Measles

Definition:

Also known as Rubeola, an acute highly communicable infection characterized by fever, rashes and symptoms referable to upper respiratory tract; the eruption is preceded by about 2 days or coryza, during which stage grayish pecks (Koplik spots) may be found on the inner surface of the cheeks. A morbilliform rash appears on the 3rd or 4th day affecting face, body and extremities ending in branny desquamation.

Death is due to complication (e.g. secondary pneumonia, usually in children under 2 years old. Measles is severe among malnourished children with fatality of 95-100%. Infection confers life-long immunity.

Etiologic Agent: Filterable virus of Measles

Source of Infection: Secretion of nose, mouth and throat of infected persons.

Modes of Transmission:

1. Directly - by being sprayed with droplets emanating from a cough or sneeze
2. Indirectly - with articles newly contaminated with respiratory secretions from a patient.
3. Probably Airborne

• Incidence peak age is about 1-5 years old in congested urban areas and at early school age in less crowded sections.
• Immunity from the disease is long lasting while passive immunity transmitted transplacentally from mothers who have had measles may last about 5-6 months. The live attenuated vaccine confers almost lifelong immunity while the inactivated antigen gives an immunity 0f 6-18 months.
• Recent data suggests that cases is on the rise again in the United States and Canada due to the unsubstantiated claim that measles vaccine is associated with autism. In fact, various studies by government and non-government agencies disputing these claims.

Incubation Period:

• 10-12 days; one attack usually confers a lasting immunity
• 8 days shortest; 20 days longest

Period of Communicability:

• During the period of coryza or catarrhal symptoms - 9 days (from 4 days before and 5 days after rash appears)

Clinical Manifestations:

1. Pre-eruptive Stage
   • patient is highly communicable
   • fever
   • catarrhal symptoms - start in the nasal cavities; then in the conjunctivae, oropharynx, progress to the bronchi resulting successively in rhinitis, conjunctivitis and then bronchitis.
   • Respiratory symptoms - which appear first as a common cold, and sneezing nasal discharges, steadily progress into a distressing and annoying cough that persists up to convalescence.
2. Eruptive Stage/Stage of Skin Rashes
   • exanthem sign - means eruption in the skin
     • Maculopapular Rashes - appears 2-7  days after onset
     • With high fever - increases steadily
     • Anorexia and irritability - are disturbing particularly at the height of the fever
     • Diarrhea, pruritis, lethargy and occipital lymphadenopathy
3. Stage of Convalescence
   • Rashes - fade in the same manner as they appeared, from the face downwards, leaving a dirty brown pigmentation and finely granular which maybe noted for several days.
   • Fever - gradually subsides as the eruptions disappear on the hands and feet

Tests:

• Usually none (most diagnosis is based clinically)
• Measles serology
• Viral culture (rarely done)

Treatment:

No therapy is indicated for uncomplicated measles, Gamma globulin although effective in prophylaxis is no value once symptoms are evidence. Patient should be monitored for the development of bacterial infections which should be treated with appropriate antibiotics on the basis of clinical and bacteriological findings.

The patient may also take over-the-counter medications such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) to help relieve the fever that accompanies measles. Don’t give aspirin to children because of the risk of Reye’s syndrome — a rare but potentially fatal disease.

Maintain bedrest and provide quiet activities for the child. If there is sensitivity to light, keep room darkly lit. Remove eye secretions with warm saline or water. Encourage the patient not to rub the eyes. Administer antipyretic medication and tepid sponge baths as ordered. A cool mist vaporizer can be used to relieve cough. Apply antipruritic medication to prevent itching. Isolate child until fifth day of rash.


Prognosis


Prognosis is very good specially for those who do not develop complications like bronchitis, encephalitis (1 of 1000 cases), ear infections and pneumonia.

