Reference no: EM133860038
Sara and Mary Sara and Mary are 2-month-old twins born at 35 week's gestation and weighing 2,272 g (81.1 oz) and 2,300 g (82.1 oz), respectively. They remained hospitalized for 4 weeks to gain weight and were discharged to home weighing 2,600 g (92.8 oz). They are scheduled to see the health care provider to begin their immunizations at 10 weeks of age. The twins' mother has taken extended maternity leave to remain home with the twins until they are 4 months old. The twins' mother, Fran, noted that both infants, 9 weeks of age, had runny noses when she picked them up from daycare. The twins' father left at 5:00 A.M. for a 5-day business trip and at 6:00 A.M., Fran heard them both coughing. Their coughs sounded dry; however, when she checked them, they both had runny noses and felt warm to the touch. She took their temperatures; Sara's was 37.8 °C (100°F), and Mary's was 38°C (100.4°F).
She administered 15 mg/kg of acetaminophen. This lowered their temperatures to 37.4°C (99.3°F) and 37.5°C (99.25°F), respectively; however, they continued to cough. Three hours later, both girls began exhibiting a high-pitched, whooping sound when inhaling during their coughing attacks. When Fran noted the girls experienced brief apneic periods during their coughing spells and appeared "bluish" in color, she phoned her pediatrician and was told to go to the nearest emergency department.
The girls were admitted to the pediatric nursing unit with a diagnosis of "rule out pertussis:'' Sara's leukocyte count is 31,000 cells/mm3 and Fran's count is 32,300 cells/mm3 on admission. Nasal and throat cultures and serology tests are pending. Intravenous access devices are placed, and intravenous fluids of D5W with .225% sodium chloride is initiated at 20 mL/hour. Their oxygen saturation is continuously monitored using pulse oximetry, and each is started on 0.5 L of oxygen per nasal cannula in response to oxygen saturation readings of 94% for Sara and 92% for Mary. Arterial blood gases are drawn from each infant with the following results:
For Sara: pH, 7.35; Pco2, 35 mm Hg; Po2, 90 mm Hg; oxygen saturation, 95%; and HCO3, 22 mEq/L.
For Mary: pH, 7.37; Pco2, 37 mm Hg; Po2, 85 mm Hg; oxygen saturation, 92%; and HCO3, 23 mEq/L.
On admission, Sara weighs 2.9 kg (6 lb, 8 oz) and Mary weighs 3.2 kg (7 lb).
1. Discuss pertussis, and how can it be prevented?
2. Should the twins be placed in respiratory isolation to protect the nursing staff?
3. The twins respond favorably to treatment, and following a week of hospitalization, their health care provider discharges them to home.
Fran and her husband Jack are preparing for discharge. Discuss appropriate hospital discharge instructions for this family.