MEDSURG

MS. BUNNYLOU PITOC | SEMI-FINALS

MODES OF TRANSMISSION
Topic Outline:
1. Direct contact with patients who shed the virus from
 Chickenpox (Varicella)
→ Infectious Agent the vesicles on their skin.
Varicella Zoster Virus (VZ-V) 2. Indirect contact (linens and fomites)
Herpesvirus varicellae 3. Airborne or spread by droplet infection
→ Incubation Period
→ Modes of Transmission PERIOD OF COMMUNICABILITY
→ Period of Communicability → Most contagious – 1-2 days before the rash appears
→ Pathogenesis until all the blisters are dried and crusted.
→ Clinical Manifestations
o Pre-eruptive & Eruptive Stage → Can be transmitted – about a day before the
o Eruptive Stage eruption of the first lesion up about 5 days after the
→ Diagnostic test appearance of the last crop.
→ Complications
○ Furuncle, Cellulitis, Skin abscess, Erysipelas PATHOGENESIS
→ Treatment Modalities
→ Preventions
→ Nursing Management

 German Measles (Rubella/Three-day Measles)

→ Infectious Agent
Rubella Virus (Family-Togaviridae;
Genus-Rubivirus)
→ Incubation Period
→ Mode of Transmission
→ Period of Communicability
→ Pathogenesis
→ Clinical Manifestations
Prodromal period
Eruptive period
→ Classic Congenital Rubella Syndrome CLINICAL MANIFESTATIONS
o Cleft Palate PRE-ERUPTIVE STAGE ERUPTIVE STAGE
o Clift Lip → Mild fever and malaise → Rash start from
o Talipes/Clubfeet the trunk
→ Treatment Modalities (unexposed
→ Complications area), then
→ Congenital Malformation Risk spreads to the
→ Prevention other parts of the
→ Nursing Diagnosis
body
o Prevention
→ Initial lesions are
 MEASLES (Rubeola/Morbill) distinctively red
→ Etiologic Agent papules where
Morbillivirus of the family paramyxoviridae contents become
→ Incubation Period milky and pus-like
→ Period of Communicability within 4 days.
→ Source of Infection → Lesions are more
→ Mode of Transmission widespread and
→ Clinical Manifestation more severe -
Pre-eruptive Sign Adults and bigger
Eruptive Sign children.
Stage of Convalescence → With rapid
→ Pathognomonic Sign progression in 6-8
o Koplik’s Spots hours
→ Risk factors
→ Very pruritic
→ Unfavorable Signals
vesicular lesions
→ Diagnostic Procedure
→ Treatment Modalities → All stages are
→ Complications present
→ Prevention simultaneously
→ Nursing Management before all are
covered with
CHICKEN POX (VARICELLA) scabs
→ All lesions appear
→ An acute and highly contagious disease of viral
in different stages
etiology that is characterized by vesicular eruptions in at one time.
the skin and mucous membranes with mild
constitutional symptoms.
INFECTIOUS AGENT
Varicella Zoster Virus (VZ-V)
Herpesvirus varicellae
o A DNA-containing virus
o Humans-only source of infection
INCUBATION PERIOD
→ 10-21 days; maybe prolonged after passive
immunization against chickenpox

CASIO, YH.C, SN | 1
CLINICAL MANIFESTATIONS: ERUPTIVE STAGE TREATMENT MODALITIES
1. Acyclovir (Zovirax) 500mg/tablet, 1 tab BID for 7 days
CHICKENPOX LESION STAGES DESCRIPTION 2. Oral acyclovir 800 mg TID for 5 days
Stage 1: Macule → Lesion that is not 3. Oral antihistamine
elevated above the
4. Calamine lotion
skin.
Stage 2: Papule → a lesion that is 5. Antipyretic (acetaminophen or paracetamol)
elevated above the
NOTE: anti-inflammatory painkillers (ibuprofen) and Aspirin
surface of the skin
must not be given.
with a diameter of
about 3cm. PREVENTION:
Stage 3: Vesicle → a pop-like eruption 1. Active immunization with live attenuated varicella
filled with fluid; the vaccine:
thin-walled vesicle
→ 1st shot: 12 to 15 months old
easily bursts and
dries up in 3-5 days → 2nd shot: 4 to 6 years old
Stage 4: Pustule → a vesicle that is → Over 13 y.o. and never been vaccinated: 2 doses,
infected or filled with at least 28 days apart
pus; if the lesion 2. Avoid exposure to infected persons
becomes infected
the scar may be big NURSING MANAGEMENT:
and wide 1. Respiratory isolation (until all vesicles have crusted)
Stage 5: Crust → a scab or eschar; a 2. Hygienic care (prevents secondary infection)
secondary lesion 3. Cool, wet washcloth
caused by the 4. Nasopharyngeal secretions and discharges: Dispose
secretion of vesicle
properly; disinfect linens: sunlight or chemical means
drying on the skin;
5. Cut fingernails short and wash hands more often
the scars are
superficial, (minimizes bacterial infections)
pigmented and take 6. A child must wear mittens; diversional activities
time to fade out 7. See a doctor:
→ Shortness of breath and dizziness
→ Vomiting, stiff neck, and fever over 38.5 °C
→ Rashes spread to one or both eyes
→ The rash gets very red, warm or tender

