Measles

Measles

Measles, also known as Morbilli, is a highly contagious acute infection of the respiratory system caused by the morbillivirus. 

It is characterized by a widespread skin rash, fever, and inflammation of the mucous membranes.

The transmission of measles occurs through respiration, mainly by coming into contact with fluids from the nose and mouth of an infected person. Due to its high contagion, it can easily spread among individuals.

The incubation period for measles typically lasts from 9 to 12 days.

 Risk Factors

Several risk factors increase the likelihood of contracting measles, including:

1. Immunodeficiency in children.
2. Traveling to regions where measles is common or having contact with individuals who have visited these areas.
3. Malnutrition, which can weaken the immune system.
4. Pregnancy, as it may increase susceptibility to the virus.
5. Vitamin A deficiency, which can compromise the body\’s ability to fight infections.

Signs and symptoms of measles/Stages

Measles, an acute and highly communicable infection caused by the morbillivirus, presents a clinical picture that can be divided into three distinct stages: prodromal, eruptive, and convalescent. Suspecting measles becomes crucial when patients exhibit the classic triad of the three \”Cs\”: cough, conjunctivitis, and coryza.

Stage 1: Prodromal Stage

• The incubation period lasts approximately 10-14 days.
• Patients may not show any signs or symptoms during this stage.
• Abrupt onset of mild to moderate symptoms, characterized by:
  • Fever
  • Headache
  • General malaise
  • Loss of appetite (anorexia)
  • Enlarged neck lymph nodes
  • Abdominal pain
  • Diarrhea
  • Vomiting

Stage 2: Eruptive Stage

• Abrupt onset with severe symptoms, including:
  • Very high fever
  • Cough
  • Photophobia (sensitivity to light)
  • Red eyes and conjunctivitis
  • Hoarseness of the voice
  • Distinctive Koplik spots on the mucous membrane of the mouth, next to the molar teeth. These spots may disappear once the rash appears.
• Temperature rises on the first day (37.8-39.4 degrees Celsius), may slightly fall on the third day, then rise again on the fourth day with the onset of the rash.
• The rash appears around the fourth day and starts on the forehead, behind the ears, neck, and then spreads over the face and entire body. The rash is a red maculo-papular eruption, giving the face a bloated, swollen appearance.

Stage 3: Convalescent Stage

• Improvement and disappearance of signs and symptoms begin.
• Key features include:
  • Desquamation of the skin (shedding of the rash)
  • A decline in body temperature
  • Resolution of hoarseness of the voice
  • Weight gain as the patient\’s condition improves.

Nursing Care/Management for a Patient within 72 Hours of Measles:

Aims of Care/Management:

1. To reduce body temperature.
2. To correct dehydration.
3. To prevent further complications.

Admission:

1. Admit the child to a well-ventilated room in an isolation unit in the children\’s ward.
2. Record the patient\’s particulars, including name, age, next of kin, and full address on the admission forms.
3. Reassure the mother/caregiver about the child\’s condition.

Observations:

1. Monitor vital signs (Temperature, pulse, respiration, blood pressure, and weight) and record them in an observation chart for baseline monitoring.
2. Conduct a comprehensive head-to-toe assessment to identify any abnormalities such as jaundice, edema, dehydration, cyanosis, anemia, and lymphadenopathy. Document findings in the patient file.
3. Inform the doctor about the patient\’s condition and prepare for any required investigations and medical treatments.
4. Carry out procedures, such as tepid sponging, based on the patient\’s findings (e.g., in case of high fever).

Investigations:

1. Conduct necessary investigations to rule out other diseases, such as:
   • Blood slide for malaria parasites
   • Full blood count (FBC) to rule out other infections
   • Urinalysis
   • Salivary measles-specific IgA testing (rarely done).

Medical Treatments:

1. There is no specific treatment for measles; it is managed symptomatically.
2. Prescribe the following drugs based on symptoms:
   • Antibiotics to treat underlying infections (e.g., Cephalexin or Amoxyl syrup).
   • Intravenous Ceftriaxone for severe cases.
   • Analgesics to reduce pain and fever (e.g., Syrup Cetamol).
   • Antihistamines to reduce itching (e.g., Calamine lotion).
   • Vitamins A capsules for children below 1 year to prevent eye complications.
   • Grovit drops or syrup multivitamin to improve appetite.

Fluids and Diet:

1. Provide plenty of oral fluids to replace lost fluids due to vomiting and diarrhea.
2. Offer easily digestible foods rich in vitamins and proteins for quick recovery.
3. Encourage the child to take frequent small meals.
4. Use a nasogastric tube for feeding if the child cannot eat or drink.
5. Administer intravenous fluids in cases of severe dehydration.

Skin Care:

1. Pad the fingers to prevent excessive scratching of the skin.
2. Apply prescribed calamine lotion to relieve itching.

Mouth and Eye Care:

1. Emphasize oral hygiene with frequent mouth care using warm saline.
2. Keep the nostrils clean and maintain cleanliness around the nasogastric tube.
3. Apply gentian violet 1% for mouth ulcers.
4. Use glycerin borax to lubricate the lips and prevent cracking.
5. Clean the eyes with warm saline and avoid rubbing them.
6. Apply TEO ointment if necessary.
7. If one eye is affected, encourage the child to lie on the affected side to prevent infecting the other eye.
8. Avoid direct sunlight on the eyes.

