Lerelyn Case Reading4

8/6/2019 Lerelyn Case Reading4

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MEASLESRubeola/Morbilli


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Measles is an acute, contagious and

exanthematous disease that usually

affects children which aresusceptible to Upper Respiratory

Tract Infection (URTI).

one of the most common and mostserious of all chidhood diseases


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Etiologic agent:

Filtrable virus that belongs to genyus

Morbilivirus of the family paramyxoviridaeis the agent of measles


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MODE OF TRANSMISSION

by droplet spread or direct contact with

infected persons, or indirectly through

articles freshly soiled with secretions of nose

and throat, in some instances probably

airborne


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INCUBATION PERIOD

10-12 days (the longest is 20 days and theshortest is 8 days)


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PERIODOF COMMUNICABILITY

Usually lasts about 9-10 days, measured

from the beginning of the prodromal

symptoms to the fading of rash.The disease is communicable 4 days before

and 5 days after the appearance of rashes

The disease is communicable during the

height of rash


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PATHOGNOMONIC SIGN

Kopliks Spots - these are inflammatory

lesions of the buccal mucosa glands withsuperficial necrosis.1. They appear on the mucosa of the inner cheek opposite to the 2nd

molars, or near the junction of the gum and the inner cheek

2

. They usually appear1-2

days before the measles rash.


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CLINICALMANIFESTATION

3 STAGES:

1. Pre-eruptive stage

a. Fever catarrhal symptoms (rhinitis,

conjunctivitis, photophobia, coryza)

b. Respiratory symptoms start from commoncolds to persistent coughing

c. Enanthema sign (kopliks spot)


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2. ERUPTVE STAGE

a. the rash is usually seen late on the 4th day

b. macula-papular rash appears 1st on the cheeks,

bridge of nose, along the hairline, at the temple or at

the earlobe

c. the rash is fully developed by the end of the 2nd dayand all the symptoms are at the maximum at this time.

d. High grade fever comes on and off

e. Anorexia and irritability

f. Abdominal typanism, pruritus letharyg. The throat is red and often extremely sore.

h. As fever subsides, coughing may diminish, but more

often it hangs on for a week or2, become looser and

less metallic


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3. STAGE OF CONVALESCENCE

a. Rashes fade away in the manner as they

erupted

b.F

ever subsides as eruption disappearsc. When the rashes fade, desquamation

begins

d. Symptoms subside and appetite is

restored


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Laboratory exams

1. nose and throat swab

2. urinalysis

3. blood exams (CBC, leukopenia,leukocytosis)

4. complement fixation or hemogglutinin test


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Drug of choice

1. anti

-viral drugs(Isoprenosine)

2. Antibiotics if with complication

3. Supportive therapy (oxygen

inhalation, IV fluids)


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NURSINGINTERVENTION1. Isolation of the patient is necessary ( the room must be

quiet, well-ventilated, and must have subdued light.

2.Control of the patients high temperature with warm ortepid sponges.

3. Skin care is utmost. The patient should have a daily

cleansing bed bath. The water should be comfortably

warm.

4.Oral and nasal hygiene is a very important aspect of

nursing care of patient with measles.

5. Care of the eye is necessary. The patient is sensitive to

light, therefore, position the patient where a direct glare of

light is avoided.


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PATHOPHYSIOLOGY

measles virus

respiratory tract

epithelial cells(multiply)

lymphoid tissueblood (first virusemia)

MPS(multiply)

blood (second virusemia)

general toxic symptoms

measles virus

respiratory tractepithelial cells(multiply)lymphoid tissueblood (first virusemia)MPS(multiply)blood (second virusemia)

general toxic symptoms


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Chicken pox(Varicella)


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Definition:

is highly contagious disease caused by herpesvirus varicella, characterized by vesicular

eruptions on the skin and mucous membranes

usually with mild constitutional manifestations


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Incubation Period:

From10-21 days with a mean of14 days or

2 weeks

Period ofCommunicability:

The patient is contagious about a day beforethe eruption of rashes and continuous to be

so up to the 5th or 6th day after the last scab

formation or until all vesicles have become

encrusted.


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Modes ofTransmission:

1. Direct Contact with patient who

sheds the virus from vesicles

2. Indirect Contact through

articles fresh soiled by discharges

of infected persons3. Airborne or spread by

droplet infection


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PATHOGNOMONIC SIGN- vesiculo-papular rash


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Clinical Manifestations: Pre- eruptive manifestations aremild fever and malaise

Eruptive stage Rash starts from the trunk (unexposed area), then spread

to other parts of the body

Initial lesions are distinctively red papules whwerecontents become milky and pus-like within 4 days

In adult and bigger chidren, the lesions are morewidespread and more severe.

There is srapid progression so that transition is completedin 6-8 hours.

Vesicular lesions are very puritic.

