MEASLES

By: Paula Ellis Dela Cruz Siena College Taytay

 Measles is a highly contagious, serious disease caused by a virus. Before the introduction of
measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately
every 2–3 years and measles caused an estimated 2.6 million deaths each year.
 The disease remains one of the leading causes of death among young children globally, despite
the availability of a safe and effective vaccine. Approximately 89 780 people died from measles
in 2016 – mostly children under the age of 5 years.

Synonyms:

 rubella.
 epidemic roseola.
 contagion.
 German measles.
 morbilli.
 rubeola.
 contagious disease.
 three-day measles.

Pathognomonic Sign:

 Measles is marked by prodromal fever, cough, coryza, conjunctivitis, and pathognomonic

enanthem (ie, Koplik spots), followed by an erythematous maculopapular rash on the third to
seventh day

Classification of Measles:
There are two types of measles, each caused by a different virus. Although both produce a rash and
fever, they are really different diseases. When most people use the term measles, they are referring to
the first condition below.

 The rubeola virus causes "red measles," also known as "hard measles" or just "measles."
Although most people recover without problems, rubeola can lead to pneumonia or
inflammation of the brain (encephalitis).
  The rubella virus causes "German measles," also known as "three-day measles." This is usually a
milder disease than red measles. However, this virus can cause significant birth defects if an
infected pregnant woman passes the virus to her unborn child.

Causative Agent:
 The causative agent of measles is a respiratory infection known as 'morbillivirus'. This highly
contagious disease is spread by droplets in the air or by direct contact.

Mode of Transmission: Airborne/Droplet

 Measles is a highly contagious virus that lives in the nose and throat mucus of an infected
person. It can spread to others through coughing and sneezing. Also, measles virus can live for
up to two hours in an airspace where the infected person coughed or sneezed.

Symptoms:
Measles signs and symptoms appear 10 to 14 days after exposure to the virus. Signs and symptoms of
measles typically include:

 Fever
 Dry cough
 Runny nose
 Sore throat
 Inflamed eyes (conjunctivitis)
 Tiny white spots with bluish-white centers on a red background found inside the mouth on the
inner lining of the cheek — also called Koplik's spots
 A skin rash made up of large, flat blotches that often flow into one another
 The infection occurs in sequential stages over a period of two to three weeks.

Infection and incubation. For the first 10 to 14 days after you're infected, the measles virus incubates.
You have no signs or symptoms of measles during this time.

Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often
accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This
relatively mild illness may last two or three days.

Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and
bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first, particularly
behind the ears and along the hairline.
Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and
feet. At the same time, fever rises sharply, often as high as 104 to 105.8 F (40 to 41 C). The measles rash
gradually recedes, fading first from the face and last from the thighs and feet.

Communicable period. A person with measles can spread the virus to others for about eight days,
starting four days before the rash appears and ending when the rash has been present for four days.
Medical Management:
No treatment can get rid of an established measles infection. However, some measures can be taken to
protect vulnerable individuals who have been exposed to the virus.

 Post-exposure vaccination. Nonimmunized people, including infants, may be given the measles
vaccination within 72 hours of exposure to the measles virus to provide protection against the
disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter
time.
 Immune serum globulin. Pregnant women, infants and people with weakened immune systems
who are exposed to the virus may receive an injection of proteins (antibodies) called immune
serum globulin. When given within six days of exposure to the virus, these antibodies can
prevent measles or make symptoms less severe.

Medications:
 Fever reducers. You or your child may also take over-the-counter medications such as
acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) or naproxen (Aleve) to help
relieve the fever that accompanies measles.

Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in
children older than age 3, children and teenagers recovering from chickenpox or flu-like
symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome,
a rare but potentially life-threatening condition, in such children.

 Antibiotics. If a bacterial infection, such as pneumonia or an ear infection, develops while you or
your child has measles, your doctor may prescribe an antibiotic.

 Vitamin A. People with low levels of vitamin A are more likely to have a more severe case of
measles. Giving vitamin A may lessen the severity of the measles. It's generally given as a large
dose of 200,000 international units (IU) for two days.