Methods of Prevention and Control

1. Avoid exposing children to any person with fever or with acute catarrhal symptoms
2. Isolation of cases from diagnosis until about 5-7 days after onset of rash
3. Disinfection of all articles soiled with secretion of nose and throat
4. Encourage by health department and by private physician of administration of measles immune globulin to susceptible infants and children under 3 years of age in families or institutions where measles occurs.
5. Live attenuated and inactivated measles virus vaccines have been tested and are available for use in children with no history of measles, at 9 months of age or soon thereafter

Public Health Nursing Responsibilities

1. Emphasize the need for immediate isolation when early catarrhal symptoms appear .
2. If immune serum of globulin is available (gamma Globulin), explain this to the family and refer to physician or clinic giving this service.
3. Observe closely the patient for complications during and after the acute stage.
4. Teach, demonstrate, guide and supervise adequate nursing care indicated.
5. Explain proceedings in proper disposal of nose and throat discharges.
6. Teach concurrent and terminal disinfection.

Nursing Care

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.

Chicken Pox vs. Small Pox

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In smallpox, lesions are commonly found on the palms and soles. In chickenpox, however, there are very few or no lesions on the palms and soles.

In smallpox, fever is present for 2 to 4 days before the rash begins, while with chickenpox, fever and rash develop at the same time.

All the pocks of the smallpox rash are in the same stage of development on any given part of the body and develop slowly. In chickenpox, the rash develops more rapidly, and vesicles, pustules, and scabs may be seen at the same time.

Small Pox

• Evolution: Centripetal distribution - eruption starts from the face and extremities towards the body
• Rashes: Pocks present on palms and soles
• Associated Symptoms: Malaise, fever, rigors, vomiting, headache and backache
• Incubation Period: 7 to 17 days after close contact with a smallpox patient
• Prodromal Period: Prolonged and severe; systematic manifestations are more pronounced
• Fever: High grade fever
• Scabs: Forms 10 to 14 days after appearance of rash and may be infectious; fall off 14 to 28 days after rashes appear
• Characteristics: Multilocular, areas of the body (areas of the pressure and tight skin), hard shotty discrete and deep lesions
• Vesicles: Do not collapse on puncture

Chicken Pox

• Evolution: Centrifugal distribution - eruption starts from the trunk and spread to exposed parts or away from the center
• Rashes: Pocks seldom present on palms and soles
• Associated Symptoms: None
• Incubation Period: 14 to 21 days after close contact with chicken pox patient
• Prodromal Period: Milder constitutional manifestations with less complications
• Fever: Low grade fever
• Scabs: Form 4 to 7 days after appearance of rash and may not be infectious; fall off within 14 days after rashes appear
• Characteristics: Unilocular, over the body (exposed parts of the body), skin superficial lesions
• Vesicles: Collapse on puncture

Nervous System In Focus

Overview

The brain performs a lot of things for a human body to function well such as controlling what a person thinks and feel, learning and remembering things, the way a person moves and talk, and some other things such as the beating of the heart, digestion of the food and etc. Thus, it is very important to have an understanding on how this amazing brain or the nervous system works.

The nervous system is essentially a biological information highway, and is responsible for controlling all the biological processes and movement in the body, and can also receive information and interpret it via electrical signals which are used in this nervous system

It consists of the Central Nervous System (CNS), essentially the processing area and the Peripheral Nervous System which detects and sends electrical impulses that are used in the nervous system


Central Nervous System

The Central Nervous System is effectively the centre of the nervous system, the part of it that processes the information received from the peripheral nervous system. The CNS consists of the brain and spinal cord. It is responsible for receiving and interpreting signals from the peripheral nervous system and also sends out signals to it, either consciously or unconsciously. This information highway called the nervous system consists of many nerve cells, also known as neurons

The Nerve Cell

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Each neurone consists of a nucleus situated in the cell body, where outgrowths called processes originate from. The main one of these processes is the axon, which is responsible for carrying outgoing messages from the cell. This axon can originate from the CNS and extend all the way to the body's extremities, effectively providing a highway for messages to go to and from the CNS to these body extremities.

