Measles

Measles is a contagious illness brought on by a virus that causes fever, coughing, coryza, lacrimation, koplik spots in the pre-eruptive stage, and a maculopapular rash that appears on the fourth and fifth day of the illness.

A paramyxovirus family RNA virus is what causes measles. The only reservoir for infection and disease is a man, and these conditions might be endemic or epidemic. Usually 4 days and 5 days before and after the onset of a rash, the disease is spread by droplet spread from the secretions of the nose and throat.

Incubation Period

8-12 days

Risk Factors

• Age: Common among five kids, especially those who are preschoolers
• Sex: Both sexes are affected.
• Nutrition: Children who are underweight are more likely to get sick than children who are well-fed.
• Season: Common during hot dry season
• Socio-economic status: Poor and illiterate families, a child living in crowded areas.

Clinical Features

Three stages make up a disease's progression. Clinical characteristics based on the stage of the disease:

• Pre-eruptive stage: Acute onset accompanied by a mild increase in body temperature, a dry hacking cough, a runny nose, sneezing, redness of the eye, and excessive lacrimation. Koplik spots are tiny, bluish-white spots with a red base that are smaller than a pinhead that appear on the inner side of the cheeks, opposite of the second molars, on the second or third day of the illness. They vanish by the end of the second day of the rash.
• Eruptive stage: The stage is distinguished by a distinctive dark red, macular or macular-popular rash that starts behind the ears and rapidly spreads in a matter of hours over the face, neck, and lower body, taking 2-3 days to progress. the lower body's extremities When pressure is applied, rashes on the 4therythematous skin blanch (blotchy). When the rashes reach the palm and sole, they become brownish and do not go away with pressure.
• Post-measles stages: After 4-5 days, the rashes begin to fade in the same order in which they first appeared, leaving a brownish discoloration that may last for two months or longer. The temperature drops as the rash starts to go away. However, if the temperature stays high for an extended period of time, the infant will have lost weight. The problem may result in a failure to heal and a slow worsening into chronic illness.

Diagnosis

• The most important factor in making a diagnosis is the clinical presentation.
• Serological evaluation
• The test most frequently used to identify measles antibodies is the ELISA and hemagglutination inhibition. A fourfold increase in antibody titer against measles is regarded as diagnostic.

General Management

Symptomatic and supportive therapies are used in the treatment of measles. This comprises:

• The use of antipyretics for fever
• Antibiotics for bacterial infections that are secondary
• Maintain your hydration and nutrition
• For a persistent cough, nebulization
• Keep your body and mouth clean.
• injection of phenobarbital or diazepam for convulsion, if present.

Classification and Management according to IMCI Guidelines

Severe Complicated Measles

Diagnosis:

• Any one of the clinical manifestations listed below plus the aforementioned clinical presentations being unable to shrink or nurse, vomiting everything and trembling
• Examination revealed the following indicators of complications: lethargy or unconsciousness, ocular clouding, a deep and extensive mouth ulcer, pneumonia, diarrhea, strider, and seriously undernourished.

Treatment:

• Place the kid in a medical facility.
• Unless the youngster has already received enough vitamin A to avoid blindness, administer vitamin A therapy. For children older than 1 year old, the dosage is 2 lakh units given orally over the course of two days, with the first dose given right away and the second given during a follow-up visit if the child exhibits symptoms of severe malnutrition or vitamin A deficiency.
• Supportive care: Isolation for the fifth day after the rash appears, care and maintenance of respiratory hygiene, bed rest during the pro-dermal stage, use of an antipyretic to treat fever, nutritional support (assessment of nutritional status, baby weight), continuation of breastfeeding, frequent small meals, monitoring and treatment of mouth ulcers, eye care, and skin care.
• Check for fever twice a day, and keep an eye out for complications.
• Follow up: In the event that something goes wrong, ask the mother to come back right away.

Nonsevere Measles

Diagnosis:

Measles rashes or if a child has a generalized rash, a fever, and one of the following symptoms (a cough, a runny nose, or a red eye), but no other signs of a severe case of the disease.

Treatment:

Treatment in an outpatient setting, management of measles along with care for an eye condition, and administration of vitamin A

Supportive care:

• For fever, use paracetamol.
• if there is secondary infection treatment
• nutritional assistance
• Apply tetracycline eye ointment three times daily for seven days if an infection is present and clean cotton dipped in boiled, cooled, and warm water to clean the eyes.
• If a mouth sore is present, treat it with clean, salty water.
• Observation in 2 days

Complication:

• Respiratory: Otitis media, cervical lymphadenopathy, laryngitis, pneumonia
• Neurological: Encephalitis
• Digestive system: Appendicitis hepatitis, ileocolitis malnutrition
• Others: Acute glomerulonephritis, steven johnson syndrome disseminated intravascular coagulation.

 REFERENCE

Ambika Rai, Kabita Dahal. Community Health Nursing-II. Kathmandu: Makalu Publication House, 2011.

Chabers, A.M. (2007). Surgical nursing of children. India: Elsevier Private Limited

Mandal, G.N. A textbook of adult nursing . Kathmandu: Makalu publication house, 2013.

Marks, R. (1995). Common skin disease (16th ed.). London Champ man and Hall

Tuitui, Roshani. Community Health Nursing. Kathmandu: Vidyarthi Prakashan (P.) LTD., 2067.

Sharma, P.R. (2002). A hand book of pediatric problems. Ktahmandu: HLMC

Smeltzer, S.C., & Bare, B.B. (2004). Brunner Siddhath’s, text book of medical surgical nursing (10th ed.). Lippincott: Williams and Wilkins.

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