CHAPTER II THEORY REVIEW A. DEFINITION Measles is a contagious disease.

Measles (rubeola, measles 9 days) or known as Gabagen (in Javanese), or Kerumut (in Banjar). In medical terms is referred to as Morbili, Measles. (Aru: 2006: 1447) Morbili are: acute viral disease, infectious characterized by 3 stages, ie stage prodormal (catarrhal), stage of eruption and konvalisensi stage, which is manifested by fever, conjunctivitis and Koplik spots (Children Kesehatann Science Edition 2, th 1991. Medicine). Measles is a highly contagious acute infection characterized by prodormal symptoms of fever, cough, runny nose, sore eyes accompanied with red speckling makulopapurer that spreads throughout the body which then blackened and peeling. (Fanani. 2009: 61-62) B. Etiology Way through the droplet and contact transmission, which is due to inhalation of spray saliva (droplet) of the nose, mouth and throat patients morbili / measles.means a person can be infected with measles virus morbili when inhaled, can be in a public place, in the car or on the go. Patients can transmit the infection within 2-4 days before the rash rimbulnya skin and during skin rash there. The incubation period is 10-14 days before symptoms appear. Before the widespread use of measles vaccination, measles outbreaks occur every 2-3 years, especially in children aged pre-school and elementary school children.If someone has had measles, then the rest of his life he would be immune to this disease. Acquired immunity to measles after vaccination, infection is active and passive immunity in infants born to a mother who had been resistant (lasts for 1 year). People who are susceptible to measles are: infants older than 1 year babies who do not get immunized

teens

and

young

adults

who

have

not

received

second

immunization.
A.

CLINICAL

Incubation Usually asymptomatic and lasts 10-12 days. Prodromal Usually lasts 2-5 days. The main symptoms are fever appeared, which continued to increase until it reaches a peak temperature of 39.4 0 - 40.6 0C on day 4 or 5, which is when the rash appears. Other symptoms may also arise cough, runny nose, red farings, painful swallowing, stomatitis, and conjunctivitis.

Spotting Koplik gray white, surrounded by erythema needle tip is almost always found at the end of the prodromal stage. Koplik's patches appear on the 1-2 days before the rash appears (day 3-4) and disappeared after 1-2 days of appearance of rash. There tends to be dealing with a lower molar, especially molar 3, but can spread irregularly on the buccal mucosa others. Eruption (Rash)

Occurrence of macular erythema-shaped papules with a rising body temperature. The rash appears first on the hairline and forehead area, as well as behind the ears and then spread rapidly to the entire face, neck, upper arms and upper chest at about 24 hours. Over the next 24 hours the rash spread all over his back, abdomen, around the arms, and thighs. Rash generally embrace each other so that the face and chest became confluent.Persist for 5-6 days. The temperature rose suddenly when the rash appears and often reach 40 to 40.5 C. Patients today may seem very ill, but within 24 hours after the temperature drops they are essentially looking good.Additionally, cough and diarrhea became worse so that children can experience shortness of breath or dehydration. Was often accompanied by vomiting and anorexia. Otitis media, bronchopneumonia, and gastrointestinal symptoms, such as diarrhea and vomiting, more common in infants and young children. Sometimes there is a slight bleeding of the skin. , Enlarged lymph nodes in the mandibular angle and in the neck area. Can also occur slight splenomegaly. When the rash reaches 2-3 feet in the day, the rash began to disappear from the face. Loss rash heading down the same order as when the rash appears. black and peeling skin (hyperpigmentation) which weeks. Hyperpigmentation is a pathognomonic symptom for morbili. will disappear after 1-2

Symptoms begin to appear within 7-14 days (Another reference mentions about 10-20 days) after infection, which are: - sore throat - runny nose - Cough - Muscle aches - fever - red eye - photophobia (prone to light, glare) .However, not all of these symptoms occur in each patient depending on their stamina. Clinical symptoms were divided into three stages, namely: Early stage (prodromal) In the early stages of measles lasts about 4-5 days, characterized by heat, fatigue (malaise), muscle aches, cough, runny nose, konjungtivitits, photophobia (fear of light), diarrhea due to inflammation of the respiratory and digestive tract. At this stage, the symptoms similar to influenza. However, diagnosis can be made towards Morbili 2-4 days later when the small white spots appear on the inside of the mouth (Koplik spots). Inner cheek wall (mucosa bukalis) and the patient had contact with patients morbili in the last 2 weeks.

