Tropical Medicine

Nursing Care/Management for a Patient within 72 Hours of Measles:

Aims of Care/Management:

1. To reduce body temperature.
2. To correct dehydration.
3. To prevent further complications.

Admission:

1. Admit the child to a well-ventilated room in an isolation unit in the children’s ward.
2. Record the patient’s particulars, including name, age, next of kin, and full address on the admission forms.
3. Reassure the mother/caregiver about the child’s condition.

Observations:

1. Monitor vital signs (Temperature, pulse, respiration, blood pressure, and weight) and record them in an observation chart for baseline monitoring.
2. Conduct a comprehensive head-to-toe assessment to identify any abnormalities such as jaundice, edema, dehydration, cyanosis, anemia, and lymphadenopathy. Document findings in the patient file.
3. Inform the doctor about the patient’s condition and prepare for any required investigations and medical treatments.
4. Carry out procedures, such as tepid sponging, based on the patient’s findings (e.g., in case of high fever).

Investigations:

1. Conduct necessary investigations to rule out other diseases, such as:
   • Blood slide for malaria parasites
   • Full blood count (FBC) to rule out other infections
   • Urinalysis
   • Salivary measles-specific IgA testing (rarely done).

Medical Treatments:

1. There is no specific treatment for measles; it is managed symptomatically.
2. Prescribe the following drugs based on symptoms:
   • Antibiotics to treat underlying infections (e.g., Cephalexin or Amoxyl syrup).
   • Intravenous Ceftriaxone for severe cases.
   • Analgesics to reduce pain and fever (e.g., Syrup Cetamol).
   • Antihistamines to reduce itching (e.g., Calamine lotion).
   • Vitamins A capsules for children below 1 year to prevent eye complications.
   • Grovit drops or syrup multivitamin to improve appetite.

Fluids and Diet:

1. Provide plenty of oral fluids to replace lost fluids due to vomiting and diarrhea.
2. Offer easily digestible foods rich in vitamins and proteins for quick recovery.
3. Encourage the child to take frequent small meals.
4. Use a nasogastric tube for feeding if the child cannot eat or drink.
5. Administer intravenous fluids in cases of severe dehydration.

Skin Care:

1. Pad the fingers to prevent excessive scratching of the skin.
2. Apply prescribed calamine lotion to relieve itching.

Mouth and Eye Care:

1. Emphasize oral hygiene with frequent mouth care using warm saline.
2. Keep the nostrils clean and maintain cleanliness around the nasogastric tube.
3. Apply gentian violet 1% for mouth ulcers.
4. Use glycerin borax to lubricate the lips and prevent cracking.
5. Clean the eyes with warm saline and avoid rubbing them.
6. Apply TEO ointment if necessary.
7. If one eye is affected, encourage the child to lie on the affected side to prevent infecting the other eye.
8. Avoid direct sunlight on the eyes.

Hygiene and Bed Rest:

1. Give the patient a daily bath and change bedding frequently.
2. Use appropriate precautions for discharging ears and administer antibiotics as needed.
3. Disinfect used soiled linen and utensils.
4. Properly dispose of used swabs, discharges, or secretions.

Visitor and Ward Management:

1. Restrict visitors and maintain visiting hours.
2. Keep radio and TV volumes low to allow for patient rest.
3. Encourage dim lighting due to photophobia.
4. Encourage adequate sleep by switching off lights and minimizing noise.

Observations:

1. Continue monitoring the patient’s general condition and vital signs regularly.
2. Take note of any deviations from the normal and act accordingly.
3. Perform tepid sponging, give cold drinks, and apply cold compress on the forehead if the temperature is very high.

Bowel and Bladder Care:

1. Observe and treat diarrhea or constipation as needed.
2. Monitor and address any issues with the child’s urine output.

Exercises and Health Education:

1. Encourage the patient to do active and passive exercises, including deep breathing exercises.
2. Stimulate the child’s mind with play objects like toys.
3. Educate the mother/caregiver about the mode of spread, signs, symptoms, and prevention of measles.

Complications of Measles:

• Pneumonia
• Acute Laryngo-Tracheo-Bronchitis (LTB)
• Otitis media leading to deafness
• Conjunctivitis
• Encephalitis
• Acute gastroenteritis
• Malnutrition (PEM) – Kwashiorkor and marasmus
• Subacute sclerosing panencephalitis.