The recent uptick in measles cases brings special concerns to nurses who may have never seen a case and therefore must remain especially vigilant if they are to recognize this viral infection.
According to the CDC, the U.S. saw a record number of measles cases during 2014: 644 cases states were reported across 27 states. This is the largest number of cases documented since the U.S. declared, in 2000, that it had eliminated measles. During the 2014-2015 holiday season, a major outbreak occurred as a result of infected children who visited Disneyland and exposed others. Most of these cases (about 45) occurred in California, with about seven other cases confirmed in Utah, Colorado, and Washington. During the outbreak, public health nurses worked to track down anyone who may have been exposed, verify their vaccination status, and initiate a quarantine when necessary – a reflection of just how contagious and infectious measles is known to be.
There are several reasons why measles, also known as Rubeola, spreads so quickly. It is a true airborne virus, capable of floating in the air for many hours after being expelled by the cough or sneeze of a sick person. Those who are infected can shed the virus silently before they develop symptoms and know they are ill. And 90 percent of those who are exposed will catch the disease if they are exposed to the virus and not immune to it, either through vaccination or natural immunity from surviving the disease. Yet despite this, immunization rates have dropped precariously in some communities, due to unfounded fears about vaccine side effects. This leaves babies under the age of one especially vulnerable, because they are too young to receive the vaccine and have no natural immunity.
According to the CDC, in 2011, 38 percent of children under five who acquired measles in the U.S. became so ill that they had to be treated in a hospital. Severe cases of measles can lead to serious complications, including pneumonia, encephalitis, febrile seizures, brain damage, and death.
Symptoms and diagnosis
The first sign of measles infection is fever and what can easily be mistaken for an upper respiratory infection: a constellation of symptoms that includes cough, runny nose, and conjunctivitis. Fever may reach as high as 104F in young children. Several days later, a rash of small, red, raised bumps appears. It typically starts on the face, often at the hairline, and spreads downward on the body over three to four days. Clinicians can also check for the presence of Koplik’s spots as a diagnostic criterion. These are found inside the mouth, at the back of the throat or by the gum line. The spots are red with a bluish-white center.
There are two immediate considerations when measles is diagnosed or strongly suspected. The first is that measles is a reportable disease. Both the CDC and state and local health departments track its incidence and engage in contact tracing whenever appropriate.
The next is isolation. According to the CDC, providers must implement isolation precautions immediately to limit the spread of the disease. Misdiagnosis, delayed reporting, and delayed contact precautions can all interfere with infection control measures and lead to a more widespread outbreak. Patients with measles frequently seek medical care, so providers should remain vigilant and suspect measles whenever a patient presents with a febrile rash in addition to symptoms of upper respiratory infection.
Nursing considerations in prevention and treatment
Nursing’s role in preventing measles is to provide accurate information about the importance of immunization. Patient education is a vital part of patient advocacy; this is where you can correct misperceptions and offer an objective analysis of the risk-benefit ratio when it comes to the measles vaccine (which is a combination vaccine known as MMR, for measles, mumps, rubella). When you talk to parents who have unfounded fears about immunization, it’s best to listen and acknowledge these concerns empathetically as the first step to counteracting them. People who feel like they are being dismissed rather than being heard, or who feel they are being lectured, are likely to tune out everything you have to say.
Medical treatment for measles is supportive care, focused primarily on maintaining hydration and managing fever. Nursing interventions, especially for hospitalized children, revolve around maintaining skin integrity and offering emotional support to the isolated patient, who may be separated from unvaccinated friends and siblings. As a nurse, you might suggest to parents that they prevent broken skin due to scratching by keeping fingernails trimmed and skin covered – with long sleeves, socks, and gloves. Calamine lotion can be used to relieve itching; topical cortisone is not generally recommended.
As a nurse, you may be most likely to encounter your first case of measles in an ambulatory setting. Yet if you’re interested in planning, implementing, and evaluating infection prevention and control measures within a hospital or public health setting, consider making this in-demand field your career specialty. As a first step, you can develop new skills and empower yourself with knowledge through an online RN to MSN degree with a specialization in infection control from American Sentinel University, an innovative, accredited provider of online nursing degrees.
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