Nursing Care for measles 1. Protect eyes of patients from glare of strong light as they are apt to be inflamed.

2. Keep the patient in an adequately ventilated room but free from drafts and chilling to avoid complications of pneumonia. 3. Teach, guide and supervise correct technique of giving sponge bath for comfort of patient. 4. Check for corrections of medication and treatment prescribed by physician. Make the child comfortable. Control temperature. Give plenty of fluids and small, frequent feeds. Give a high dose of vitamin A to prevent complications. Watch out for complications such as encephalitis, pneumonia and eye and mouth complications. Diptheria Agent caused by Corynebacterium diphtheriae, a facultative anaerobic Gram-positive bacterium. Epidemiology Diphtheria is a serious disease, with fatality rates between 5% and 10%. In children under 5 years and adults over 40 years, the fatality rate may be as much as 20%.[6] Outbreaks, though very rare, still occur worldwide, even in developed nations such as Germany and Canada. After the breakup of the former Soviet Union in the late 1980s, vaccination rates in its constituent countries fell so low that there was an explosion of diphtheria cases. In 1991 there were 2,000 cases of diphtheria in the USSR. By 1998, according to Red Cross estimates, there were as many as 200,000 cases in the Commonwealth of Independent States, with 5,000 deaths.[9] This was so great an increase that diphtheria was cited in the Guinness Book of World Records as "most resurgent disease". Life cycle

Treatment The disease may remain manageable, but in more severe cases lymph nodes in the neck may swell, and breathing and swallowing will be more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. Abnormal cardiac rhythms can occur early in the course of the illness or weeks later, and can lead to heart failure. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases will be put in a hospital intensive care unit (ICU) and be given a diphtheria anti-toxin. Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration is associated with an increase in mortality risk. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation.[6]

Antibiotics have not been demonstrated to affect healing of local infection in diphtheria patients treated with antitoxin. Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The CDC recommends[8] either:

Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg). Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.

In cases that progress beyond a throat infection, diphtheria toxin spreads through the bloodstream and can lead to potentially life-threatening complications that affect other organs of the body, such as the heart and kidneys. The toxin can cause damage to the heart that affects its ability to pump blood or the kidneys' ability to clear wastes. It can also cause nerve damage, eventually leading to paralysis. 40% to 50% of those left untreated can die.

The only effective treatment of diphtheria is the prompt administration of antitoxin to neutralize any exotoxin still circulating in the bloodstream. The administration of antibiotics, such as penicillin and streptomycin, has not proved to be of any value in treating diphtheria. General supportive measures, such as bed rest and increasing the patients' intake of fluids are helpful in making the patient comfortable. Guava tea is excellent in dissolving dried mucus and killing bacteria in the respiratory tract.

Nsg interventions

Obtain culture specimens as ordered. Administer humidified oxygen as ordered, and elevate the head of the bed to prevent pressure on the diaphragm and compromised breathing. Administer drugs as ordered. Before giving diphtheria antitoxin, which is made from horse serum, review eye andskin test results t o identify the patients sensitivity level. Although time-consuming and hazardous, desensitization should be attempted if test results indicate sensitivity to diphtheria antitoxin the only specific treatment available. If test results are normal, antitoxin is usually administered

before laboratory confirmation of the diagnosis because mortality increases when drug administration is delayed. Offer frequent, small feedings of liquids and soft foods to the patient with mild to moderate dysphagia. Give parenter al fluids as ordered to a patient who cant swallow. Suction as needed to prevent aspiration. Maintain strict infection and isolation precautions until two consecutive nasopharyngeal culture results are negative for C. diphtheriae at least 1 week after dru g therapy stops. Report all cases of diphtheria to local public health authorities; follow up on others who have been exposed to the patient, if appropriate. If the patient sustains paralysis, assist him to begin a rehabilitation program to restore optimal functioning. Teach the patient the proper technique for disposing of nasopharyngeal secretions. Explain the need for follow -up testing. Prepare the patient to expect a prolonged convalescence. Inform the patients family about diphtheria. Explain that treating exposed people with antitoxin remains controversial. If family members havent been immunized, suggest that they arrange to receive diphtheria toxoid (which is usually given as combined diphtheria and tetanus toxoids or as a combination including pertussis vaccine for children younger than age 6).

Prevention Prevention of Diphtheria Immunization for diphtheria has been part of routine well-child care for decades. This is the "D" in the "DPT" shots. Immunization of all infants and booster doses throughout life will prevent any resurgence of diphtheria. Diphtheria vaccine is made of a toxoid, which is a weakened form of the diphtheria toxin. This stimulates the immune system to make antibodies against the toxin to protect against the disease. The immunity wanes so that a booster is needed every ten years. The toxoid comes in two strengths - children younger than seven need the higher concentration to develop immunity. Anyone older than seven should get the low concentration because it has fewer side effects and is strong enough to boost immunity.

The vaccine labeled with a capital D is the strong concentration, and a lower case d stands for the lower concentration toxoid.

The immunity that results from administering diphtheria toxoid lasts for at least several months and usually longer. It is common practice to administer the toxoid to children before the age of 1. At present the diphtheria vaccine is usually given in a combination shot with tetanus and pertussis vaccines, known as DTP vaccine. A child should have received four DTP shots by 18 months of age, with a booster shot at age 4 years to 6 years. After that, diphtheria and tetanus boosters should be given every 10 years to provide continued protection. Because a person may have had diphtheria without knowing it, the only way to determine if he has had the disease is to test his immunity to it. The most widely used test for determining a person's state of immunity to diphtheria is the Schick test. In this test, a small amount of diphtheria exotoxin is introduced into the skin. If the area becomes reddish over a period of 3 to 4 days, the person is susceptible to diphtheria. If no reaction occurs, the level of antitoxin in the person's blood is high enough to protect against the disease.