coughing can lead to aspiration and pressure-related complications in thoracic and abdominal structures.
Classification
- Typical pertussis pattern: Fever/rhinorrhea phase followed by whooping paroxysmal cough.
- Infant atypical pattern: Apnea, cyanosis, and bradycardia may predominate over classic whoop.
- Complicated pertussis: Secondary pneumonia, CNS events, or pressure-related structural injury.
Nursing Assessment
NCLEX Focus
Prioritize infant respiratory compromise cues and hydration/nutrition tolerance during prolonged cough illness.
- Assess cough frequency, nighttime worsening, and triggers such as noise or cold air.
- Monitor for cyanosis, apnea, syncope, or post-tussive vomiting.
- In infants, assess tachypnea, bradycardia, and feeding intolerance as high-acuity cues.
- Review diagnostic data: nasopharyngeal culture, PCR availability/result, and WBC trend.
- Monitor for complications, including aspiration pneumonia, seizures, intracranial bleeding, pneumothorax, diaphragmatic rupture, hernia, and rectal prolapse.
- Assess household exposure history to guide prophylaxis coordination.
Nursing Interventions
- Provide supportive airway and oxygenation management, including suctioning and oxygen as ordered.
- Maintain hydration and nutrition support; escalate for inability to feed or prolonged illness burden.
- Coordinate hospitalization for severe hypoxemia, secondary infection, poor intake, or infants younger than 1 year.
- Administer ordered antibiotics and reinforce that early treatment may have limited symptom-duration impact but reduces infectivity.
- Coordinate prophylactic antibiotics for close contacts according to care plans.
- Enforce droplet/isolative workflows until the infectious window closes (commonly 5 days after antibiotic start).
- Teach vaccine prevention (DTaP/Tdap), cough etiquette, and return-precaution signs.
Infant Deterioration Risk
Infants can decompensate quickly with apnea or bradycardia even before classic whooping cough is obvious.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| antibiotics | Macrolide-centered pertussis regimens | Used to reduce transmission and support contact prophylaxis planning. |
| oxygen-therapy adjuncts | Ordered oxygen support | Treat hypoxemia during coughing crises or infant compromise. |
Clinical Judgment Application
Clinical Scenario
A 4-month-old has worsening cough spells with cyanosis and brief apnea episodes after household exposure to persistent cough illness.
- Recognize Cues: High-risk infant pattern for pertussis-related respiratory compromise.
- Analyze Cues: Airway instability and feeding risk outweigh routine outpatient management.
- Prioritize Hypotheses: Immediate priorities are oxygenation stabilization and complication prevention.
- Take Action: Escalate to inpatient-level monitoring, implement ordered respiratory support, and coordinate antibiotic/isolation workflows.
- Evaluate Outcomes: Apnea episodes decrease, oxygenation stabilizes, and hydration is maintained.
Related Concepts
- transmission-based-precautions - Droplet-spread containment workflow.
- pneumonia - Common secondary complication linkage.
- active-and-passive-immunity - DTaP/Tdap prevention context.
- airway-suctioning - Secretion-management support in severe coughing illness.
Self-Check
- Why are infant pertussis presentations often different from classic whooping cough?
- How does antibiotic timing change goals of pertussis therapy?
- Which findings indicate need for hospitalization?