All stages are present simultaneously before all arecovered with scabs, known as Celestial Map

All lesions appear in different stages at one time or it willpass through the ff: stages:


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H. Macule is a lesion that is not elevated above the skin

surfaceI. Papule is a lesion that is elevated above the skin surface

with a diameter of about 3mm

J. Vesicle is a pop-like eruption filled with fluid. The thin

walled vesicle easily bursts and dries up in 3-5 days

K. Pustule is a vesicle that is infected or filled with pus. L. If

the lesion becomes infected the scar may be big and wide.

M. Crust is a scab or eschar. This is a secondary lesion

caused by the secretion of vesicle drying on the skin.

N. The scars are superficial, depigmented and take time tofade out.


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COMPLICATION1. secondary to infection ofsecondary to infection of

the lesionsthe lesions Furuncles,Furuncles,cellulites, skin abscess,cellulites, skin abscess,

erysipelaserysipelas

2.

2.meningoencephalitismeningoencephalitis

3.3. pneumoniapneumonia

4.4. sepsissepsis


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Antivirals

Antiviral drugs can reduce symptoms for people at risk of complications

from the chicken pox including: adults, smokers, and people with a

compromised immune system. Acyclovir and immune globulin

intravenous (IGIV) must be taken no more than a day after the rash firstappears. Valacyclovir and famciclovir can be taken after a day,but are only

approved for adults.

Vaccine

The chicken pox vaccine can eliminate or reduce symptoms, even if it is

taken after exposure to the virus.

Antibiotics

Some complications of chicken pox, such as skin infection andpneumonia, may require treatment with antibiotics. Smokers are

especially at risk for pneumonia.

Itch Relievers

Over-the-counter medications such as antihistamines and itch-relief

creams can help alleviate itching. This reduces scratching, which

increases the chance of skin infection.

Pain Relievers

Acetaminophen can relieve the pain of chicken pox symptoms. Never

use aspirin with the chicken pox; it can lead to Reye's syndrome, which

causes liver failure and even death.


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NURSING INTERVENTION Respiratory isolation is a MUST until all vesicles have crusted. Prevent secondary infection of the skin lesion through

hygienic care of the patient

Attention should be given to nasopharyngeal secretions and

discharges. Linens must be didinfected under the sunlight or

through biling

Cut finger nails short and wash hands more often to minimize

bacterial infections that may be introduced by scratching.

A child must wear mittens.

Provide activities to keep child occupied to lessen pruritus.


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PREVENTION active immunization with live attenuated varicellavaccine is necessary.

avoid exposure as much as possible to infected

persons


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DIAGNOSTICPROCEDURES

Determination Of V-Z Virus

through Complement FixationTest

Determination Of V-Z Virus

through Electron MicroscopicExamination


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DRUGSZoverax 500mg/ tablet, 1 tab 2x a aday for 7 days must be

administered.

Oral acyclovir 800mg 3x a day for 5 days must also be givenOral antihistamine can be taken to symptomatic pruritus.

Calamine lotion will ease itchiness.

Salicylates must not be given.

Antipyretic might be given for fever.


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Pathophysiology

NEW VICTIM ENTER BLOOD

STREAM

ENTER OTHER

LUNGS

DROPLET

CONTAINS

VIRUS

VIA

AIRBORNE

INFECTED

PERSON


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German

measles(Rubella / three day Measles )


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Definition- is a mild viral illness caused by rubella

virus

- it causes mild feverish illneess associted

with rashes and aches in joints

- has a teratogenic effect on the fetus


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CAUSATIVE AGENT

Rubella virus (Family- Togaviridae; Genus Rubivirus

INCUBATION PERIOD

From exposure to the appearance of rash,the incubation period is usually 14-21 days

PERIOD OF COMMUNOICABILITY

the virus is communicable approximately 1week before and 4 days after the onset of rashes,

but is at its worst when the rash is at its peak.

highly communicable infants with congenital

Rubella may shed virus for months after births.


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MODE OF TRANSMISSION

1. direct contact with nasophayngealsecretions

2.air droplets

3.transplacental transmission in congenital

rubella4. infants with congenital rubella she d large

quantities of virus in the pharyngeal

secretions and urine in which serve assource of infection to other contacts.


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PATHOGNOMONIC SIGN

Forchhmeirs spot


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SIGN AND SYMPTOMS1. Prodromal period

Low grade fever

Headache

Malaise

Mild coryza Conjunctivitis

Post-auricular, sub-occipital, and posteriorcervical lymphadenopathy which occur on

the 3rd to the 5th days after onset


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2. Eruptive stage A pinkish rash on the soft palate

(Forchheimers spot), an exanthematous rashthat appears first on the face, spreading to the

neck, the arms, trunk, and legs. Eruption appears after the onset of

adenopathy

Children usually present less or noconstitutional symptoms.

The rash may last for one to five days andleaves no pigmentation nor desquamation

Testicular pain inyoung adults

Transient polyathralgia and polyarthritis mayoccur in adults and occasionally in children.