GERMAN MEASLES
→ An acute viral illness caused by rubella virus; it causes
mild feverish illness associated with rashes and aches
in joints; and swollen lymph nodes; has teratogenic
effect on the fetus

INFECTIOUS AGENT
Rubella virus (Family - Togaviridae; Genus - Rubivirus)

INCUBATION PERIOD
→ 14 to 21 days
→ From exposure to the appearance of rash
DIAGNOSTIC TEST: MODE OF TRANSMISSION:
1. Determination of V-Z virus through Complement → Direct contact with nasopharyngeal secretions
Fixation Test → Air droplets
2. Determination of V-Z virus through Electron → Transplacental transmission in congenital rubella
Microscopic examination of vesicular fluid o Infants with congenital rubella shed large
COMPLICATIONS: quantities of the virus in their pharyngeal
1. Secondary infection of the lesions – furuncles, secretions and urine which serve as a source of
cellulitis, skin abscess, erysipelas infection to other contacts
2. Meningoencephalitis
PERIOD OF COMMUNICABILITY:
3. Pneumonia → approximately 1 week before and 4 days after the
4. Sepsis onset of rashes
→ at its worst when the rash is at its peak
→ highly communicable infants with congenital Rubella
may shed virus for months after birth

CASIO, YH.C, SN | 2
PATHOGENESIS
cd

Rubella virus

Maternal viremia

Placental infection

Fetal viremia

Disseminated infection
Involving many fetal organs

CLINICAL MANIFESTATIONS
PRODROMAL PERIOD ERUPTIVE PERIOD TREATMENT MODALITIES
→ low grade fever → a pinkish rash on the soft → Essentially symptomatic; Very little treatment is
→ headache palate (forchheimer's necessary
→ malaise spot) → Bed rest
→ mild coryza → an exanthematous rash
→ conjunctivitis that appears first on the COMPLICATIONS
→ post-auricular; face, spreading to the 1. Encephalitis
sub- occipital, and neck, the arms, trunk, and 2. Neuritis
posterior cervical legs 3. Arthritis
lymphadenopathy → eruption appears after 4. Arthralgia
which occur on the onset of adenopathy
5. Rubella syndrome, manifested by microcephally,
the 3rd to the 5th → children present less or no
day after onset constitutional symptoms mental retardation, cataract, deaf-mutism, heart
→ rash may last for 1 to 5 disease.
days and leaves no
RISK OF CONGENITAL MALFORMATION
pigmentation nor
1. 100% when maternal infection occurs on the first
desquamation
→ testicular pain in young trimester of pregnancy or 1st month of gestation
adults 2. 4% in the 2nd and 3rd trimester of pregnancy
→ transient polyarthralgia 3. 90% of congenital rubella cases will excrete the virus
and polyarthritis in adults at birth and are therefore infectious
and occasionally in 4. 10% remain contagious until one year of age
children
PREVENTION
→ Administer live attenuated measles, mumps, and
rubella (MMR vaccine) (12 to 15 months old)
→ Pregnant women should avoid exposure to patients
infected with rubella
→ Administer immune serum globulin 1 week after
exposure with rubella
→ If not known if vaccinated or not, have immunity
tested especially if:
o She is a woman of childbearing age and is not
pregnant
o Working in an educational facility; or
o Planning to travel to a country that does not offer
immunization against rubella
CLASSIC CONGENITAL RUBELLA SYNDROME
→ The possibility of spontaneous abortion COMMON NURSING DIAGNOSIS
→ Cleft palate, harelip, talipes, and eruption of teeth Social Isolation
→ Intrauterine growth retardation; infant haslow birth Knowledge deficit
weight Impaired Physical Mobility
→ Thrombocytopenic purpura known as “blueberry Impaired Skin Integrity
muffin” skin Pain
→ Lethargy and hypothermia Risk for infection

