A.

BASIC CONCEPTS

1. DEFINITION
Morbili is an acute, infectious viral disease characterized by 3 stages, namely the
prodormal (kataral) stage, eruption stage and convalisensive stage, which is
manifested by fever, conjunctivitis andhead spotting (Children's Health Sciences
Edition 2, 1991). FKUI). Morbili is a common infectious childhood disease usually
characterized by mild major symptoms, a rash similar to mild measles or fever,
scarlet, enlargement and spleen pain (Children's Health Sciences vol 2, Nelson, EGC,
2000)

2. ETIOLOGY
The cause is the morbili virus found in the nasopharynce secretion and blood during
the prodormal period up to 24 hours after the spots appear. This virus is an RNA virus
that belongs to the family Paramiksoviridae, genus Morbilivirus. The way it is
transmitted is with droplets of infection.

3. PATHOPHYSIOLOGY
The cause of measles is measles virus  (MV), genus of morbili virus,
familyparamyxoviridae. The virus becomes inactive when exposed to heat, light,
acidic pH, ether, and trypsin and lasts less than 2 hours in the open air. The measles
virus is transmitted through droplets, attaches and multiplies to the nasopharyngeal
epithelium. The virus enters through the respiratory tract especially the upper part,
also possibly through the tear glands.
Two to three days after invasion, replication and colonization continues in the
regional lymph nodes and the first viremia occurs. The virus spreads in all
reticuloendothelial systems and follows a second viremia after 5-7 days of initial
infection. The presence of giant cells and the inflammatory process is the pathological
basis of rash and peribronchial infiltration of the lungs. There are also udema, dams
and bleeding that spread to the brain. Colonization and spread of the epithelium and
skin cause coughs, colds, red eyes (3 C: coryza, cough and conjuctivitis)and fevers
that are getting higher. Symptoms of heat, cough, cold are getting heavier and on the
10th day since the beginning of infection (on the day the patient comes into contact
with the source of infection) begins to appear a rash of makulopapuler reddish color.
 The virus can multiply also in the central nervous system and cause clinical symptoms of
encefalitis. After the convelesent period on the descent and hypervascularization subsides
and causes the rash to get darker, turning into desquamation and hyperpigmentation. This
process is caused because at first there is pericular bleeding and lymphocyte infiltration.

1. CLINICAL SYMPTOMS
The period of budding / incubation of the disease lasts approximately 10-20 days and the
onset of symptoms that are divided into 3 stages:

A. Kataral stadium (prodormal)

The prodormal stage lasts for 4-5 days characterized by ringa to moderate fever, mild dry cough,
coryza, photophobia and conjunctivitis. Towards the end of the catalytic stage aand 24 hours before
enantema arises, corplic spotting is patognomonic for morbili, but is very rare. The koplic
patches are gray white, as big as the tip of a needle and surrounded by erythema.

       The localization is webcosed openly opposite the molar below, but can spread irregularly
on the entire surface of the cheek. Although rare, they can also be found in the middle of the
lower lip, palate and lacrimal karankula. The patches appear and disappear quickly within 12-18
hours. Sometimes the prodormal stage is severe because it is accompanied by a sudden high fever
accompanied by convulsions and pneumoni. Peripheral blood images are lymphocytosis and
leukopenia.

B. Stage of eruption

Coryza and the coughing increased. Embossed erythema / red dots are hammered durum and
palate mole. The occurrence of erythema in the form of macula macula is accompanied by an
increase in body temperature. Erythema arises behind the ear at the top of the lateral nape of
the neck, along the hair and the lower back. Sometimes there is primary bleeding on the
skin. Itching, swollen face. There is an enlargement of the lymph nodes in the angle of the
mandible and in the area of the back neck. There is also a little splenomegaly, not
infrequently accompanied by diarrhea and vomiting. A variation of this common morbily is
"Black Measles" which is a morbily accompanied by bleeding on the skin, mouth, nose and
digestivus truck.
c. Stadium convalescence

Reduced eruptions leave older colored marks (hyperpigmentation) that can disappear on their
own. In addition to hyperpigmentation in Indonesian children, it is often found that scaly skin
is also found. Hyperpigmentation is a patognomonic symptom for morbili. In other diseases
with erythema or exantema the skin rash disappears without hyperpigmentation. The
temperature drops until it becomes normal unless there are complications.

Complications

a. Acute otitis media

b. Pneumonia/bronchopneumoni

c. Encefalitis

d. Bronchiolitis

e. Obstruction laryngitis and laryngrachrachticetis

6. NURSING DIAGNOTIC

On blood tests, the number of leukocytes is normal or increases if there are complications of
bacterial infection. IgM antibody screening is the fastest way to confirm the presence of an
acute measles infection. Because IgM may not be detectable in the first 2 days of rash, an
IgM blood test is done on the third day to avoid false negatives. IgM begin to be difficult to
measure at 4 weeks after the rash appears.

