Bachelor Nursing Assignment: Case Study on Whooping Cough in Children

This nursing assignment presents a case study of a 2-year-old male admitted to the pediatric ward with whooping cough. The report explores the impact of the infection on the patient's activities of daily living, specifically breathing and temperature control, and details the assessment process for these areas. It identifies the clinical issue of paroxysmal cough and outlines a comprehensive nursing care plan to address it, including isolation, environmental control, antibiotic therapy, and supportive care. The assignment emphasizes the importance of early intervention and supportive care to prevent complications and promote patient recovery. The report provides an overview of the disease, its pathogenesis, and the nursing interventions required to manage the symptoms and improve the patient's well-being, reflecting key concepts in pediatric nursing care and the nursing process.

Running head: BACHELOR NURSING ASSIGNMENT
Bachelor nursing assignment
Name of the student:
Name of the University:
Author’s note

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Introduction:
Nurses play a critical role in individualized care and recovery of patients.
Systematically prepared care plan is the right means of guidance for them to meet specific
health care needs of patient and manage their critical conditions. Assessment of activities of
daily living is also an important action before preparing care plan. It helps to determine the
level of support and assistance needed by patients while under care (Howatson-Jones et al.
2015). This meticulous process of assessment of patient condition and planning care is
described in this report through the case of Kyle. Kyle is a 2 year old male admitted to the
paediatric ward with whopping cough. The main symptoms observed in patient includes
rhinorrhea, red blood shot eyes and repetitive forceful coughs. In relation to the patients
conditions, the report specifically provides an overview about changes in the activity of
living of breathing and controlling body temperature due to whooping cough and how the
assessment related to the changes can be done. Furthermore, the assessment process guides
in determining the type of treatment needed for each symptom. Secondly, the report
identifies one clinical issue related to breathing and the nursing strategies and evaluative
measures needed to address the issue. On the whole, the report develops understanding
regarding the critical elements of care and nursing process followed for implementation of
care.
Discussion of activities of daily living related to the case study (breathing and
controlling body temperature):
Kyle has been admitted in hospital due to whooping cough. It is a condition in
which a person experiences long burst of cough due to infection in the nose, throats and
lungs. The infection is mainly caused by the bacterium, Bordetella pertusis (Giayetto et al.
2017). Small children like Kyle face difficulty due to several coughing spells and breathing
difficulty. This causes great distress to children and affects their activities of living
particularly breathing and controlling body temperature (Shields and Thavagnanam 2013).
Affect on activities of living(AoL) due to whooping cough:

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Breathing difficult in children with whooping cough is seen as a result of the action
of the bacteria Bordetella pertusis. It leads to the production of toxin after the bacteria
attaches to the cilia of the respiratory epithelial cells. This results in inflammation of the
respiratory tract and disrupts clearing of the pulmonary secretion (Kilgore et al. 2016). This
ultimately has an impact on the activities of living of breathing and children like Kyle
experience breathing problem and regular spells of cough. During bout of cooking, the face
turns red and attempts to breath lead to production of whooping sound. In some children,
the breathing also stops at the end of a coughing bout and they go pale for sometime. It
resumes again making child go pale for some time.
In relation to of the AoL of controlling body temperature, this is altered
significantly due to whooping cough. The infecting bacteria affect the lining of the airways
and in the first stage, mild cough and slightly high temperature is seen. Secondly, in the
paroxysmal stage (main coughing stage) too, fever is seen with bouts of intense coughing
(Kline et al. 2013). Fever is an adaptive response to inflammation in the respiratory tract.
Schell-Chaple et al. (2015) also points to the body temperature abnormalities in patients
with respiratory distress
Nursing assessment for the two identified AoL:
The first step for assessment of AoL of breathing difficulty in Kyle is observation of
breathing pattern. The signs of increased work of breathing and wheezing sound indicates
ineffective breathing pattern in patients. Children like Kyle may engage in frantic exhaling
and inhaling activities. To detect alterations in breathing patterns, the nurse can do the
following assessment:
 Assessment of respiratory rate, rate and depth of breathing
 Assessment of ABG levels and oxygen saturation level
 Assessment of breathing pattern and rate and depths of respiration
 Regularly checking the children for shortness of breath is important
 Nurse can also look for level of accessory muscle use and skin color to
determine the level of difficulty in breathing

