MEASLES

CASE DISCUSSION
 Patient Infomation
Name : Villa, Jessy
Address : Mansilingan, Bacolod City
Age : 19 y.o.
Sex: Female
Date of Birth : Feb 13, 2003
Civil Status : Single
Educ. Attainment : Third year college, Engineering student
Occupation : none
Religion: Roman Catholic
 Other Information
No. of Dependents : none

Date of Admission : August 30, 2021

Chief Complaints : fever and skin rashes

Admitting Diagnosis : Measles

Attending physician : Dr. Montoya


 Health History
 Jessy was an active student in their school. She always joined every activity,
particularly sports. She and her friend would always go to school meets to compete
with other teams. She is a non-smoker and drinks alcohol occasionally. She has no
previous history of admission. She also doesn't have a history of MMR vaccination
but received immunization through the DOH program such as DPT, Measles, BCG,
Oral Polio Vaccine and Hepatitis B Vaccine.

 History of the present Illness

 Seven days Prior to admission, patient was experiencing flu-like symptoms. Runny
nose, fever, watery eyes, body malaise and body pains. Then a day after, there were
small spots or rashes (red and slightly raised) appearing on the patient’s skin.
Initially thought to be chicken pox, the folks of the patient decided to seek medical
attention. It was also noted that the patient has not received MMR vaccination,
same goes with her friend.
 IV infusions: # 1 PNSS @ 100 cc/hr, to follow #2 same solution, same rate
 Precautions: Airborne Precaution
 Oxygen: None
 Diet: DAT
 Special Endorsement:
V/S Q4  monitoring
MIO Q Shift
Encourage increased fluid intake
 Medications:
Paracetamol 500 mg/tab, 1 tablet PO Q4hrs x 24hrs then prn for fever
  Benadryl 50mg/tab, 1 tablet PO TID X 2 days
      Calamine lotion applied to affected areas OD
      Vitamin A 20,000 IU/tab, 1 tab PO OD
  
 Laboratories:
CBC reveals Leukopenia or low WBC count
       Hgb Hct within normal range
       LFT Urinalysis presence of RBC in the urine at +6
 Stool exam: normal
 Diagnostic Test: C-XRAY no abnormal findings
 MEASLES
Definition:

Measles, or rubeola, is a 
viral infection that starts in the
respiratory system. It still remains
a significant cause of death
worldwide, despite the availability
of a safe, effective vaccine.
Symptoms:  Small white
spots in the
mouth
  Runny nose (Koplik’s sign)
 Sneezing appearing 2–3
days after early
 Watery eyes symptoms
 Body aches   Fever, possibly
up to 40°C
cough
 Red rash,
appearing
around 3–5
days after
symptoms start
 Causes / risk factors:
The disease is contagious. Research indicates that a person can
transmit the virus from 4 days before and about 4 days after
the rash appears.

The
 infection spreads through:


 Touching a surface with the virus on and then putting fingers

into the mouth, or rubbing the nose or eyes
 Unvaccinated people are at most risk of contracting measles,
 DIAGNOSTIC TOOL

 Reverse-transcription polymerase chain reaction (PCR).

PCR evaluation is highly sensitive at visualizing measles virus
RNA in blood, throat, nasopharyngeal, or urine specimens and,
where available, can be used to rapidly confirm the diagnosis of
measles.
 Chest radiography. 

If bacterial pneumonia is suspected, perform chest radiography; the

frequent occurrence of measles pneumonia, even in uncomplicated
cases, limits the predictive value of chest radiography for bacterial
bronchopneumonia.
 DIAGNOSTIC TOOL

 Antibody assays. 
The quickest method of confirming acute measles; laboratories can
confirm measles by demonstrating more than a 4-fold rise in IgG
antibodies between acute and convalescent sera, although relying solely
on rising IgG titers for the diagnosis delays treatment considerably.