Stadium speckling (eruption) In stage two can be found rash (redness of skin) which feels a bit itchy, appeared about 2-5 days after the initial stage. Characterized by: increased fever, red spots spread throughout the body, accompanied by intense itching. This could take the form of macular rash (rash flushing the horizontal) and papules (red rash that stands out). At first the rash appears on the face, which is in front of and below the ears and on the neck next to the side. Within 1-2 days, the rash spreads to the torso, arms and legs, while a rash on the face started to fade. Furthermore, these symptoms will disappear around the third day. Sometimes accompanied by diarrhea and vomiting. At the peak of the disease, the patient was very ill, and the rash is widespread body temperature reaches 40 Celsius. 3-5 days later his temperature dropped, the patient begins to feel well and left the rash which soon disappeared. fever, lethargy, runny nose, cough and red eyes and throat for a few days followed by a rash of red pimples on the face and began to spread into the body and there for 4 days to 7 days. Convalescence stage (convalescent) At this stage, the above symptoms gradually disappeared. Body temperature became normal, unless there are complications.
B.

Pathophysiology

Transmission occurs by droplet and contact this virus through the respiratory tract and into the reticuloendothelial system, multiply and then spread throughout the body. It will cause the symptoms of the respiratory tract, gastrointestinal tract, conjunctiva and patoknomi followed by symptoms such as skin rash and Koplik spots. The antibodies play a role in the onset of rash on the skin and in the circulation of virus neutralization. Cellular immunological mechanisms also play a role in the elimination of the virus.

1.

EXAMINATION SUPPORT

a. Peripheral blood examination only found the leukopeni. b. In sputum, nasal secretions, urine sediment can be found the typical multinucleated giant cells.

c. On serological examination by hemaglutination inhibition test and complement fiksatior test will reveal any specific antibody in 1-3 days after the onset of the race and peaked at 2-4 weeks later.
C.

COMPLICATIONS

In children who are healthy and nutritious enough, measles is rarely serious repercussions. However, complications can occur due to decreased immunity as a result of measles disease. Some of the complications that can accompany measles: 1) Bacterial infections: pneumonia and middle ear infections 2) Sometimes there thrombocytopenia (decreased platelet count), so pendeita easy bruising and easy bleeding Encephalitis (brain inflammation) occurs in 1 of 1.000 to 2000 cases. Bronkopnemonia (respiratory tract infection) Otitis Media (ear infections) laryngitis (infection of the larynx) Diarrhea Seizures Fever (step)

3) 4) 5) 6) 7) 8)

D. MANAGEMENT THERAPY In order for measles attack does not become too heavy, we can do the following things based on its phases: - Incubation period Incubation phase lasts about 10-12 days. In this phase is rather difficult to detect the infection because the symptoms are still common even not visible at all. Some children may have a fever but generally children do not feel any change. Red blotches that are characteristic of measles has not yet come out. That needs to be done: Keep children well balanced diet so that the body resistance remains high. For example by eating vegetables, fruits, as well as maintain his fitness. If it will really strike measles likelihood will not be too severe. Phase prodormal Is the phase where the symptoms of the disease has begun to emerge as the flu, coughs, colds, and fevers. Child's eyes will look reddish and watery. Not only that, the child can not see clearly into the light because he felt the glare(photo phobia) . Another characteristic, appearing next to the mouth of the

white spots that will last 3-4 days. Some children also experience diarrhea.One or two days later a high fever a spotty, ranging from 38 to 40.5 C. In the second phase of the red spots have appeared. That needs to be done: Get checked the child to the doctor when flu, coughs, colds, and fevers began to emerge. Not to wait for the emergence of red blotches because the child needs help as soon as possible. Fast action is helpful to anticipate the severity of the disease. Phase Makulopapuler Phase makulopapuler the release of red spots which is often accompanied by a high fever between 38 to 40.5 C. Initially, these spots only appear in some part of the body, usually behind the ears, neck, chest, face, arms and legs. To differentiate from other diseases, measles is generally color patches would be very typical: red with a size that is not too big but not too small. Typically, red patches all over the body will meet within one week although this is dependent on the immune system of each child. In children who have good endurance generally only red spots on some parts of the course. But the children who have a weak immune system, the more red spots. It also shows that the child suffered measles include severe. That needs to be done: Keep everything to consult a doctor. Usually the doctor will try to get red spots on the child not to appear in the whole body. When her body is filled with spots, this means campaknya quite heavy. Especially if you have symptoms of complications, then consult a doctor if the child needs to be treated or not. Most people assume that the more red spots that looked the better because it means the child will get better soon. This opinion is wrong because we are actually required to be more vigilant. But when the diagnosis has been established, and no complications, the child is cared for at home. Phase Healing When the red patches are out, usually fever will go down by itself. Further red spots would turn into black and scaly, called hyperpigmentation. In the end spots will flake off or fall off or heal itself. Generally, it takes up to 2 weeks until the child recovers completely from the remnants of measles. That needs to be done: Equipment provided medication that is given by a doctor while keeping nutritionally balanced and regular rest. Never assume that red spots are reduced and symptoms are gone means campaknya virus has disappeared.We still need to continue treatment until the child is completely healed

