Nursing Guide to Measles Rubeola: Nursing Diagnosis, Interventions, & Care Plans

Measles (Rubeola) is a highly contagious viral disease caused by the measles virus (a paramyxovirus), primarily affecting children, but it can also infect unvaccinated adults. It presents with fever, cough, runny nose, conjunctivitis, and a characteristic maculopapular rash that spreads from the face to the rest of the body.  

Measles can lead to severe complications, including pneumonia, encephalitis, and even death, particularly in young children and individuals with weakened immune systems. It is preventable through vaccination, and outbreaks can occur in communities with low immunization rates. 

Etiology and epidemiology 

Measles is caused by the measles virus, which spreads through respiratory droplets when an infected person coughs or sneezes. The virus can remain active and contagious in the air or on surfaces for up to two hours. Measles is one of the most contagious diseases, with a high basic reproduction number (R0) of 12–18, meaning one infected individual can spread the virus to 12–18 susceptible people in a non-immune population. 

Risk factors for measles 

• Lack of vaccination: Individuals who are not vaccinated or have not received the full two doses of the measles, mumps, and rubella (MMR) vaccine are at the highest risk.
• Travel to endemic areas: People traveling to areas where measles outbreaks are common may be exposed to the virus.
• Weakened immune system: Individuals with compromised immune systems (e.g., due to HIV, cancer, or immunosuppressive therapy) are at higher risk of complications. 

Epidemiology 

Before the introduction of the measles vaccine in 1963, measles was a leading cause of childhood mortality worldwide. Despite widespread vaccination efforts, measles outbreaks still occur, particularly in regions with low vaccination coverage.  

The World Health Organization (WHO) estimates that measles caused approximately 140,000 deaths globally in 2018, mostly among children under five years old. 

Measles ICD-10 code 

The ICD-10 code for measles is B05.9 – Measles without complications. 

Diagnosis 

Diagnosis of measles is typically based on clinical presentation and confirmed by laboratory testing. The characteristic rash and history of exposure to an infected individual help in the clinical diagnosis. 

1. Clinical signs: The illness typically follows a sequence of symptoms:
2. Prodromal phase (3-4 days): Fever, cough, coryza (runny nose), conjunctivitis, and Koplik’s spots (small white spots inside the mouth).
3. Rash phase: A red, blotchy rash starts on the face and spreads downward to the trunk and limbs. The rash usually appears about 3-5 days after the onset of symptoms. 

Laboratory tests: 

1. Measles-specific IgM antibodies: These antibodies can be detected in the blood three days after the onset of the rash.
2. Polymerase chain reaction (PCR): Detects measles RNA in respiratory or blood samples and confirms diagnosis.
3. History of exposure: A recent history of exposure to a known measles case or travel to an area with an outbreak supports the diagnosis. 

Management 

There is no specific antiviral treatment for measles; management is primarily supportive, aimed at relieving symptoms and preventing complications. Early identification and isolation are crucial to prevent transmission. 

Symptomatic treatment: 

1. Fever management: Administer antipyretics like acetaminophen or ibuprofen to control fever.
2. Hydration: Encourage adequate fluid intake to prevent dehydration.
3. Nutritional support: Ensure proper nutrition, particularly in children, to promote recovery.
4. Vitamin A supplementation: The WHO recommends high-dose vitamin A for all children diagnosed with measles, especially in areas with vitamin A deficiency. This has been shown to reduce the severity of the disease and the risk of complications like pneumonia and blindness.

Infection control: 

1. Isolation: Patients should be isolated for four days after the onset of the rash to prevent further spread of the virus.
2. Quarantine and vaccination: Unvaccinated contacts of the patient should receive the MMR vaccine within 72 hours of exposure or immune globulin within six days for those at high risk (e.g., pregnant women, infants, immunocompromised individuals).
3. Complication management: Measles can lead to complications like pneumonia, otitis media, and encephalitis, which may require additional interventions such as antibiotics for bacterial superinfections or intensive care for severe cases. 

Measles nursing care plan 

Nursing considerations 

Nurses play a vital role in identifying early signs of measles, managing symptoms, and preventing complications. They must also educate families on vaccination and infection control practices. 

Assessment 

• Vital signs: Monitor temperature, respiratory rate, and oxygen saturation to detect fever or signs of respiratory distress.
• Hydration status: Assess for signs of dehydration, such as dry mucous membranes, decreased urine output, and poor skin turgor.
• Skin assessment: Examine the progression of the rash and note any secondary infections, such as impetigo.
• Nutritional status: Evaluate the patient’s appetite and nutritional intake, particularly in young children who may refuse food or fluids due to discomfort. 

Nursing diagnosis/risk for 

• Risk for infection related to viral contagion and potential secondary bacterial infections.
• Risk for dehydration related to fever, decreased fluid intake, and high metabolic demands.
• Impaired skin integrity related to the maculopapular rash and scratching.
• Deficient knowledge related to lack of understanding of the disease process and the importance of vaccination. 

Interventions 

• Infection control: Implement airborne precautions, including the use of masks and isolating the patient to prevent the spread of infection. Ensure that healthcare personnel are vaccinated against measles.
• Fever management: Administer antipyretic medications as needed and use cool compresses to lower body temperature.
• Hydration support: Provide oral fluids or intravenous (IV) fluids if necessary to prevent dehydration.
• Vitamin A supplementation: Administer vitamin A as prescribed, especially in children under two or those in areas with high vitamin A deficiency.
• Skin care: Keep the patient’s skin clean and dry. Use non-irritating creams to soothe itching and prevent scratching, which can lead to secondary infections. 

Expected outcomes 

• The patient will have a reduced fever and maintain adequate hydration.
• The patient will experience no secondary skin infections or complications.
• The patient’s nutritional and hydration needs will be met through adequate intake.
• The patient and caregivers will demonstrate an understanding of measles, its transmission, and the importance of vaccination. 

Individual/caregiver education 

• Vaccination importance: Educate caregivers on the importance of the MMR vaccine to prevent measles, mumps, and rubella. Inform them about vaccine schedules and the necessity of both doses for full protection.
• Infection control: Instruct caregivers on how to prevent the spread of measles, including isolating the patient until they are no longer contagious and disinfecting commonly touched surfaces.
• Symptom management: Teach caregivers how to manage symptoms at home, including administering antipyretics for fever, ensuring proper hydration, and providing a balanced diet.
• Complication awareness: Inform caregivers about the warning signs of complications, such as difficulty breathing, persistent high fever, or altered consciousness, and when to seek immediate medical attention. 

References 

1. Mayo Clinic: Measles Overview
2. Centers for Disease Control and Prevention: Measles Information
3. World Health Organization: Measles Fact Sheet
4. ICD-10 Data: B05.9 Measles without complications Measles - StatPearls - NCBI Bookshelf 

Resources 

• Centers for Disease Control and Prevention (CDC): Provides up-to-date information on measles outbreaks, prevention, and vaccination.
• World Health Organization (WHO): Offers guidelines on measles management, including global vaccination strategies and vitamin A supplementation recommendations.
• Immunization Action Coalition: Supports healthcare providers and the public with resources about vaccines, including the MMR vaccine.
• Measles & Rubella Initiative: A global partnership working to eliminate measles and rubella through vaccination and public health campaigns.