Which of the following is the most appropriate initial nursing intervention for a child with early-stage pertussis presenting with a mild cough and fatigue?

B) Encourage adequate hydration and rest

A) Administer bronchodilators as prescribed

B) Encourage adequate hydration and rest

C) Provide supplemental oxygen therapy

D) Initiate isolation precautions

What is the most appropriate initial nursing intervention for a 7-year-old child with suspected early-stage pertussis?

B) Encourage adequate hydration

A) Start oxygen therapy immediately

B) Encourage adequate hydration

D) Initiate antibiotics treatment

Which of the following interventions is most effective in helping to alleviate the child's nighttime coughing episodes?

B) Using a cool-mist humidifier in the child's room

A) Administering cough syrup before bedtime

B) Using a cool-mist humidifier in the child's room

C) Elevating the child's head with extra pillows

D) Giving the child a warm bath before sleep

A 7-year-old patient with a whooping cough has shown improvement with the use of a cool-mist humidifier. What is the primary benefit of using a cool-mist humidifier in managing this patient's respiratory condition?

A) It increases the humidity in the air, helping to keep the throat moist and reduce coughing.

B) It directly kills the bacteria causing the whooping cough.

C) It warms the air in the room, helping to soothe the patient's airway.

D) It decreases the need for antibiotics by curing the infection.

A child has developed mild gastrointestinal symptoms with a slight decrease in serum potassium levels. Which dietary recommendation should the nurse prioritize to help normalize the child's potassium levels?

A) Incorporate bananas into the diet

B) Increase the intake of dairy products

What is the most appropriate nursing intervention for a child who has developed mild gastrointestinal symptoms and a slight decrease in serum potassium levels?

A) Encourage the child to take frequent sips of oral rehydration solutions

B) Administer antiemetic medication to prevent further vomiting

C) Restrict the child's fluid intake to prevent overhydration

D) Place the child on a clear liquid diet until symptoms resolve

What is the most effective initial intervention for addressing mild dehydration and electrolyte imbalance in children?

B) Encouraging oral rehydration solutions

A) Administering intravenous fluids

B) Encouraging oral rehydration solutions

C) Providing antiemetic medications

D) Initiating a clear liquid diet

What is the most appropriate intervention for a nurse to recommend to a mother to prevent dehydration in her child who is recovering from mild gastrointestinal symptoms?

B) Provide the child with oral rehydration solutions as recommended.

A) Encourage the child to drink clear fluids such as water or juice.

B) Provide the child with oral rehydration solutions as recommended.

C) Allow the child to consume only solid foods to avoid fluid imbalance.

D) Restrict the child's fluid intake to prevent further vomiting.

What is the most appropriate initial dietary recommendation for a child recovering from pertussis?

B) Gradually reintroduce regular foods, one at a time

A) Return immediately to a high-protein diet

B) Gradually reintroduce regular foods, one at a time

C) Implement a strict low-sodium diet

D) Provide only clear liquids until fully recovered

Pertussis - Nursing Case Study

Pathophysiology

• Primary mechanism: Pertussis, or whooping cough, is caused by the bacterium Bordetella pertussis, which attaches to the cilia of the respiratory epithelial cells, releasing toxins that paralyze the cilia and cause inflammation, impairing the clearing of pulmonary secretions.

• Secondary mechanism: The bacterium produces pertussis toxin, which disrupts signaling pathways in host cells and causes increased mucus production, leading to the characteristic severe coughing fits as the body attempts to clear the mucus.

• Key complication: Prolonged coughing can lead to minor complications such as rib fractures, urinary incontinence, and hernias due to the intense pressure exerted during coughing episodes.

Patient Profile

Demographics: 7-year-old female, elementary school student

History:

• Key past medical history: Up-to-date on vaccinations, no significant past illnesses

• Current medications: None

• Allergies: None known

Current Presentation:

• Chief complaint: Persistent cough for the past two weeks

• Key symptoms: Mild cough with occasional whooping sound, low-grade fever, runny nose

• Vital signs: Temperature 37.2°C (99°F), heart rate 88 bpm, respiratory rate 22 breaths per minute, blood pressure 102/68 mmHg, oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon further assessment, the 7-year-old girl presents with a mild cough that occasionally leads to a whooping sound, particularly noticeable during the night. Her mother reports that the cough has been persistent, with occasional bouts of intense coughing that leave the child fatigued. The child is alert and oriented, engaging appropriately during the assessment. Her respiratory examination reveals clear lung sounds bilaterally, but there is an occasional dry cough noted during auscultation. There are no signs of respiratory distress; the child’s breathing is unlabored, and she maintains good oxygen saturation levels at 98% on room air.

The physical examination does not show any significant distress, though mild nasal congestion and rhinorrhea are observed. The child's throat appears slightly erythematous without significant swelling or exudate, and her tonsils are not enlarged. Her skin is warm and dry, with no rashes or lesions noted. The child denies any chest pain or difficulty breathing, though she reports feeling tired after prolonged coughing episodes. Overall, the initial assessment indicates a stable condition with mild symptoms, suggesting early-stage pertussis without severe complications at this point. This stability offers a window for supportive care and monitoring to prevent progression to more severe complications.

Given these findings, the nursing plan will focus on monitoring the child’s respiratory status and providing supportive care, including encouraging adequate hydration to help thin secretions and advising on the importance of rest. Education on recognizing signs of potential complications, such as increased respiratory distress or cyanosis, will be provided to the family, ensuring they know when to seek further medical attention. This proactive approach will help manage the current symptoms and prevent the development of secondary complications.