PREVENTION
1. Administration of live attenuated vaccine (MMR)
2. Pregnant women should avoid exposure to patients
infected with Rubella virus
3. Administration of Immune Serum Globulin one week
after exposure to Rubella

MEASLES (RRUBEOLA/MORBILL
→ An acute, highly contagious and exanthematous,
vaccine-preventable disease that usually affects
children which is referrable to upper respiratory tract
infection (URTI)

CASIO, YH.C, SN | 3
→ One of the most common and most serious of all PATHOGNOMONIC SIGN:
childhood diseases  Koplik’s spots – inflammatory lesions of the buccal
mucosa glands
ETIOLOGIC AGENT: → appear on the mucosa of the inner cheek next to
a virus genus Morbillivirus of the family the premolars and molars, or near the junction of
paramyxoviridae the gum and the inner cheek
→ Rapidly inactivated by heat, ultraviolet light, and → usually appear 1 to 2 days before the measles rash
extreme degrees of acidity and alkalinity
→ Can be serious and even fatal to small children
→ Kills more than 100,000 people a year, most under the
age of 5

INCUBATION PERIOD:
1. From 10-12 days (20 days-longest and 8 days shortest)
2. Single attack usually conveys a lifelong immunity

PERIOD OF COMMUNICABILITY
→ Usually lasts about 9 to 10 days, measured from the
beginning of the prodromal symptoms to the fading of
the rash
→ Communicable 4 days before and 5 days after the
appearance of rashes
→ Most communicable during the height of the rash

SOURCES OF INFECTION RISK FACTORS FOR MEASLES

patient’s blood
secretions from the eyes, nose, and throat
MODE OF TRANSMISSION
1. droplets spread through coughing and sneezing;
droplets may land on a surface (virus remains active
and contagious for several hours)
2. through articles or fomites freshly contaminated with
respiratory secretions of infected patients
CLINICAL MANIFESTATIONS ( 3 STAGES)
→ Being unvaccinated
→ Traveling internationally
→ Vitamin A deficiency
UNFAVORABLE SIGNALS
1. Violent onset with high grade fever
2. Fading eruption with rising fever
3. Hemorrhagic or black measles
4. Persistence of fever for 10 days or more
5. Slight eruptions accompanied by severe symptoms,
especially those of encephalitis

PRE-ERUPTIVE STAGE

a. Fever (on & off)

b. Catarrhal symptoms (rhinitis/coryza, conjunctivitis,
photophobia)
c. Respiratory symptoms start from common colds to
persistent cough
d. Enanthema sign (Koplik’s spot, Stimson’s line)

ERUPTIVE STAGE DIAGNOSTIC PROCEDURES

1. Nose and throat swab
a. Rash is usually seen late on the 4th day 2. Urinalysis
b. Macula-papular rash (cephalocaudal eruption) 3. Blood exams (CBC)
c. Rash is fully developed by the end of the 2nd day 4. Complement fixation or hemagglutinin test
and all symptoms are at their maximum
d. An on-off high grade fever TREATMENT MODALITIES
1. Anti-viral drugs (Isoprinosine – drug of choice)
e. Anorexia and irritability
2. Antibiotics if with complications
f. Abdominal tympanism, pruritus, lethargy
3. Supportive therapy (oxygen inhalation, IV fluids)
g. Sore throat
h. Coughing may diminish as fever subsides, more often COMPLICATIONS
it hangs on for 1-2 weeks, become looser and less 1. Brochopneumonia, pneumonia, bronchitis
metallic 2. Otitis media
3. Nephritis
4. Encephalitis, encephalomyelitis
CONVALESCENCE STAGE
5. Blindness (seldom)
a. Rashes fade away in the manner as 6. Preterm labor, low birth weight and maternal death
they erupted
PREVENTION
b. Fever subsides as eruption
1. Isolation
disappears
2. Immunization
c. Desquamation begins when the
→ Anti-measles vaccine, single dose at 9 mos. Old
rashes fade
→ MMR at 12 to 15 months old; 2nd dose at 6 to 8
d. Symptoms subside, and then appetite returns
years old

CASIO, YH.C, SN | 4
NURSING MANAGEMENT
1. Isolate client (quiet, well ventilated, and must have
subdued light)
2. Provide warm or tepid sponges
3. Promote skin care
4. Encourage oral and nasal hygiene
5. Provide eye care
6. Promote care of the ears
7. Daily elimination
8. During the febrile stage, limit the diet to fruit juices, milk
and water. If the patient is vomiting, give iced juices in
small amounts and more frequently
9. Patient’s position should be changed every 3-4 hours
10. Penicillin, or other prescribed medication, is usually
given in cases where there is complication

CASIO, YH.C, SN | 5