WOC Spray saliva (dropilet) Virus entering from the nose, mouth or throat

Sign in to retikolo endothelial system virus enters the blood kealiran MK: intraksi social damage

spread social body kesuluruh measles intraksi with environmental / family trgganggu

mk: changes in the family

sal respiratory tract digestibility conjunctivitis MK: resti infection

enign airway

ective - lymphoid -Appendix (Appendix mucosa irritation) Speed secretion The movement of intestinal fever Mk: changes in nutrition <unmatched body of body temperature

Influence the thermostat in the hypothalamus

Koplik blotches and rashes on the skin MK: Pain Itch MK: Resti damage skin integrity

CHAPTER III NURSING CARE SKIN WITH MEASLES Assessment is an early stage and runway in the nursing process, it is necessary for the precision and accuracy of the clients' problems that can give direction to nursing actions. The success of the nursing process is very bergantuang at this stage. This phase consists of: a. 1) a) Collecting Data Diagnose Client Identity Includes name, gender, age, address, religion, language spoken, marital status, education, employment, insurance, blood type, no. registers, date of MRS, medical diagnostics. b) Main Complaint In general, the main complaint in cases of measles are fever, cough, headache, and conjunctivitis. To obtain a complete assessment on the client measles. a) Disease History Now Data collection was conducted to determine the cause of measles, which will help in making a plan of action against the client. This can include the chronology of the disease that it can later be determined strength that occurs and the affected part of the body. In addition, by knowing the mechanism of occurrence of measles can be known other skin diseases. (Ignatavicius, Donna D, 1995). b) Previously Disease History At this assessment found probable cause measles and gave instructions how long it lasts measles.

c)

Family Disease History Family-related diseases camapak disease is one factor predisposing to measles, pneumonia, cough, fever, conjunctivitis. (Ignatavicius, Donna D, 1995).

d)

Psychosocial history, A client's emotional response to the disease and the client's role in the family and society as well as the response or influence in their daily lives either in the family or in society (Ignatavicius, Donna D, 1995).

c)

Patterns of Health Functions

(1) Perception and Management Pattern Healthy Living In the case of measles will have a fever, cough, headache, and conjunctivitis. And must undergo treatment to help cure skin health. In addition, the assessment also includes habits such clients direct contact with patients that can damage the health of the skin (Ignatavicius, Donna D, 1995). (2) The pattern of Nutrition and Metabolism On measles client must consume nutrients exceed their daily needs such as calcium, iron, protein, vit. C, vit c, and the other to help the healing process of the skin. The evaluation of the client's nutritional patterns can help determine the cause of skin problems Elimination Patterns For the case of disruption in the pattern of measles elimination, but even so it should also be assessed the frequency, consistency, color and smell of feces on the pattern of faecal elimination. Whereas the elimination pattern uri assessed the frequency, viscosity, color, odor, and amount. On both these patterns are also studied there is trouble or not. Rest and Sleep Patterns All clients measles arise pain, limited socialization, so that it can disrupt sleep patterns and needs of clients. Also, studies conducted in sleep duration, atmosphere, sleep habits. (Doengos. Marilynn E, 2002). (3) Activity Patterns

Because the onset of pain, limitation of motion, then all forms of client activity to be reduced and the needs of clients need a lot of help to others. Another thing that needs to be studied is a form of client activity especially client work. Because there are several forms of employment risk for measles transmission than other jobs (Ignatavicius, Donna D, 1995). (4) Pattern Relationships and Roles Clients will lose roles in the family and in society.(Ignatavicius, Donna D, 1995). (5) Pattern Perception and Self-Concept The effects on the measles client arising ineffective respiratory, gastrointestinal trganggu, konjungtivtis, anxiety, a sense of inability to perform activities optimally, and the view of him is wrong (body image disturbance) (Ignatavicius, Donna D, 1995). (6) Pattern of Sensory and Cognitive On the client camapak rabanya power increased, especially in the affected skin, while the other senses no problems arise. not so well on the cognitive disorder. Also, pain arises due camapak (Ignatavicius, Donna D, 1995). 10) Stress Management Pattern On the client camapak anxiety arises about his situation,.coping mechanisms that the client can not be effectively pursued. 11) Pattern Corporate Values and Beliefs For measles client can not perform particularly well serve the needs of the frequency and concentration. This can be caused by pain and limited mobility clients
a.