Hygiene and Bed Rest:

1. Give the patient a daily bath and change bedding frequently.
2. Use appropriate precautions for discharging ears and administer antibiotics as needed.
3. Disinfect used soiled linen and utensils.
4. Properly dispose of used swabs, discharges, or secretions.

Visitor and Ward Management:

1. Restrict visitors and maintain visiting hours.
2. Keep radio and TV volumes low to allow for patient rest.
3. Encourage dim lighting due to photophobia.
4. Encourage adequate sleep by switching off lights and minimizing noise.

Observations:

1. Continue monitoring the patient\’s general condition and vital signs regularly.
2. Take note of any deviations from the normal and act accordingly.
3. Perform tepid sponging, give cold drinks, and apply cold compress on the forehead if the temperature is very high.

Bowel and Bladder Care:

1. Observe and treat diarrhea or constipation as needed.
2. Monitor and address any issues with the child\’s urine output.

Exercises and Health Education:

1. Encourage the patient to do active and passive exercises, including deep breathing exercises.
2. Stimulate the child\’s mind with play objects like toys.
3. Educate the mother/caregiver about the mode of spread, signs, symptoms, and prevention of measles.

Complications of Measles:

• Pneumonia
• Acute Laryngo-Tracheo-Bronchitis (LTB)
• Otitis media leading to deafness
• Conjunctivitis
• Encephalitis
• Acute gastroenteritis
• Malnutrition (PEM) – Kwashiorkor and marasmus
• Subacute sclerosing panencephalitis.

Test Questions

MCQ: Which virus causes measles?
a) Influenza virus
b) Morbillivirus
c) Respiratory syncytial virus
d) Rotavirus
Answer: b) Morbillivirus
Explanation: Measles is caused by the morbillivirus, a member of the Paramyxoviridae family.

MCQ: During which stage of measles does the characteristic red maculo-papular rash appear?
a) Incubation stage
b) Prodromal stage
c) Catarrhal stage
d) Convalescence stage
Answer: c) Catarrhal stage
Explanation: The characteristic red maculo-papular rash appears during the catarrhal or eruptive stage of measles.

MCQ: What is the primary aim of nursing care in managing measles?
a) To reduce the risk of bacterial infection
b) To relieve itching and rash discomfort
c) To prevent complications and dehydration
d) To administer specific antiviral medication
Answer: c) To prevent complications and dehydration
Explanation: The primary aim of nursing care in managing measles is to prevent complications and dehydration, as there is no specific antiviral medication for measles.

MCQ: Which symptom is part of the classic triad used for suspecting measles?
a) Fever
b) Cough
c) Diarrhea
d) Jaundice
Answer: b) Cough
Explanation: The classic triad for suspecting measles includes cough, conjunctivitis, and coryza (common cold).

MCQ: What is the incubation period for measles?
a) 2-5 days
b) 7-10 days
c) 10-14 days
d) 21-28 days
Answer: c) 10-14 days
Explanation: The incubation period for measles typically lasts from 10 to 14 days.

MCQ: Which vitamin is administered to prevent eye complications related to measles in children below one year?
a) Vitamin B
b) Vitamin C
c) Vitamin D
d) Vitamin A
Answer: d) Vitamin A
Explanation: Vitamin A capsules are administered to children below one year to prevent eye complications associated with measles.

MCQ: Which stage of measles is characterized by an abrupt onset of severe symptoms, including very high fever and photophobia?
a) Incubation stage
b) Prodromal stage
c) Catarrhal stage
d) Convalescence stage
Answer: c) Catarrhal stage
Explanation: The catarrhal or eruptive stage of measles is characterized by an abrupt onset of severe symptoms, including very high fever and photophobia.

MCQ: What is the primary mode of measles transmission?
a) Contact with contaminated food
b) Direct skin-to-skin contact with an infected person
c) Airborne droplets from an infected person\’s respiratory secretions
d) Ingestion of contaminated water
Answer: c) Airborne droplets from an infected person\’s respiratory secretions
Explanation: Measles is primarily transmitted through airborne droplets when an infected person coughs or sneezes.

MCQ: Which of the following is NOT a risk factor for measles?
a) Immunodeficiency in children
b) Travel to areas where measles is endemic
c) Malnutrition
d) Taking vitamin supplements
Answer: d) Taking vitamin supplements
Explanation: Immunodeficiency, travel to endemic areas, and malnutrition are risk factors for measles, but taking vitamin supplements is not directly associated with measles risk.

MCQ: Which stage of measles marks the beginning of improvement, characterized by skin desquamation and a decline in body temperature?
a) Incubation stage
b) Prodromal stage
c) Catarrhal stage
d) Convalescence stage
Answer: d) Convalescence stage
Explanation: The convalescence or recovery stage of measles marks the beginning of improvement, characterized by skin desquamation, a decline in body temperature, and the resolution of symptoms.