 Viral culture. 
Throat swabs and nasal swabs can be sent on viral transport medium or a
viral culturette swab to isolate the measles virus; urine specimens can be
sent in a sterile container for viral culture.
 TREATMENT

 Non Pharmacological
Getplenty of rest to help boost the
immune system
Increase fluid intake to prevent
dehydration.
Sponge baths with lukewarm water may
reduce discomfort due to fever.
If
cough or sore throat is present, a
humidifier can help ease discomfort.
 TREATMENT
(Pharmacological)

Benadryl 50mg/tab

C: Antihistamine
H: to relieve symptoms of allergy, hay fever, and the common cold.
E: 50mg/tab, 1 tablet PO TID (6am-2pm-10pm) X 2 days
C: Get medical help right away if you notice any symptoms of a serious allergic reaction,
including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness,
trouble breathing.
Benadryl may be taken with or without food. Take exactly as directed. Do not take more
than is recommended.
K: Evaluate therapeutic response
 TREATMENT
(Pharmacological)

Paracetamol
C: Analgesic
H: relieve mild to moderate pain and reduce fevers caused by illnesses such as the
common cold and flu.
E: 500 mg I tab PO PRN for fever
C: Advice patient to call nurse if serious allergic reaction, including: rash,
itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble
breathing.
K: Evaluate therapeutic response.
 
 TREATMENT
(Pharmacological)
Calamine lotion
C: Local anesthetics
H: to relieve pain, itching, and discomfort from minor skin irritations
E: OD
C: Apply calamine topical directly to the skin and rub in gently,
allowing it to dry on skin. Wash hands with soap and water before
and after applying the medicine. Calamine lotion may leave a thin
film on the skin as it dries.
K: Give the medication to affected area. Inspect skin integrity.
Check expiration date.
 TREATMENT
Vitamin A 20,000 IU/tab
 C: Vitamin
H:  to lessen the severity of the condition and the risk of
complications
E: 20,000 IU/tab, 1 tab PO OD
C: To promote optimal absorption, take vitamin A
supplements after meals. Adverse effects such as irritability,
sleepiness, vomiting, diarrhea, loss of consciousness, headache,
vision problems, peeling skin, increased risk of pneumonia and
diarrhea can occur when amounts greater than those
recommended are taken.
K: Give medication as prescribed by physician.
 DIET

 Foods rich in Vitamin A and C like papaya,

strawberries, bell peppers, broccoli, guava, calamansi,
and dayap, spinach, green leafy vegetables, dairy
product and animal liver.
Avoiding greasy food; food containing fat and

processed items as they result in digestive

complications and may further aggravate the infection.
Not consuming caffeinated and sweet drinks like

coffee and soft drinks. Drinking around 8 glasses of

water, along with other liquids like diluted lemon
juice, barley juice, orange juice, coconut water, and
herbal tea for adults.
 DAT
 NURSING MANAGEMENT

 Keep the patient in an adequately ventilated room but free from drafts and
chilling
 Encourage patient to have adequate rest to overcome symptoms within a few
days.
 Encourage patient and family members to get MMR vaccination.
 Instruct the patient to get enough rest. No busy activates and no heavy
exercises.
 Instruct the patient to resume activities of daily living (ADL) gradually once
the body have recovered from the stress of Measles
 NURSING MANAGEMENT

 Assess and monitor vital signs,(blood pressure, Respiratory Rate,

Pulse rate and temperature) q4h.
 Increase fluid (with high electrolytes) intake replacing GI losses
volume per volume.
 Instruct the patient and or guardians to take down intake and
output. Record in MIO.
 Assess skin turgor and oral mucous membranes for signs of
dehydration.
 NURSING MANAGEMENT

 Provide isolation care and properly dispose of all gowns, masks, and
gloves.
 Encourage patient to cover nose and mouth if coughing or sneezing.
Dispose of all used tissues promptly. If no tissue available, sneeze into
the crook of the elbow, and not into hand.
 Teach patient proper hand hygiene and to wash hands frequently.
 Encourage patient to take a bath using lukewarm water. 
 Encourage patient to keep nails short, wear long pants and sleeves to
prevent scratching, keeping skin moist with health care provider
recommended lotions, and avoiding sunlight and heat.
THANK YOU!
Case discussion by:

Group 3 Topic: Measles

Genada, Cheska
Grabato, Kristina Kate M.