Measles is one of those diseases a lot of new nurses have never seen in person, unless they’re exposed to the pedia ward or they’ve had it in their childhood so this needs re-visiting. But while easily curable, it’s still highly contagious, and it’s making a comeback in many places, aaand it’s a favorite for questions about airborne precautions and the order of symptoms. Here are my notes, then a practice test.
Table of Contents
What is Measles?
Measles (rubeola) is a highly contagious viral illness caused by the measles virus, a paramyxovirus.
- Spread through the air by coughing and sneezing. The virus can stay in the air of a room for up to 2 hours after the person leaves.
- One of the most contagious infections known. Most unvaccinated people exposed will get sick.
- Contagious from about 4 days before the rash to 4 days after the rash appears.
- Watch Out For: pneumonia (most common cause of death), ear infection, encephalitis, and dehydration.
- Safety Precaution: Airborne precautions: negative-pressure room and N95 respirator. Only staff with proven immunity should care for the client.
Pathophysiology
The virus infects the respiratory tract, then spreads through the blood to the skin and other organs. It also weakens the immune system for weeks to months, which allows secondary bacterial infections like pneumonia and ear infections.
Assessment and Diagnostic Findings
Clinical presentation (in order)
- Prodrome (about 2 to 4 days): high fever and the three C’s: cough, coryza (runny nose), and conjunctivitis, with sensitivity to light.
- Koplik spots: tiny white spots on a red base inside the cheeks, appearing before the rash.
- Rash: red, flat-and-raised (maculopapular) rash that starts at the hairline and face and spreads downward to the trunk and limbs, while fever peaks.
Laboratory findings
- Measles IgM in blood, and PCR from a throat or nasal swab confirm the diagnosis.
- Notify public health right away. Measles is a reportable disease.
NCLEX Tip: The rash starts at the head and moves down, and the white spots (Koplik) come first.
Medical Management
- There is no specific antiviral. Treatment is supportive.
- Vitamin A supplementation is recommended for children with measles to reduce complications.
- Acetaminophen for fever. Antibiotics only for bacterial complications.
- Prevention: MMR vaccine, typically two doses (the first at 12 to 15 months, the second at 4 to 6 years). In outbreaks or travel, infants may get an earlier dose.
- Post-exposure: MMR within 72 hours, or immune globulin within 6 days for those who can’t take the vaccine (such as infants, pregnant women, and immunocompromised people).
- AVOID: aspirin in children (risk of Reye syndrome).
Nursing Management
Nursing care focuses on isolation, comfort, hydration, monitoring for complications, and prevention.
- Infection control: Airborne precautions until 4 days after the rash starts. Staff with unknown immunity should not enter. Report to infection control.
- MONITOR: respiratory status, fever, hydration, level of consciousness, and signs of ear infection or pneumonia.
- Comfort: Dim the lights because of light sensitivity. Give tepid baths, acetaminophen, and humidified air to ease cough.
- Eye care: Gently clean the eyes with warm water.
- Hydration and nutrition: Encourage fluids and soft, easy foods.
- Education: Stay home until the contagious period is over, make sure family members are vaccinated, and return for trouble breathing, confusion, or ongoing high fever.
NCLEX High-Yield Notes
- Airborne precautions with a negative-pressure room.
- 3 C’s: cough, coryza, conjunctivitis.
- Koplik spots come before the rash.
- Rash goes head to toe.
- Vitamin A and MMR vaccine.
- Dim the room for photophobia.
Mnemonic (MEASLES):
- MMR vaccine prevents it
- Eyes are red and light-sensitive
- Airborne precautions
- Spots in the mouth (Koplik)
- Lights dim
- Each rash starts at the face and spreads down
- Support with fluids, vitamin A, acetaminophen