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 Listening to breathing sounds such as whooping or wheezing sound is also
an important assessment as it gives an idea about the cause of breathing
problem (Sousa et al., 2015).
Measuring body temperature of Kyle is a vital activity to ensure safety and proper care of
Kyle. The following nursing assessment is needed to identify this:
 To regularly obtain baseline temperature of patients and compare them with further
recordings
 To closely observe the child for symptoms of hypothermia or hyperthermia
 In case of initiation of antimicrobial therapy, nurse should regular observe for
adverse signs and symptoms
Treatment of symptoms in Kyle for each AoL:
To manage breathing difficulty faced by Kyle, the nurse can provide the following
treatment and intervention:
 The first step is to reduce respiratory distress in patient by providing antibiotics and
respiratory medications as per physician’s order. Generally, erythromycin family of
antibiotics is given for 2 weeks.
 Secondly, regular observation of vital signs, respiratory status and pulse oximetry is
needed to manage adverse issues instantly.
 Supportive care is also needed to remove thick secretions from the throat and nasal
passage of Kyle
 Rapid active bronchodilator should be given for wheezing sounds and the child
should be observed after every three hours for signs of improvements or
complications (World Health Organization 2013).
Nursing treatment for body temperature are:
 If Kyle had fever then paracetamol and antipyretic medications should be provided
 Environmental factors of Kyle like room temperature and body temperature should
be adjusted.

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 In case of fever, nurse should maintain adequate food intake in patient (Wang et al.
2014)
Nursing care plan:
Considering the current symptoms of Kyle, the major clinical issue in the child is
his paroxysmal cough. This is making him lethargic and apathetic. The repetitive bout of
cough is seen in the paroxysmal stage where series of cough is followed by sudden
inspiration and whooping sound (Hartzell and Blaylock 2014). Children like Kyle stop
breathing temporarily and sign of cyanosis is seen during coughing bout. Hence,
paroxysmal cough is a factor that affects the AoL of breathing pattern and developing care
plan to address this issue is important. The main goal of the care plan will be to reduce
bouts of cough in Kyle, observe the severity of cough and breathing difficult, provide a
calm environment, adequate rest and maximize nutrition and recovery of the child (Bocka
2017). To prevent the child from additional difficulty, a comprehensive care plan is needed
that can address the following:
 Firstly, during the catarrhal stage of infection, Kyle should be isolated to prevent
transmission of infection
 There is a need to provide restful environment to patient free from dust and smoking
so that any incidence of paroxysm is prevented. Proper body alignment of the child
should also be maintained to maximize breathing pattern. Humidifying the room
promotes clearance of secretion (McNamara et al. 2014).
 Preventing the child from infection at this stage is important. So, it will be necessary
to start antibiotic therapy and regularly observe for signs of airway obstruction by
checking vital signs, respiratory rate and pulse oximetry. To reduce breathing
problem, the plan is to carefully observe for apnea and cyanosis and provide
mechanical ventilation and breathing treatments at the right time (Scanlon et al.
2015).
 The most important plan for recovery of Kyle would be to provide supportive
therapy effectively. This includes all activities to prevent risk and complication in
patients. This is dependent on regular observation of patients and monitoring of
heart rate, breathing rate and oxygen rate.