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Diagnostic procedures Rubella hemagglutination inhibiting Abs present by

second day of rash and incease in quantity over the next

10-21 days

Others: CF (Compliment Fixation Test), ELISA (o

Enyyme s Link Immunosorbent Assay, SRH (SingleRadial Hemolysis), RIA ( Radioimmunoassay),

IgM(Specific Ab test)

Hemagglutination Inhibition(HI) antibody test is accepted

as the most useful tecnique for diagnosis


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DRUGS Acetaminophen

Nonsteroidal anti-inflammatory drugs:

Aspirin

Ibuprofen

Naproxen

Ketoprofen

AcetaminophenAcetaminophen decreases feverand pain, but does not helpinflammation.

Adult dosing is 2 regular strength (325 mg) every 4 hours or2 extra-strength (500 mg) every 6 hours.

Maximum dose is 4,000 mg per day.Avoid this drug if you have alcoholism, liver disease or an allergy to the

drug. See the package instructions.

Common brand names include Tylenol, Panadol, and many others.


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Common medications used at home for

pain and fever in children with rubella

include:

Acetaminophen

Ibuprofen

Naproxen (must be13

or older)

Aspirin and most of the othernonsteroidal

anti-inflammatory drugs (NSAIDS) are not

used in children except under a doctor's

care.


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PATHOPHYSIOLOGY


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Herpes

zoster(Shingles)also known as zona,

an n ect on o sensory nerve t s an extreme y


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- an n ect on o sensory nerve, t s an extreme y

painful infection which the lesion occur only along

the sensory nerve that is affected


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CAUSATIVE AGENT Varicella-zoster (V-z) virus

This agent has been found to cause two diseases,varicella and herpes zoster

The incubation period of herpes zoster is unknown it isbelieved to be 13-17 days.

INCUBATION PERIODThe incubation period is unknown, it is believed to

be 13-17 days

Period of communicabilityHerpes zoster is communicable a day before theappearance of the first rash until five days after the lastcrust.


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MODE OF

TRANSMISSION Herpes zoster can be transmitted through direct contact,

through droplet infection, and airborne spread.

It can also be transmitted through indirect contact,through articles freshly soiled by secretions and

discharge from the infected person.


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PATHOGNOMONIC SIGN

-regional painful rash AND lesion follow peripheral nerve pathway of CN V andCN VII

L


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SIGN AND SYMPTOMS- burning, itching, and pain, erythematous pathes appearfollowed by crops of vesicles which forms a band-likedistribution of along the course of involved dermatomes,eruptions are unilateral and nerve crosses the midline ofthe body

- the vesicles become umbilicated and crusting starts.Successive crops may appear. The lesion may last 1-2wks. Usually there are no scars unless secondaryinfections sets in.

- fever and regional lymphadenopathy

-Iridocycliitis and corneal anesthesia when the opthalmic

or fist division of the 5th

cranial nerve is affected, this iscalled Gasserian Ganglionitis

-Paralysis of the facial nerve and vesicles in the externalauditory canal are the results of infection of the 7th cranialnerve or the Geniculate Ganglion, the condition is called

Ramsav Hunt Syndrome


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COMPLICATION Encephalitis

Paralytic ileus, bladder paralysis

Ophthalmic herpes which may

lead to blindness


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NURSING INTERVENTION

Put patient on strict isolation Apply cool, wet dressings with NSS to

pruritic lesions.

Efforts should be made to preventsecondary infection

Prevent entrance of microorganism into

the lesions especially if they break.


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PREVENTION Prevention

Avoid contact with active Shingles orChicken Pox

Consider prophylaxis if exposure in high-risk groups

Varicella Vaccine

May reduce risk of developing Shingles

Now part of routine Primary Series

BoosterVarivax for age >55 years may be

considered


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DIAGNOSTIC PROCEDURE

Characteristic skin rash may bediagnostic

Tissue culture technique the virusmaybe isolated from fluid taken

from newly developing vesicles.

Smear of vesicle fluid

Microscopy


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DRUGSPeople with mild to moderate pain can be treated

with over the counter analgesic.Topical lotions containing calamine can be used onthe rash or blisters and may be soothing.Occasionally, severe pain may require an opioidmedication, such as morphine.Once the lesions have crustedover, capsaicin cream (Zostrix) can be used.Antiviral drugs inhibit VZV replication and reduce theseverity and duration of herpes zoster with minimalside effects, but do not reliably prevent postherpeticneuralgia of these drugs, acyclovir has been the

standard treatment, but the newdrugs valaciclovir and famciclovir demonstratesimilar or superior efficacy and good safety andtolerability.


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PATHOPHYSIOLOGY

After the primary infection the varicella zostermay persist in a dormant state in the dorsal

root ganglia

the virus may later emerge from the siteeither spontaneously or in association with

immunosuppression which causes herpes

zoster

it produces localized vesicular skin lesionconfined to dermatoe and severe neurologic

pain in the peripheral areas innervated by the

nerves arising in inflamed root ganglion

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