DEFINITION

• MEASLES (Rubeola/Morbilli) is an acute, contagious

and exanthematous disease that usually affects
children who are susceptible to upper respiratory
tract infection (URTI). this may be one of the most
common and most serious of all childhood
diseases.
ETIOLOGY
• A fILTRABLE VIRUS which belongs to the genus
Morbilivirus of the family Paramyxoviridae is the
agent of measles.
• The measles virus is rapidly inactivated by heat,
ultraviolet light and extreme degrees of acidity and
alkalinity.
SOURCE OF INFECTION
• The virus has been found in patient's blood, as well
as in the secretions from the eyes, nose and throat.
MODE OF TRANSMITION
• The disease is transmitted through direct contact
with droplets spread through coughing or sneezing.
• it can also be transmitted indirectly through articles
or fomites freshly contaminated with respiratory
secretions of infected patients.
INCUBATION PERIOD
• The incubation period is from ten to twelve days
(the longest is 20 days and the shortest is eight
days)
• A single attack conveys lifelong immunity.
PATHOGENESIS
• After infection, virus enters lymphoid tissue of
tonsils, adenoids and lymphnodes with hyperplasia of
reticuloendothelial system and then enters blood.
• It starts with symptoms of common cold and
photophobia which develops by the 2nd day.
•
• Diagnostic "Koplik’s spots" are red irregular macules
(1-3mm) with central white speck, appear on the
buccal mucosa opposite 2nd molar tooth, around the
opening of the parotid duct.
•
• In severe cases they can involve the entire mucous
membrane of the mouth.
•
• After 3-4 days, "Koplik’s spots" disappear and
blotchy, erythematous rash develops at the back of
ears, which becomes maculopapular and rapidly
spreads over face and down the neck, trunk and
limbs.
•
• Nonproductive cough and fever increases.
•
• Rash clears with desquamation of epidermis and
symptoms disappear within a few days.
 PATHOGNOMONIC SIGN
• KOPLIK'S SPOTS are the pathonomonic of measles. these
are inflammatory lessions of the buccal mucous glands
with superficial necrosis.
1.) They appear on the mucosa of the inner cheek
opposite to the second molars, or near the junction
of the gum and the inner cheek.
2.) They usually appear one to two days before the
measles rash.
COURSE OF THE DISEASE

1.) PRE- ERUPTIVE STAGE

a.) Fever
b.) Catarrhal symptoms ( rhinitis, conjunctivis,
photophobia, coryza)
c.) Respiratory symptoms start from common colds to
persistent coughing.
d.) Enanthem sign (Koplik's spot, Stimson's line)
2.) ERUPTIVE STAGE
a.)A maculo- papular rash usually starts to appears
late on the 4th day.
b.)The maculo-papular rash appears first on the
cheeks, bridge of the nose, temples, earlobes or
along the hairline.
c.) The rash is fully developed by the end of the
second day and alll symptoms are their most severe
at this time.
d.) High-grade fever comes on and off.
e.) Anorexia and irritability
f.) Abdominal tympanism, pruritus and lethargy
g.) The throat is red and often extremely sore.
h.) As fever subsides, coughing may diminish, but
more often it hangs on for a week or two and
becomes looser and less metallic.
3.) STAGE OF CONVALESCENCE
a.) Rashes fade away in the same manner as they
eruptive.
b.) The fever subsides as the rashes start to fade.
c.) When the rashes have faded, desquamation
begins.
d.) Symptoms subside and appetite is restored.
COMPLICATIONS
• Bronchopneumonia
• Otitis media
• Pneumonia/ Bronchitis
• Nephritis
• encephalitis, encephalomyelitis
• blindness
• cervical adenitis
• Laryngitis
• Diarrhea
DIFFERENTIAl DIAGNOSIS
• Characteristic of Koplik spots.
• Leukopenia
• The measles hemagglutination antibody test is
rarely used except in cases of a questionable
diagnosis.
DIAGNOSTIC PROCEDURES
• Nose and throat swab
• Urinalysis
• Blood exams (CBC, leukopenia, leukocytosis)
• Complement fixation or hemogglutinin test
MODALITIES OF TREATMENT
• Antiviral drugs (isoprinosine)
• Antibiotics if with complication
• Analgesic such as aspirin and nonnarcotic drug
mixture maybe ordered.
• immune human globulins administerd within one
week after exposure may prevent or modify the
disease.
• supportive theraphy (oxygen inhalation, IV fluids)
PERIOD OF COMMUNICABILITY
• Measles usually lasts about nine to ten days,
measured from the beginning of the prodromal
symptoms to the fading of the rash.
• The diseases is communicable four days before and
five days after the appearance of rashes.
• The disease is most communicable at the height of
the rash.
METHOD OF CONTROL

• RECOGNITION AND REPORTING – disease is

recognized by the clinical symptoms, and is
confirmed by laboratory diagnosis.
• ISOLATION
• QUARANTINE
• IMMUNIZATION
NURSING CARE
• ISOLATION

• COMFORT OF THE PATIENT- the room should be light

and airy. sunlight is essential, but the patient's eyes
should be protected from direct or to bright light.

• PERSONAL HYGIENE- (care of the skin) a warm

sponge bath should be given daily, itching or burning
of the skin may relieved by applying a 5 percent
solution of sodium bicarbonate, or calamine lotion or
by rubbing with carbolized petrolatum.
• (Care of the mouth) - dilute hydrogen peroxide,
sodium bicarbonate, or any alkaline antiseptic
solution may be used to cleanse a mouth.
• (Care of the nose) - A paper bag for soiled
handkerchiefs may be attached to the bedside table
with scoth tape.
• DIET- milk, fruit juices, broth, cereals and ice cream
constitute the diet for child.
COMMON NURSING DIAGNOSES
• Ineffective airway clearance
• Altered nutrition: Less than body requirement
• Impaired skin integrity
• Knowlege deficit
• Body image disturbance
• Alteration in comfort
• Sleep pattern disturbance
• Alterd body temperature