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 Adequate sleep periods and rest should be provided to relieve Kyle for distress.
 Although there is no specific consideration, considering the age of Kyle, he should
be given oral feedings or intravenous fluids if oral feeding is not appropriate due to
breathing problem. Regular fluid intake and small and frequent feeding is important
(Heininger 2010).
Improvement in the work of breathing, respiratory rate and breathing sounds can give
an indication if the above mentioned care plan was successful for the recovery of Kyle or
not.
Conclusion:
The case analysis of Kyle, a 2 year old child with summarized gave insight into the
series of clinical issues faced by children with whooping cough. As the bacteria Bordetella
pertusis causes inflammation in the respiratory tract, it disrupts clearance of pulmonary
secretions. Due to the pathogenesis of the disease, two AoL was identified to be affected
and altered in patient- breathing patterns and control of body temperature. The report
discussed how both these AoLs are affected in Kyle. The report provided the idea for
nursing assessment needed to identify these alterations. Secondly, in relation to the issue of
breathing problem and changes in body temperature, the report gave appropriate treatment
options to provide relief to patient. It also reflected on one issue arising due to breathing
problem and gave a comprehensive care plan to promote recovery of patient. The key
learning from this research is that to prevent complications in patients, it is necessary to
start supportive care for patients early to promote recovery and well-being.

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Reference
Bocka, J. 2017. Pertussis Treatment & Management: Approach Considerations,
Pharmacologic Therapy, Immunization. Emedicine.medscape.com. Retrieved 10 August
2017, from http://emedicine.medscape.com/article/967268-treatment
Giayetto, V.O., Blanco, S., Mangeaud, A., Barbas, M.G., Cudola, A. and Gallego, S.V.,
2017. Features of Bordetella pertussis, Bordetella spp. infection and whopping cough in
Córdoba province, Argentina. Revista chilena de infectologia: organo oficial de la
Sociedad Chilena de Infectologia, 34(2), p.108.
Hartzell, J.D. and Blaylock, J.M., 2014. Whooping cough in 2014 and beyond: an update
and review. Chest, 146(1), pp.205-214.
Heininger, U., 2010. Update on pertussis in children. Expert review of anti-infective
therapy, 8(2), pp.163-173.
Howatson-Jones, L., Standing, M. and Roberts, S., 2015. Patient assessment and care
planning in nursing. Learning Matters.
Kilgore, P.E., Salim, A.M., Zervos, M.J. and Schmitt, H.J., 2016. Pertussis: microbiology,
disease, treatment, and prevention. Clinical microbiology reviews, 29(3), pp.449-486.
Kline, J.M., Lewis, W.D., Smith, E.A., Tracy, L.R. and Moerschel, S.K., 2013. Pertussis: a
reemerging infection. American family physician, 88(8)

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McNamara, D.G., Asher, M.I., Rubin, B.K., Stewart, A. and Byrnes, C.A., 2014. Heated
humidification improves clinical outcomes, compared to a heat and moisture exchanger in
children with tracheostomies. Respiratory care, 59(1), pp.46-53.
Scanlon, K.M., Skerry, C. and Carbonetti, N., 2015. Novel therapies for the treatment of
pertussis disease. Pathogens and disease, 73(8).
Schell-Chaple, H.M., Puntillo, K.A., Matthay, M.A., Liu, K.D. and National Heart, Lung,
and Blood Institute Acute Respiratory Distress Syndrome Network, 2015. Body
temperature and mortality in patients with acute respiratory distress syndrome. American
Journal of Critical Care, 24(1), pp.15-23.
Shields, M.D. and Thavagnanam, S., 2013. The difficult coughing child: prolonged acute
cough in children. Cough, 9(1), p.11.
Sousa, V.E.C., Lopes, M.V.D.O., Silva, V.M. and Keenan, G.M., 2015. Defining the key
clinical indicators for ineffective breathing pattern in paediatric patients: a meta‐analysis of
accuracy studies. Journal of clinical nursing, 24(13-14), pp.1773-1783.
Wang, K., Bettiol, S., Thompson, M.J., Roberts, N.W., Perera, R., Heneghan, C.J. and
Harnden, A., 2014. Symptomatic treatment of the cough in whooping cough. The Cochrane
Library.
World Health Organization, 2013. Pocket book of hospital care for children: guidelines for
the management of common childhood illnesses. World Health Organization.