Physical examination:

Eyes: There conjunctivitis, fotophobia Head: Headache Nose: Many are secret, influenza, rhinitis / koriza, bleeding nose Mouth and lips: lips dry mucosa, stomatitis, cough, taste in the mouth. (on eripsi stad).

Skin: The skin surface (dry), skin turgor, itching, macular rash on legs (at stad. Konvalensi), evitema, heat (fever).

the neck, face, arms and

Breathing: breathing pattern, RR, coughing, shortness of breath, wheezing, renchi, sputum Growth: BB, TB, BB Birth, growth and development R / immunization. Defecation pattern: BAK, BAB, Diarrhea Nutritional status: intake - food output, food lust 1. a. b. c. Nursing Diagnosis Impaired nutritional needs less than body requirements related to anorexia. disturbances increase in body temperature associated with viral infection. Impaired sense of security and comfort associated with the presence of fever, malaise bedan, dizziness, bitter taste in the mouth, vomiting and sometimes itchy. risk of complications associated with a decreased immune system. lack of parental knowledge about the disease. INTERVENTION / IMPLEMENTATION Impaired nutritional needs less than body requirements related to anorexia. Criteria - standard: Demonstrate an increase in body weight toward the goal of increasing right. Demonstrate behaviors / lifestyle changes to improve and or maintain a proper weight. Nursing Intervention: 1. Give plenty to drink (fruit juice, syrup is not wearing ice). Rational : to compensate for an increase in body temperature and stimulate appetite 2. Provide small portions but often milk (milk made thin and not too sweet, and give the milk in a warm state when drunk). Rational : to meet nutritional needs through nutritious fluids. 3. Provide soft foods, such as porridge taking gravy, soup or porridge with coconut milk using the sugar a little bit but the quantity of servings that often. Rational : to make it easier to digest food and increase food intake.

d. e. 2. a.

4.

Provide TKTP rice, if the body temperature had dropped and appetite began to improve.

Rational : to meet the nutritional needs of the body after illness. b. Disturbances increase in body temperature associated with viral infections. Criteria - standard: - Patients showed a decrease in body temperature reaches normal. - The patient showed no complications. Nursing interventions: 1. Provide cold compress / warm.

Rational : to assist in the reduction in the patient's body temperature. 2. medical Collaboration for antipiretikum therapy. Rational : antipiretikum work to lower the body temperature rise. 3. Monitor the temperature of the environment, limit / add bed linen as indicated. Rational : indoor temperature / number of blankets to be changed to maintain the body temperature to remain normal. c. Impaired sense of security and comfort associated with the presence of fever, malaise bedan, dizziness, bitter taste in the mouth, vomiting and sometimes itchy. Criteria - standard: - Patients showed comfort, do not feel itchy anymore. - The look fresh and not feel dizzy. Nursing interventions: 1. Bedaki child's body with salicylic powder 1% or more on prescription. Rational : 1% salicylic powder can reduce the itching of the child's body. 2. Avoid children not sleeping under the lights due to glare and make it uncomfortable. Rational : the lights are too bright create glare and increase the child's discomfort. 3. During the fever is still high and should not be bathed frequently powdered. Rational : powdered body will make the patient feel comfortable pasa.

4.

If the body temperature drops, to reduce the itching can be washed with warm water or a PK or can also bethadine. Rational : warm water / PK can reduce itching and adds a sense of comfort.

d. Risk of complications associated with a decreased immune system. Criteria - standard: - Patients showed an increase in body condition. - Endurance optimal body showed no signs of panyakit susceptible. Nursing interventions: 1. Changing the attitude of baring children several times a day and give them a pillow to elevate his head. Rational : elevating the position of the head can provide air circulation in the lungs. 2. Reseat child / lap at the time of drinking.

Rational : to prevent aspiration. 3. Avoiding patient lay in front of the window or take it out as long as the fever. Rational : prevent children exposed to the wind and increase the body temperature. e. Lack of parental knowledge about the disease. Criteria - standard: - The parents indicates neighbor understand the disease process. - Parents understand how to prevent and improve nutrition to avoid severe complications arise easily. Nursing interventions: 1. Provide counseling on providing good nutrition for children, especially toddlers that are not easily get infections.

Rational : to provide knowledge to parents. 2. Explain to parents about prevention morbili about relationships with measles vaccination and nutrition that are not easily arise severe complications. Rational : to provide knowledge to parents about their disease prevention. 4. EVALUATION

a. Normal body temperature / down (36.7 C - 37.6 C). b. Fluids and nutrients in the body balanced. c. The body does not feel itchy. d. Parents / families understand the disease and its prevention morbili.