While IgG antibodies can be detected 4 days after the rash appears, most IgG can be detected
1 week after onset to 3 weeks after onset. IgG can still be found until a few years
later. Measles virus can be isolated from urine, nasopharyngeal aspirates, blood given
heparin, and throat swabs during prodromal times up to 24 hours after spotting. The virus can
remain active for at least 34 hours at room temperature.

7. NURSING MANAGEMENT

There are indications of sedative, antipyretic drugs to overcome high fever. Rest in bed and
adequate fluid intake. It may be necessary to humidicate the room for people with laryngitis
or cough bothersome and better simplify the warm room temperature.
The management of the cited:

a. Vitamin A

b. Rest baring as long as the temperature increases, antipyretic administration

c. Giving antibiotics to children at high risk

d. Administration of cough and sedativum

 
B. CONCEPT OF NURSING
1. Assessment
a. Self-identity
b. History of Immunization
c. Contact with an infected person
d. Physical examination:
1) Eyes: conjunctivitis, photophobia
2) Head: Headache
3) Nose: There are many secret, influenza, rhinitis / koriza, nasal bleeding (in stad
eripsi).
4) Mouth & lips: Mucosa dry lips, stomatitis, cough, mouth feels bitter.
5) Skin: Skin surface (dry), turgor skin, itching, maecular rash on the neck, face, arms
and legs (on stad. Convalence), evitema, heat (fever).
6) Breathing: Breathing pattern, RR, cough, shortness of breath, wheezing, renchi,
sputum.
7) Growth and Development: BB, TB, BB Born, Growth and Development R /
immunization.
8) Defecation Pattern: BAK, BAB, Diarrhea
9) Nutritional Status: intake – food output, appetite

E. General State: Consciousness, TTV

 
2. NURSING DIAGNOSIS
Diagnoses that may appear in Morbili patients are
A.A The high risk of infection is associated with your generator and infectious agents.
Pain associated with skin lesions, malaise
Damage to social interaction is associated with isolation from peers
High risk of skin integrity damage associated with pruritus scratching
Changes in family processes are related to children suffering from acute illness
Changes in nutrients less than the body needs are associated with failure to digest food
inability or absorption of necessary nutrients

Inability of the airway is associated with increased secretion production.

3. NURSING ASSESMENT

A. A.A high risk of infection is associated with your generator and infectious agent.

Expected results:

1) Vulnerable children do not experience disease.

2) The infection does not spread

3) The child does not show evidence of complications such as infection and dehydration.

 INTERVENTION

Identifying children at high risk

Rationale: make sure the child avoids exposure

1) Make a referral to a public health nurse if necessary.

Rationale: to ensure proper procedures at home.
2) Monitor the temperature
Rationale: An unexpected increase in body temperature can indicate an infection.
1. Maintain good body hygiene.
Rationale: to reduce the risk of secondary infection from lesions
2. Give a little but often water uptake or your child's favorite drink as well as fine or soft
foods.

Rational:

a. To ensure adequate hydration

Many children experience anorexia during illness.
b. Pain associated with skin lesions, malaise

Expected results:

1) The skin and mucous membranes are clean and free from irritation.
2) The child shows evidence of minimum discomfort.

Intervention:

1) Use a cold dew vaporiser, gargles, and suction tablets.

Rationale: to keep mucous membranes moist
2) Clean the eyes with a physiological saline solution
Rationale: to remove secretions or leprosy
3) Keep your child cool.
Rationale: because the air is too hot can increase itching.
4) Give a cold shower and give lotions such as kalamin
Rationale: to reduce itching
5) Provide analgesics, antipyretics, and antipruritus as needed and provided.
Rationale: to reduce pain, lower body temperature, and reduce itching

c) Damage to social interaction is associated with isolation from peers.

Expected results:

1) The child shows an understanding of restrictions

2) Children do the right activities and interact.

Intervention:

1) Explain the reasons for isolation and the use of special vigilance.
Rationale: to improve the child's understanding of the discussion.
2) Let the child play gloves and masks
Rationale: to facilitate positive coping.
3) Provide redirection activities
Rationale: to perform the right activities and interact
4) Encourage parents to stay with the child during hospitalization.
Rationale: to lower separation and provide closeness.
5) Prepare your child's peers for changes in physical appropriity
Rational: to encourage peer acceptance

D). A high risk of skin integrity damage is associated with pruritus scratching Expected
results: the skin remains intact

Intervention:
 1) Keep your nails short and clean
Rationale: to minimize trauma and secondary infections.
2) Wear gloves or elbow restrein
Rationale: to prevent scratching
3) Give clothes that are thin, loose, and not irritating.
Rationale: because excessive heat can increase itching.
4) Cover the 19/30s (long sleeves, trousers, one-layer clothing).
Rationale: to prevent scratching
5) Give a softening lotion (just a little on the open lesion).

