Question

Active learning template system disorder measles

ACTIVE LEARNING TEMPLATE: em Disorder STUDENT NAME DISORDER/DISEASE PROCESS Measles REVIEW MODULE CHAPTER 3lo Alterations in Health (Diagnosis) Pathophysiology Related to Client Problem Health Promotion and Disease Prevention ASSESSMENT SAFETY CONSIDERATIONS Risk Factors Expected Findings Laboratory Tests Diagnostic Procedures PATIENT-CENTERED CARE Complications Nursing Care Medications Client Education Therapeutic Procedures Interprofessional Care ACTIVE LEARNING TEMPLATES

Answer 1

Diagnosis:
Diagnosis of measles based on the disease's characteristic rash as well as a small, bluish-white spot on a bright red background — Koplik's spot — on the inside lining of the cheek.If necessary, a blood test can confirm whether the rash is truly measles.

Pathophysiology:

Measles is caused by a paramyxovirus and is a human disease with no known animal reservoir or asymptomatic carrier state. It is extremely communicable; the secondary attack rate is > 90% among susceptible people who are exposed.

Measles is spread mainly by secretions from the nose, throat, and mouth during the prodromal or early eruptive stage. Communicability begins several days before and continues until several days after the rash appears. Measles is not communicable once the rash begins to desquamate.

Transmission is typically by large respiratory droplets that are discharged by cough and briefly remain airborne for a short distance. Transmission may also occur by small aerosolized droplets that can remain airborne (and thus can be inhaled) for up to 2 hours in closed areas (eg, in an office examination room). Transmission by fomites seems less likely than airborne transmission because the measles virus is thought to survive only for a short time on dry surfaces.

An infant whose mother has immunity to measles (eg, because of previous illness or vaccination) receives antibodies transplacentally; these antibodies are protective for most of the first 6 to 12 months of life. Lifelong immunity is conferred by infection. In the US, almost all measles cases are imported by travelers or immigrants, with subsequent indigenous transmission occurring primarily among unvaccinated people.

Health promotion and disease prevention:

Measles vaccine in children

To prevent measles in children, doctors usually give infants the first dose of the vaccine between 12 and 15 months, with the second dose typically given between ages 4 and 6 years. Keep in mind:

• If you'll be traveling abroad when your child is 6 to 11 months old, talk with your child's doctor about getting the measles vaccine earlier.
• If your child or teenager didn't get the two doses at the recommended times, he or she may need two doses of the vaccine four weeks apart.

Measles vaccine in adults

You may need the measles vaccine if you're an adult who:

• Has an increased risk of measles — such as attending college, traveling internationally or working in a hospital environment — and you don't have proof of immunity. Proof of immunity includes written documentation of your vaccinations or lab confirmation of immunity or previous illness.
• Was born in 1957 or later and you don't have proof of immunity. Proof of immunity includes written documentation of your vaccinations or lab confirmation of immunity or previous illness.

If you're not sure if you need the measles vaccine, talk to your doctor.

Preventing measles during an outbreak or known infection

If someone in your household has measles, take these precautions to protect vulnerable family and friends:

• Isolation. Because measles is highly contagious from about four days before to four days after the rash breaks out, people with measles shouldn't return to activities in which they interact with other people during this period.

  It may also be necessary to keep nonimmunized people — siblings, for example — away from the infected person.

• Vaccinate. Be sure that anyone who's at risk of getting the measles who hasn't been fully vaccinated receives the measles vaccine as soon as possible. This includes infants older than 6 months and anyone born in 1957 or later who doesn't have written documentation of being vaccinated, or who doesn't have evidence of immunity or having had measles in the past.

Risk factors :

Risk factors for measles include:

• Being unvaccinated. If you haven't received the vaccine for measles, you're much more likely to develop the disease.
• Traveling internationally. If you travel to developing countries, where measles is more common, you're at higher risk of catching the disease.
• Having a vitamin A deficiency. If you don't have enough vitamin A in your diet, you're more likely to have more-severe symptoms and complications.

