Introduction

This case study provides a thorough investigation of a person diagnosed with a certain
disease. This includes the profile of the patient, anatomy and physiology, the pathophysiology,
the clinical manifestations of the disease along with its complications, the laboratory tests,
diagnoses and nursing management needed. This case study is an important tool to determine an
effective nursing study and nursing care to patients. This case is of Bethany C. Mendoza, a 5-
year-old female who is diagnosed with German measles. German measles is defined as a
contagious viral infection best known by its distinctive red rash. 

It affects children and adolescents worldwide and can also affect young adults. When
rubella virus infects susceptible women early in pregnancy, it may be transmitted to the fetus and
may cause birth defects. Therefore, accurate diagnosis is critical in pregnancy. The rubella virus
is a member of the genus Rubivirus in the family Togaviridae.
 Patient Profile

Name: Bethany C. Mendoza

Room Number: 102

Age: 5 years old

Gender: Female

Civil Status: Single

Date of Birth: October 10, 2016

Birthplace: Pagadian City, Zamboanga del Sur

Cultural Group: Cebuano

Religion: Roman Catholic

Date of confinement: October 20, 2021

Description of Patient: A 5-year-old female patient was hospitalized because of fever and
swollen lymph nodes that was present for the preceding month. Five days prior to admission the
fever become severe and she also had experience cough, runny nose, and watery eyes. The
patient is also having rashes.

Diagnosis: Risk for impaired skin integrity related to raking pruritus

Procedure: Rubella Blood Test

Reason for Admission: Elevated Body Temperature

Test/Examination:

Vital signs: BP: 130/60 mmHg

HR: 80bpm

R: 20 breaths per minute

 TEMP: 39°C

Measurement: Height: 37 inches; weight: 25kg

General appearance: Viral rashes, appearing as either pink or light red spots.
Anatomy and Physiology:

Rubella virus is a spherical, 40- to 80-nm, positive-sense, single-stranded RNA virus with
spike-like, hemagglutinin-containing surface projections. An electron-dense 30 to 35 nm core is
surrounded by a lipoprotein envelope.

Pathophysiology:

Rubella infection in the first 3 or 4 months of pregnancy provides opportunities during

the period of maternal viremia for invasion of the placenta and subsequent fetal infection.
Development of infection probably depends upon gestational age. It has been estimated that the
fetus has a 40 to 60 percent chance of developing multiple rubella-associated defects if the
mother is infected during the first 2 months of pregnancy, with the risk dropping to 30 to 35
percent during the third month of gestation and 10 percent during the fourth. This difference in
both risk for and severity of fetal infection seen with gestational age may be associated with
immature host defenses during the first trimester of pregnancy.

During fetal infection, the virus can multiply in and damage virtually any organ system.
Pathogenesis of the congenital defects is not fully understood; however, a number of
mechanisms have been proposed. Cell culture studies show that the virus produces chromosomal
abnormalities, slows cellular growth rates, and causes cell lysis and death in some cell types;
these effects appear capable of producing the characteristic abnormalities of cell structure and
function. In addition, rubella infection induces angiopathy of early placental and embryonic
tissues, causing interference with the fetal blood supply and subsequent compromised growth
and/or malformation of the fetus. In the congenitally infected fetus and infant, virus persistence
occurs in the presence of neutralizing antibodies; immunological tolerance does not develop.
Clinical Manifestations:

Rubella is usually mild in children. Sometimes it doesn't cause any symptoms. A pink or
red-spotted rash is often the first sign of infection. It starts on the face and spreads to the rest of
the body. The rash lasts about 3 days. This is why rubella is sometimes called the "3-day
measles." Along with the rash, you or your child might have: A mild fever -- from 99 F to 100 F
Swollen and pink-colored eyes (conjunctivitis) Headache Swollen glands behind the ears and on
the neck Stuffy, runny nose Cough Sore joints (more common in young women) General
discomfort Lymph nodes may be swollen and enlarged.