Nursing Management:
 Keep infected person in isolation until the 5th day of rash.
 Keep the patient in bed until fever and cough subside.
 Provide eye care (i.e., clean eyelid, irrigate eye with saline).
 Protect eyes of patients from glare of strong light as they are apt to be inflamed.
 Keep the patient in an adequately ventilated room but free from drafts and chilling to avoid
complications of pneumonia.
 Increase fluid intake during fever.
 Increase humidity in the patient’s room to relieve cough.
 Administer tepid baths and apply soothing lotion (such as calamine) to relieve itching of skin.
  Immune serum or gamma-globulin may be given to modify illness and reduce complication.
 Antibacterial therapy may be given as ordered for treatment of complication (i.e., respiratory
infection or gastroenteritis).
 Maintain good body hygiene of patient to reduce the risk of secondary infection from the
lesions.
 Use a cool mist vaporizer, mouthwash, and tablets to suck on to keep mucous membranes
moist.
 Give analgesic, antipyretic, and anti-pruritus as ordered to reduce pain, lower body
temperature, and reduce the itching.

Health Teaching & Discharge Instructions:

Seek care immediately if:
 Your child has trouble breathing or is breathing faster than usual.
 Your child has a headache, drowsiness, and stiff neck.
 Your child seems confused or less alert than usual.
 Contact your child's healthcare provider if:
 Your child's cough lasts for more than 4 days.
 Your child coughs up thick mucus.
 Your child has an earache.
 Anyone in your household develops a rash.
 You have questions or concerns about your child's condition or care.

Medicines: Your child may need any of the following:

 Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much
to give your child and how often to give it. Follow directions. Acetaminophen can cause liver
damage if not taken correctly.
 NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available
with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in
certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him.
Always read the medicine label and follow directions. Do not give these medicines to children
under 6 months of age without direction from your child's healthcare provider.
 Cough medicine is given to decrease your child's urge to cough and help him rest.
 Do not give aspirin to children under 18 years of age. Your child could develop Reye syndrome
if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your
child's medicine labels for aspirin, salicylates, or oil of wintergreen.
 Give your child's medicine as directed. Contact your child's healthcare provider if you think the
medicine is not working as expected. Tell him or her if your child is allergic to any medicine.
Keep a current list of the medicines, vitamins, and herbs your child takes. Include the amounts,
and when, how, and why they are taken. Bring the list or the medicines in their containers to
follow-up visits. Carry your child's medicine list with you in case of an emergency.

Manage your child's symptoms:

 Give your child liquids as directed. Liquids help prevent dehydration. Ask how much liquid to
give your child each day and which liquids are best for him. Give your child water, juice, or broth
instead of sports drinks. He may need an oral rehydration solution (ORS). An ORS has the right
 amounts of water, salts, and sugar your child needs to replace body fluids. Ask your child's
healthcare provider where you can get ORS.
 Help your child rest. He should rest as much as possible and get plenty of sleep.
 Use a cool mist humidifier. A humidifier helps increase air moisture in your home. This may
make it easier for your child to breathe and help decrease his cough.
 Give your child a variety of healthy foods. Healthy foods include fruits, vegetables, whole-grain
breads, low-fat dairy products, beans, lean meats, and fish. This will help your child feel better
and have more energy. If he is not hungry or gets tired easily, try feeding him smaller amounts
more often.
 Protect your child's eyes. Keep the lights dim or give your child sunglasses to wear. This will help
decrease pain caused by sensitivity to light.

Prevent measles:
 Ask your child's healthcare provider about the MMR vaccine. This vaccine helps protect your
child and others around him from measles, mumps, and rubella.
 Prevent the spread of germs. Have your child stay away from others, especially anyone who is
pregnant, or who has not had the MMR vaccine. Keep your child home from school or daycare
until his healthcare provider says he can return.

Follow up with your child's healthcare provider as directed:

 Write down your questions so you remember to ask them during your child's visits.