Dendrites are smaller secondary processes that grow from the cell body and axon. On the end of these dendrites lie the axon terminals, which 'plug' into a cell where the electrical signal from a nerve cell to the target cell can be made. This 'plug' (the axon terminal) connects into a receptor on the target cell and can transmit information between cells

Definition

The nervous system is an organ system that contains a network of specialized cells called neurons. This is the master controlling and communicating system of the body. It coordinates the action of an animal and transmits signals between the different parts of the body. Every thought, movement and emotions reflect the activity of the nervous system.

Communication

The "All-Or-None-Law" applies to nerve cell communication as they use an on / off signal (like an digital signal) so that the message can remain clear and effective from its travel from the CNS to the target cell or vice versa. This is a factor because just like electricity signals, the signal fades out and must be boosted along its journey. But if the message is either 1 or 0 (i.e.) on or off the messages are absolute.

Classification of Neurons

Interneurones - Neurones lying entirely within the CNS

Afferent Neurones - Also known as sensory neurones, these are specialised to send impulses towards the CNS away from the peripheral system

Efferent Neurones - These nerve cells carry signals from the CNS to the cells in the peripheral system

Functions of the NERVOUS SYSTEM

1. To monitor changes that takes place inside and outside the body. The nervous system utilizes the million sensory receptors to carry out this function. Any changes or stimuli occurring are noted by the nervous system and the gathered data is now called a sensory input.
2. Another important function of the nervous system is to process and interpret the sensory input or gathered data. It is the working of this system to make decision about what should be done at each moment. This is the process known as INTEGRATION.
3. As the nervous system has reached a decision of what response and appropriate action to be done in response to the stimuli, it then effects a response by activating muscles or glands through motor output.

These functions of the nervous systems works hand in hand. The process starts with the sensory input. The nervous system then processes and integrates this information. The nervous system then  sends motor output to response.

Differentiating True from False Labor

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Pregnant women who are approaching near their expected date of delivery experience signs of labor. However, these women are not sure if what they are experiencing is either real or false labor. For every woman, every pregnancy is different. But in every pregnancy the same definitive signs of labor will be experienced by women. To figure out if the body is just practicing and preparing for the delivery or actual labor is occurring, pregnant women should be able to classify false from true labor.

Labor is a physiologic process during which the products of conception are expelled outside of the uterus. Regular contractions cause progressive dilatation of the cervix and sufficient muscular force to allow the baby to be pushed to the outside. Labor is a time of change, both an ending and a beginning for a woman, a fetus and a family.

A false labor also termed as prodromal labor is common because the exact time of the labor’s onset is rarely known and usually is gradual. This type of labor often causes women to rush to the birth center, thinking that labor has started. Several characteristics distinguish true labor from labor: contractions, discomfort and cervical change. The BEST distinction is that contractions of true labor cause a progressive change in the cervix, thus, in false labor there is no dilatation of cervix.

Signs of true labor involve uterine and cervical changes. The more a woman knows about the true labor signs, the better. Because it is only in this way that she can better recognize them once she is experiencing contractions. Knowing about the difference between true and false labor is helpful to prevent preterm birth and for the woman to feel secure knowing what is happening during the labor.

Contractions:

True Labor

• Begin irregular but become regular and predictable
• Contractions last between 4 to 6 minutes apart and may last up to 60 seconds or more
• Have a consistent pattern of increasing frequency, duration and intensity
• Tends to increase with walking
• Vaginal pressure and back pain accompanies contractions
• Begin in lower back and gradually sweeps around to lower abdomen
• Contractions accompanied by bloody show or mucous plug

False Labor

• Begin and remain irregular
• Do not increase in frequency, duration and intensity
• Weak contractions
• Interval between contractions don't occur shorter and remains the same all throughout
• Often disappear with ambulation, sleep, lying down or drinking fluid
• Felt first abdominally and remained confined to the abdomen and groin

Discomfort:

True Labor

• May persist as back pain in some women
• Often resembles menstrual cramps during early labor

False Labor

• Discomfort confined at the abdomen and groin only

Cervix:

True Labor

• Includes progressive effacement and dilatation (most important characteristic)

False Labor

• No cervical effacement and dilatation noted

Preschool Period

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Overview

The preschool period includes ages 3 to 5 years old children. During this time, physical growth is considerably slow and personality and cognitive growth is substantial. The psychosocial development of preschoolers is initiative vs. guilt. As preschool children encounter a widening social world, they are challenged more than when they were infants. Active, purposeful behavior is needed to cope with these challenges. Children are asked to assume responsibility for their bodies, their behavior, their toys, and their pets. Developing a sense of responsibility increases initiative. Uncomfortable guilt feelings may arise, though, if the child is irresponsible and is made to feel too anxious.

Language Development

1. Children of this age are constantly asking mostly “how” and “why” questions. Parents have to answer these questions simply curiosity, vocabulary building and questioning are encouraged.
2. Mealtime conversation is encouraged as preschoolers find this enjoyable and they can describe something from their day in great detail.
3. Parents should correct “bathroom language,” as children of this age imitate language exactly.
4. Adults should watch out their language as preschoolers imitate exactly what they hear and this is the language pattern they adopt.

Play

Children at this age do not need too many toys. The imagination that this age group has is keener than they will be at any other time in their lives. Playing house and games that use imitation ate the ones they enjoy a lot. What preschoolers see that their parents are doing, they imitate. Thus, it is very important that parents and caregivers set a good example to these children. Actions that preschoolers love to imitate are eating meals, mowing the lawn, cleaning the house, arguing and etc.

When playing with other preschooler, they pretend to be teachers, cowboys, firefighters, doctors, nurses, dentists and etc. imaginary friends are normal at this stage because of having an active imagination. Imaginary friends often exist until these children formally begin school.

Iglesia ni Cristo Officially Supports Reproductive Health Bill

In a letter to Representative Rogelio J. Espina, chairman of the population and family relations committee in the House of Representatives, Eduardo Manalo, INC executive minister, said the organization supports “modern methods of contraception” as long as they do not encourage abortion that, with the use of “abortifacients involve the taking of life, which God explicitly forbids.”

Antepartum Care

Definition

The antepartum or pre-natal period starts when the woman’s pregnancy is diagnosed and ends just before the baby is delivered. Antepartum care promotes patient education and provides ongoing risk assessment and development of an individualized patient management plan. The major goal of prenatal care is not only to ensure that a healthy baby is born but also to promote the optimum health for the mother.

The following are the goals of antepartum care:

• To evaluate the health status of the mother and the fetus
• To estimate the gestational age
• To identify the patient at risk for complications
• To anticipate problems before they occur and prevent them if possible.
• To promote patient education and communication

Diagnosis of pregnancy

• Commercial kits are available for the diagnosis of pregnancy, all of which depend on detection of human chorionic gonadotropin (hCG) by an antibody. The various techniques used to detect hCG include agglutination inhibition, radioimmunoassay, enzyme-linked immunosorbent assay, and immunochromatography. Some tests can detect hCG at levels as low as 25 mlU/mL or as early as 1 week after implantation.
• Home tests have relatively high positive predictive values. Some of these tests, however, may have high rates of false-negative results.

Estimating Gestational Age

Age of gestation (AOG) should be estimated to calculate the exact date of delivery and the estimated weight and height of the fetus. The following are some estimates of AOG methods:

• Nagele’s Rule
• McDonald’s Method
• Bartholomew’s Rule
• Haase’s Rule
• Johnson’s Rule

Identifying Patient at Risk for Complications

Risk Factors

• Age < 16 or > 35
• 2 spontaneous or induced abortions
• < 8th grade education
• > 5 deliveries
• Abnormal presentation
• Active TB
• Anemia (Hgb <10, Hct <30%)
• Chronic pulmonary disease
• Cigarette smoking
• Endocrinopathy
• Epilepsy
• Heart disease class I or II
• Infants > 4,000 gm
• Isoimmunization (ABO)
• Multiple pregnancy (at term)
• Poor weight gain
• Post-term pregnancy
• Pregnancy without family support
• Preterm labor (34-37 weeks)
• Previous hemorrhage
• Previous pre-eclampsia
• Previous preterm or SGA infant
• Pyelonephritis
• Rh negative
• Second pregnancy in 9 months
• Small pelvis
• Thrombophlebitis
• Uterine scar or malformation
• Venereal disease