Complications of Rubella
The most serious of these could happen during pregnancy, when the virus can pass from
mother to baby in the womb. The risk is highest during the first 3 months of pregnancy.
Babies who are infected can have serious birth defects called congenital rubella syndrome (CRS).
This is very rare in the Philippines, but a baby can get it if they travel to another country where the
virus spreads.
CRS is a group of health problems in a baby that can include: 

 Heart defects
 Cataracts
 Deafness
 Delayed learning
 Liver and spleen damage
 Diabetes
 Thyroid problems

Some women who get rubella during pregnancy have a miscarriage. In other cases,
the baby doesn't survive long after birth. It’s best to get vaccinated against rubella before you get
pregnant to protect your baby. You should wait at least 4 weeks after getting the vaccine to become
pregnant. If you’re already pregnant, you shouldn’t get the vaccine.
Rubella can also cause complications in women who aren't pregnant, and in men. Young girls and
women who get it can develop sore joints (arthritis). This side effect usually goes away within 2
weeks, but a small number of women will have it long term. It rarely happens in men and children.
In rare cases, rubella can cause more serious health problems, like brain infections or swelling and
bleeding problems.
Tests and Diagnosis

Diagnosis
The rubella rash can look like many other viral rashes. So doctors usually confirm rubella
with the help of laboratory tests. You may have a virus culture or a blood test, which can detect
the presence of different types of rubella antibodies in your blood. These antibodies indicate
whether you've had a recent or past infection or a rubella vaccine.

Rubella Blood Test

A rubella blood test detects antibodies that are made by the immune system to help kill
the rubella virus. These antibodies remain in the bloodstream for years. The presence of certain
antibodies means a recent infection, a past infection, or that you have been vaccinated against the
disease.

Treatment

No treatment will shorten the course of rubella infection, and symptoms don't usually
need to be treated because they're often mild. However, doctors often recommend isolation from
others — especially pregnant women — during the infectious period.

Lifestyle and home remedies

Simple self-care measures are required when a child or adult is infected with the virus that causes
rubella, such as:

 Bed rest

 Acetaminophen (Tylenol, others) for relief from fever and aches

Nursing Management

Nursing Diagnosis

Based on the assessment data, the major nursing diagnoses are:

 Impaired social interaction related to isolation from friends.

 Risk for impaired skin integrity related to raking pruritus.
 High risk of infection related to the host and infectious agents.
 Acute pain related to skin lesions and irritated mucous membranes.

Nursing Considerations

Interventions for a child with measles are:

 Isolation. Patients will need to be on isolation precautions to decrease transmission

within the community; emphasize the need for immediate isolation when early
catarrhal symptoms appear.
 Skin care. Measles causes extreme pruritus; nursing interventions include keeping the
patient’s nails short, encourage long pants and sleeves to prevent scratching, keeping
skin moist with health care provider recommended lotions, and avoiding sunlight and
heat.
 Eye care. Treat conjunctivitis with warm saline when removing eye secretions and
encourage patient not to rub eyes; protect the eyes from the glare of strong light.
 Hydration. Encourage oral hydration; medical literature encourages the use of oral
rehydration solution.
 Temperature control. Antipyretics should be administered to the patient as ordered
for a temperature greater than 100.4 Fahrenheit unless directed elsewise by a
healthcare provider; be sure to remind parents not to administer aspirin due to the risk
of Reye’s syndrome.
References

1. Bakshi SS, Cooper LZ: Rubella (review). Clin Dermatol 7:8. 1989 . [PubMed] 2. Centers for
Disease Control: Rubella and Congenital Rubella Syndrome — United States, January 1, 1991-
May 7, 1994. MMWR 43:391, 1994 . [PubMed] 3. Centers for Disease Control: Rubella
Prevention. MMWR, Recommendations and Reports 39:1–18, 1990.