Rationale: because in open lesions the absorption of the drug increases to decrease pruritus.

6) Avoid heat exposure or sunlight.

Rationale: cause a rash.

E. Changes in family processes are related to children suffering from acute illness.

Expected results:

1) The family proceeds to achieve the goal.

2) The family is looking for the support it needs.

Intervention:

1) Provide information to parents about treatment options.

Rationale: to seek the support needed.
2) Emphasize the family's efforts to carry out a treatment plan.
Rationale: for the family to proceed to achieve the goal.
3) Give the family awareness of the child's progress.
Rationale: to encourage an optimistic attitude.
4) Emphasize the speed of recovery in most cases.

Rationale: to lower anxiety.

F. Nutritional changes less than the body needs are associated with failure to digest
or inability to digest food or absorption of nutrients which is necessary.
Expected results:

1) Showed an increase in weight or stable weight with normal laboratory values.

 2) No signs of malnutrition.
3) Exhibit behavior, lifestyle changes to increase and or maintain appropriate weight.
Intervention:

Review the history of nutrition, including the foods you like.

1) Rational: identifying deficiencies, suspecting possible interventions.

2) Observation and record the patient's food input.
3) Rational: Supervise calorie input or quality of food consumption deficiency
4) Weigh weight every day
5) Rational: evaluate weight loss or effectiveness of nutritional interventions.
6) Give food a little of the frequency often and or eat between meals.
7) Rational: Eating a little can reduce weakness and increase income and also prevent
gaster distension.
8) Observe and record the incidence of nausea or vomiting, flatus, and other related
symptoms.

Rationale: Symptoms of intestinal gastro can indicate the effects of anemia (hypoxia) on
organs.

G. Inability of the airway is associated with increased secretion production.

Expected results:

1) Maintain the patient's airway with a clean or clear breath sound.

2) Exhibit behaviors to improve airway cleanness, for example: cough effectively and
secrete secretions.

Intervention:

1) Accusculation of the sound of breath

some degree of bronchial spasm occurs with airway obstruction.

2) Assess or monitor the frequency of breathing

Takipnea usually exists to some degree and can be found in reception or during stress or
the presence of an acute infection process.

3) Note the presence or degree of dipsnoe

 Respiratory dysfunction is a variable that depends on the stage of chronic processes in
addition to the acute processes that give rise to hospitalization.

4) Maintain environmental pollution, for example; dust, smoke, and pillow feathers
associated with individual conditions.

Rationale: the originator of a type of respiratory allergic reaction that can be an acute
episode.

5) Observation of cough characteristics

Cough can be persistent but ineffective, especially when the patient is elderly, acute pain,
or weakness. Coughing is most effective in a high sitting position or head down after
percussion

EVALUATION

a. The expansion of the infection did not occur.

b. The child shows effective breathing patterns

c. Children can maintain skin integration

d. Children show fulfilled signs of nutritional needs

e. Children can perform activities according to age.

A. Active immunization

This can be achieved by using a live measles vaccine that has been attenuated. The first
living vaccine to be used was the Edmonston B strain. The subsequent weakening of the
Edmonston B strain brought about the widespread development and use of the Schwartz and
Moraten strains. The vaccine is given subcutaneously and causes long-lasting immunity.

In the investigation, it turned out that the immunity began to decrease 8-10 years after
vaccination. It is recommended that routine measles vaccination cannot be done before the
baby is 15 months old because before the age of 15 months it is estimated that the child
cannot form antibodies properly because there are still antibodies from the mother. In
communities where measles is endemic, immunization can be given when the baby is 12
months old.

 
B. Passive immunization (immunoglobulin)

Passive immunization with collected adult serum, collected healing stage serum, collected
placental globulin (gama globulin plasma) can provide effective results for the prevention or
weakening of measles. Measles can be prevented with serum immunoglobulin at a dose of
0.25 ml/kg BB im and given for 5 days after exposure or as soon as possible.

Indication:

1) Children aged > 12 months with immunocompromised have not been immunised, contact

with measles patients, and mmr vaccine are contraindicated

2) Infants aged < 12 months who are directly exposed to measles patients have a high risk for
developing complications of this disease, so immunoglobulin should be given as soon as
possible within 7 days of exposure. After that the MMR vaccine is given as soon as possible
until the age of 12 months, at intervals of 3 months after immunoglobulin administration.
 References

Doengoes, Marilynn. E,.(1999). Rencana Asuhan Keperawatan Pedoman untuk Perencanaan

dan Pendokumentasian Perawatan Pasien.EGC : Jakarta.

Tarwoto dan Wartonah. (2000). Kebutuhan Dasar Manusia dan Proses Keperawatan.
Salemba Medika : Jakarta.

http://pediatricinfo.wordpress.com/2008/07/09/campak-morbili-measles-rubeola/

http://www.scribd.com/doc/22319650/asuhan-keperawatan-anak-morbili