Expected findings :

Measles signs and symptoms appear around 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.

  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, the 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.
  

Laboratory tests :

A complete blood count is unnecessary but, if obtained, may show leukopenia with a relative lymphocytosis.

Laboratory confirmation is necessary for public health and outbreak control purposes. It is most easily done by demonstration of the presence of measles IgM antibody in an acute serum specimen or by viral culture or RT-PCR of throat swabs, blood, nasopharyngeal swabs, or urine samples. A rise in IgG antibody levels between acute and convalescent sera is highly accurate, but obtaining this information delays diagnosis. All cases of suspected measles should be reported to the local health department even before laboratory confirmation.

Diagnostic procedures:

• Clinical evaluation

• Serologic testing

• Viral detection via culture or reverse transcription–polymerase chain reaction (RT-PCR)

Typical measles may be suspected in an exposed patient who has coryza, conjunctivitis, photophobia, and cough but is usually suspected only after the rash appears. Diagnosis is usually clinical, by identifying Koplik spots or the rash in an appropriate clinical context. A complete blood count is unnecessary but, if obtained, may show leukopenia with a relative lymphocytosis.

Laboratory confirmation is necessary for public health and outbreak control purposes. It is most easily done by demonstration of the presence of measles IgM antibody in an acute serum specimen or by viral culture or RT-PCR of throat swabs, blood, nasopharyngeal swabs, or urine samples. A rise in IgG antibody levels between acute and convalescent sera is highly accurate, but obtaining this information delays diagnosis. All cases of suspected measles should be reported to the local health department even before laboratory confirmation.

Differential diagnosis includes rubella, scarlet fever, drug rashes (eg, resulting from phenobarbitalor sulfonamides), serum sickness (see Table: Some Causes of Urticaria), roseola infantum, infectious mononucleosis, erythema infectiosum, and echovirus and coxsackievirus infections (see Table: Some Respiratory Viruses). Manifestations can also resemble Kawasaki disease and cause diagnostic confusion in areas where measles is very rare.

Some of these conditions can be distinguished from typical measles as follows:

• Rubella: A recognizable prodrome is absent, fever and other constitutional symptoms are absent or less severe, postauricular and suboccipital lymph nodes are enlarged (and usually tender), and duration is short.

• Drug rashes: A drug rash often resembles the measles rash, but a prodrome is absent, there is no cephalocaudal progression or cough, and there is usually a history of recent drug exposure.

• Roseola infantum: The rash resembles that of measles, but it seldom occurs in children > 3 years of age. Initial temperature is usually high, Koplik spots and malaise are absent, and defervescence and rash occur simultaneously.
  

Nursing care :

• Check for the patient if he/she is taking medication properly at regular intervals. Give advice about the condition.

Therapeutic procedures:

• 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, Children's Motrin, others) or naproxen (Aleve) to help relieve the fever that accompanies measles.

  Don't give aspirin to children or teenagers who have measles symptoms. 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. Children 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 children older than a year.
  

Client education :

• All should be vaccinated properly.
• Good diet which is balanced.
• Having good body health and hygiene.

Interprofessional care :

• Providing good hospital facility and care
• Providing vaccine stocks
• Providing good medications

Complications :

Complications of measles may include:

• Ear infection. One of the most common complications of measles is a bacterial ear infection.
• Bronchitis, laryngitis or croup. Measles may lead to inflammation of your voice box (larynx) or inflammation of the inner walls that line the main air passageways of your lungs (bronchial tubes).
• Pneumonia. Pneumonia is a common complication of measles. People with compromised immune systems can develop an especially dangerous variety of pneumonia that is sometimes fatal.
• Encephalitis. About 1 in 1,000 people with measles develops a complication called encephalitis. Encephalitis may occur right after measles, or it might not occur until months later.
• Pregnancy problems. If you're pregnant, you need to take special care to avoid measles because the disease can cause preterm labor, low birth weight and maternal death.

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