Nursing care
Pertussis nursing care: what to assess and what to do first
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Pertussis, whooping cough, is a highly contagious bacterial respiratory infection spread by droplets, caused by Bordetella pertussis. Nursing care centres on droplet precautions, staged symptom recognition, and macrolide therapy. The infant too young to be fully vaccinated carries the highest risk of apnoea, pneumonia, and death, which makes early isolation of any coughing household contact a genuine priority.
The pathophysiology in one pass
Bordetella pertussis attaches to the ciliated epithelium of the respiratory tract and releases toxins that paralyse the cilia and damage the mucosa. With the cilia unable to clear secretions, thick mucus accumulates and the airway responds with the violent, repetitive coughing fits the disease is named for.
The illness runs in three recognisable stages. The catarrhal stage looks like a common cold, mild fever, runny nose, and a dry cough, and this is when the patient is most contagious yet least likely to be diagnosed. The paroxysmal stage follows one to two weeks later with the characteristic coughing fits, often ending in the inspiratory whoop as air is drawn forcibly past a narrowed glottis, and can include post-tussive vomiting. The convalescent stage sees the cough gradually ease over weeks to months. Infants frequently do not whoop at all; apnoea may be their only presenting sign.
Assessment findings that matter
Ask about the timeline and pattern of the cough before anything else, since a paroxysmal cough lasting more than two weeks with a whoop or post-tussive vomiting is the clinical picture that should trigger suspicion, even without a positive test yet available. Confirm vaccination status for the patient and, if the patient is an infant or child, for household contacts, because an unvaccinated or partially vaccinated adult in the home is frequently the source.
In infants, watch for apnoea, cyanosis during coughing spells, and poor feeding rather than waiting for a classic whoop, which may never appear in this age group. Auscultate for signs of secondary bacterial pneumonia, a common and dangerous complication, and monitor oxygen saturation continuously during and immediately after coughing paroxysms, since desaturation during a fit is common even when baseline saturation looks reassuring.
What the exam asks about this
Expect an item describing a young infant with paroxysmal coughing, a whoop, and cyanosis, asking you to identify the priority nursing diagnosis or intervention, usually ineffective airway clearance or risk for apnoea rather than a comfort measure. Vaccination timing questions are common too: the DTaP series starts at two months, so an infant under two months has essentially no protection, which is the reasoning behind cocooning strategies for the people around them.
You may also see an item testing precaution type. Pertussis is spread by droplets, not by airborne transmission, so the correct answer is a surgical mask and droplet precautions rather than an N95 and a negative-pressure room. Confusing droplet with airborne precautions is one of the more common wrong answers on infection control items generally.
Nursing interventions in priority order
Institute droplet precautions immediately on suspicion, before confirmation, because the catarrhal stage is both the most contagious period and the stage most likely to be missed. Place the patient in a single room if possible, and staff and visitors should wear a surgical mask on entry.
Maintain continuous or frequent pulse oximetry in infants and young children, and have suction equipment at the bedside for thick secretions dislodged during coughing fits. Position the infant to protect the airway during and after paroxysms, and keep the environment calm, since crying and exertion can trigger further fits. Support oral intake with small, frequent feeds offered after coughing episodes rather than during them, since post-tussive vomiting is common and undermines nutrition if feeds are timed poorly.
Medications and monitoring
Macrolide antibiotics, azithromycin, clarithromycin, or erythromycin, are the mainstay of treatment and are most effective at reducing transmission when started in the catarrhal stage, before the diagnosis is usually made. Given later, in the paroxysmal stage, they still reduce spread to others even though they do little to shorten the cough itself, so patient education should set that expectation honestly.
Trimethoprim-sulfamethoxazole is the alternative for patients with a macrolide allergy or intolerance, subject to age and pregnancy considerations. Continue droplet precautions until the patient has completed five days of appropriate antibiotic therapy, and confirm this timepoint before lifting isolation. Monitor hydration status closely in infants, since repeated post-tussive vomiting and reduced oral intake can lead to dehydration faster than the cough itself resolves.
When to escalate
Escalate immediately for any apnoeic episode, cyanosis that does not resolve promptly after a coughing fit, or a sustained drop in oxygen saturation, all of which are more common and more dangerous in infants under six months. These infants have the highest rate of hospitalisation and are the group most likely to die from pertussis.
Escalate also for signs of secondary pneumonia, new focal crackles, worsening work of breathing, or a fever that returns after the catarrhal stage has passed, and for any suggestion of pertussis-associated encephalopathy, seizures or altered consciousness, which is rare but serious. Notify public health per local reporting requirements, since pertussis is a notifiable disease and contact tracing protects other vulnerable infants in the community.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our respiratory practice questions are the closest set to what this page covers.
Common questions
Is pertussis airborne or droplet transmitted?
Droplet. Pertussis spreads through large respiratory droplets produced by coughing, which travel a limited distance and require a surgical mask and droplet precautions rather than an N95 and airborne precautions.
Why do infants not always have the classic whoop?
Infants, especially those under six months, often lack the strength to generate the forceful inspiratory whoop seen in older children and adults. Apnoea, cyanosis, or poor feeding may be their only presenting signs, which is why pertussis is easy to miss in this age group.
When is a pertussis patient no longer contagious?
A patient is generally considered non-contagious after completing five days of an appropriate course of macrolide antibiotics, or after three weeks from cough onset if untreated. Droplet precautions should be maintained until that antibiotic milestone is confirmed.
Why can't newborns just be vaccinated early to prevent this?
The DTaP series begins at two months of age, so infants younger than that have little to no vaccine-derived protection. This is why cocooning, vaccinating parents, siblings, and caregivers, and maternal Tdap vaccination during pregnancy are used to protect the infant before they can be vaccinated themselves.