Section 2

Response to Interventions:

Following the initial assessment and implementation of the nursing care plan, the 7-year-old patient has been closely monitored for any changes in her condition. Over the next 48 hours, the child’s cough remains present but appears to have slightly decreased in intensity, particularly during the daytime. Her mother reports that the child has been more comfortable at night with the use of a cool-mist humidifier in her room, which has helped alleviate some of the dryness in her throat and reduced the frequency of the whooping cough. The child is also drinking plenty of fluids, as encouraged by the nursing staff, which has contributed to thinning her respiratory secretions.

Vital signs remain stable, with a temperature of 98.6°F, heart rate of 90 beats per minute, and respiratory rate of 18 breaths per minute. Oxygen saturation continues to be adequate at 98% on room air. During follow-up auscultation, lung sounds are clear and the occasional dry cough persists, but without any signs of respiratory distress. The child reports feeling slightly less fatigued, though she still experiences tiredness after coughing episodes. Her nasal congestion has improved, and her rhinorrhea is less pronounced.

These positive responses to interventions indicate that the current management plan is effective. The nursing team will continue to emphasize the importance of hydration and rest, while also maintaining vigilance for any signs of complications. Education for the family will focus on ensuring they understand the importance of completing the antibiotic course prescribed by the pediatrician, to prevent transmission and further complications. This stage of care provides a promising outlook, and ongoing assessment will guide any necessary adjustments to the care plan.

Section 3

As the care continues, the nursing team notices a new development in the patient's condition. On the morning of the third day, the child's mother reports that her daughter has begun to exhibit mild gastrointestinal symptoms, including occasional nausea and one episode of vomiting. These symptoms are not severe but have prompted the care team to reassess the child's fluid and electrolyte status to ensure she remains well-hydrated and to prevent any potential complications. The nursing staff intensifies their monitoring of the child's fluid intake and output, and they continue to encourage small, frequent sips of oral rehydration solutions alongside her regular fluids.

Laboratory results, drawn to investigate the cause of these new symptoms, reveal a slight decrease in serum potassium levels, measuring at 3.4 mEq/L, which is just below the normal range. This finding suggests that the vomiting may have contributed to minor electrolyte imbalances. In response, the nursing team recommends dietary adjustments, such as incorporating potassium-rich foods like bananas and potatoes, to help normalize her levels. Additionally, they educate the mother on recognizing signs of dehydration and electrolyte imbalance, ensuring she is equipped to support her daughter's recovery at home.

The nursing staff continues to focus on patient comfort and effective symptom management. They regularly assess the child's overall condition, emphasizing the importance of maintaining fluid intake to prevent further complications. As the child progresses, the team remains alert for any additional changes in her health status, ready to adapt the care plan as needed. This attentive approach ensures that the patient remains on a steady path to recovery, with a focus on comprehensive care that addresses both current symptoms and potential future challenges.

Section 4

As the nursing team continues to monitor the child closely, they observe a positive response to the interventions aimed at addressing her mild gastrointestinal symptoms and electrolyte imbalance. Over the next 24 hours, the child remains stable, with improved tolerance to oral intake. Her mother reports that the child is now able to keep down small amounts of food and fluids, including the recommended oral rehydration solutions and potassium-rich foods. The nursing staff notes that the child's nausea has decreased, and there have been no further episodes of vomiting.

Vital signs remain within normal limits, with a heart rate of 98 beats per minute, respiratory rate of 22 breaths per minute, and blood pressure holding steady at 95/60 mmHg. The child's temperature is stable at 37.2°C (99°F), indicating no signs of fever. Follow-up laboratory results show an improvement in serum potassium levels, which have returned to the lower end of the normal range at 3.6 mEq/L. This improvement suggests that the dietary adjustments and increased fluid intake are effectively addressing the initial electrolyte imbalance.

The nursing team continues to emphasize education for the mother, reinforcing the importance of ongoing monitoring for any signs of dehydration or electrolyte disturbances. They provide her with information on preparing balanced meals and maintaining an appropriate fluid intake for her daughter. As the child demonstrates progress in her recovery, the care plan includes a gradual reintroduction of her usual diet while maintaining vigilance for any new or recurring symptoms. The proactive and supportive approach of the nursing staff ensures that both the child and her mother feel confident as they move towards a successful recovery.

Section 5

As the nursing team continues to care for the child, they conduct a thorough assessment to evaluate her current condition and ensure that the management plan remains effective. During the assessment, the nurse notes that the child appears more energetic and is engaging in quiet play activities, a positive sign of her recovery. Her lung sounds are clear upon auscultation, and there is no evidence of respiratory distress, which is reassuring given her initial diagnosis of pertussis. The mother shares that the child’s cough is still present but seems less frequent and severe, an encouraging indicator that the condition is stabilizing.

The nursing staff also reviews the latest laboratory results, focusing on the child's blood work to monitor any ongoing issues with electrolyte balance. The complete blood count reveals a mild leukocytosis with a white blood cell count of 12,000/mm³, which is slightly elevated but expected in the context of a pertussis infection. The electrolytes, specifically the potassium level, remain stable at 3.6 mEq/L, confirming that the dietary and fluid interventions continue to be effective. The nursing team discusses these findings with the mother, ensuring she understands the importance of adhering to dietary recommendations and the signs to watch for that might indicate a need for further intervention.

With the child’s progress closely monitored and her condition showing steady improvement, the care plan includes a continued gradual return to her regular diet. The nursing team advises the mother to introduce new foods one at a time, watching for any adverse reactions. They also emphasize the importance of maintaining hydration and monitoring the child’s overall energy levels and activity tolerance. By reinforcing these strategies, the nursing team empowers the mother to take an active role in her daughter’s recovery while remaining vigilant for any potential complications that could arise as the child continues to heal.