13.01 Rubeola – Measles

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Measles (Image)
Measles Rash (Image)
Airborne Precaution Diseases (Mnemonic)
Immunization Schedule (Cheat Sheet)

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Hey everyone, in this lesson we are going to talk about Measles or Rubeola. Just a quick note- there is another disease called Rubella or German Measles. Rubella is less severe in kids than Rubeola but, Rubella is super dangerous for both pregnant mothers and fetuses. It can cause birth defects and miscarriages. We are focusing on Rubeola or Measles because it is more severe and seen more often in kids than German Measles.
So, Rubella is an extremely, extremely contagious viral infection that can cause a lot of negative, long-term side effects. Guys, it’s so contagious that if you aren’t immunized against it and you come into contact with someone who has it there is a 90% chance that you will become infected.

It’s spread via contact with droplets and can be airborne as well.

It used to be very rare in the United States, but is not now the rise. In fact, there is currently an outbreak of Measles in the United States that the worst that’s been seen since 1994.

The rise in cases is caused by a complex, combination of things - like increasing globalism as well as undervaccination. We all know- there has been a lot of controversy around the safety of the MMR vaccine- which immunizes kids against Measles, Mumps and Rubella. A study done in the 1998 reported a link between the MMR vaccine and autism and this resulted in a decline in immunization. This study has been totally discredited. I talk a bit more about this in the Autism Spectrum Disorder lesson if you want to check that out!

So, it’s really important that we educate parents on the safety and importance of the MMR vaccine to help stop these outbreaks and protect those in the community that are vulnerable. The most vulnerable are infants and kids with compromised immune systems.

If caregivers consent to it, the MMR vaccine is given between 12 and 15 months and again between 4 and 6 years.

For your nursing assessment there are several pretty classic symptoms to be familiar with.

First, measles usually causes a high fever- like 40 degrees celsius or 104 degrees fahrenheit. Then you have the classic 3 C’s, which are Coryza, Cough, and Conjunctivitis. Coryza is just a fancy word for inflammation of the mucous membranes in the nose.

Koplik spots may then appear on the inside of the cheek. They are these small grayish-white spots you see here in the photo. These are only associated with the diagnosis of measles-so if you see them you know exactly what the diagnosis is!

The rash associated with measles is pretty extensive, covering a large portion of the body. You have small flat or raised reddish brown spots. The flat spots are called macules. The raised ones are called papules. When they occur together people call it a maculopapular rash. In measles, these spots become so numerous that they actually join together making it look like large patches. The rash will spread from head to toe.

So, the first thing to do if you suspect a child has measles is place them on airborne precautions- remember this always takes a bit of extra effort because it requires a special mask called the N95- so always make sure the staff taking care of this kid have been properly fitted for this type of mask.

For the most part all we can do is provide supportive care. So we encourage rest, monitor hydration status (giving fluids as needed), provide eye care for the conjunctivitis and a cool mist vapor may help with the cough.

Medications that may be given to child with measles are, antipyretics like acetaminophen and ibuprofen. Remember, no aspirin for kids because it can cause Reye Syndrome! In cases where the child has to be hospitalized, Vitamin A may be given because this is shown to drastically improve outcomes and prevent damage to the eyes.

This brings me to the topic of complications. Some cases of measles will be handled outpatient and the child will have few long-term issues- but complications can happen and they are devastating. In the short-term, patients may develop life threatening pneumonia or encephalitis. Long-term these kids may end up with blindness, hearing loss and learning disabilities. Monitoring for these complications has to be part of our nursing care plan!

Your priority nursing concepts for a pediatric patient with measles are immunity, infection control, and health promotion.
Let’s go over your key points for this lesson! Measles is a highly contagious, viral infection. Remember, people are contagious until 5 days after the rash appears!

It’s spread through aerosolized droplets so make sure airborne precautions are in place as soon as you suspect the measles.

In your assessment the major things to know are high fever, the 3 C’s, Koplik Spots (on the inside of the cheek) and a very extensive rash.

Treatment is supportive and in severe cases vitamin A is given to improve outcomes and prevent damage to the eye. And remember a major part of health promotion is educating on the importance of immunizations. Measles can be prevented with the MMR vaccine.

Complications are a big deal with measles- pneumonia and encephalitis are the most common causes of death for patients with measles and hearing loss and blindness can occur as well.

That's it for our lesson on Measles. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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