Choosing a Career Path in College

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One of the most difficult decisions I made is choosing what course to take in College. I asked my highschool teachers, I asked my parents and I asked my friends but they all have the same answer - whatever you want. It's a basic answer to a question that only you can answer. Choosing a career path is a great personal decision that you don't want to pass on to others because you will be the one who will bear the weight of your decision in the years to come. It can either motivate or break you in dire times that you are facing difficulties in studies. So before you jump on the bandwagon, make sure that you know what you are putting yourself into. 

The trick in making college major choice is narrow things down as you go along. When choosing a college you should consider the following:

Assess yourself

What are your interests?

What are the things that you really enjoy doing, something that you will not mind doing in 4 years? What are the subjects and topics in high school that catches your attention? It is fundamental for you to know what motivates you to read on a topic and excites you every time you discusses that topic. This may give you a clue on what field or what general area you would like to be in. If you are interested in numbers and analysis, then you may be inclined to be in engineering or accountancy fields. I'm not saying that these are your final choices but it may give you a general idea on where to start. After you settle with that, then narrow it down to specific courses.

Consider your abilities

It is good to assess what you can do. What are the subjects that I am good in and have really high grades? You will most likely succeed in a field that you are good in. What are your strong points as well as your weak ones? It is necessary for you to check this as it will show you the areas in which you might encounter problems in the future or where you will find success. It's one thing for you to be interested in something but once you get into that, you really don't excel or you have nearly passing grades then it's worth looking in to. Try to widen your scope and consider all the possibilities and all scenarios. If I am interested in the Table of Elements but my grades in Chemistry is below average then I think I should have a second thought or I should think it over.

Look forward for a Career

If you are eyeing on a certain career, know more about it. What are the chances that you will succeed in this course? Will I have a good job after I graduate? Will I enjoy being called a Engineer, or an Attorney or a Biologist? It will be good to do some research about it. Check out some forums in which people vent out their experiences. Ask some people who are already there. If some people in your community practicing what you are eyeing, then take some time to have an appointment and ask your minds out. Ask them of their difficulties, their successes, what makes them happy doing their job or what are the pros and cons of the field. All the while, assess if these responses and experiences meet your expectation of the course and job.

Know the Essentials

It is good to know what you want but it's another thing to coincide reality from plans and aspirations. Consider your family's finances. This may be a skirmish but it is vital in pursuing a career. For example, a course in Nursing  doesn't come cheap. There are many things to buy, many fees to pay and many resources to spend. So it's good to know if your family can support you on what you want to pursue. It's one thing to have the books to read in school while also having the necessary foods to eat than having the books to read but your stomach is grumbling for nourishment because you spent your money buying the book.

Of course this is not the end of it, if your family cannot support you and you really want to pursue the course, then find other options. Scholarships and grants are available with the proper grades and qualifications. Search out some opportunities for studies. Some universities offer free ranging scholarships from free tuition only to free overall expenses and some scholarships even offer allowances. So it's not really a hindrance but more of an obstacle on your course. Are you willing to go through a difficult path or you would go to a course where your family can give you the necessary support you will need like school expenses, allowances and buying of materials and books. There are also people who exchange work for free study. But of course this will take additional toll on you. 

Some people think only of the future: they think that having a lucrative career in the future will be the way to get them out of poverty. Nevermind that they will be buried in debt while getting there.This is one sticking point.

Overall, it is necessary to weigh all your options. Consider everything. Don't leave a stone unturned. Assess what you feel, weigh your choices and once you get a lock on it pursue it like your life depends on it.