IELTS Writing

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Grading System for Essays

• Task Response
• Coherence and Cohesion
• Lexical Resource
• Grammatical Range and Accuracy

“Task Response”
Means that your essay shows that you understood and covered the topic from all its sides, aspects, etc. Let’s take this topic for example – “Internet: connecting or isolating people?”. Those who chose to write about how Internet connects people – loose marks, those who chose to write about how Internet isolates people – loose marks, those who compare and contrast both sides of the Internet and give arguments for and against – gain marks.

“Coherence and Cohesion”
Means how well you connected the paragraphs and sentences inside each paragraph. You see, all of your paragraphs need to be logically connected. For example, if paragraph 1 explains the advantages of the Internet, and paragraph 2 explains its disadvantages, then paragraph 1 should have last sentence saying something like this: “In spite of Internet being such a help in communication, its drawbacks can not be overlooked”. This sentence creates the connection between 1st and 2nd paragraphs. If it wasn’t there, examiner could think that you jumped from advantages to disadvantages without a reason. The same rule applies to sentences inside the paragraph. Every sentence should lead to the next one.

“Lexical Resource”
Means vocabulary and different types of sentences, simple and complex. You should be able to use words and their synonyms.

“Grammatical Range and Accuracy”
Means spelling and grammar of sentences. You should be able to spell the words correctly, do not forget articles “a” and “the”, punctuations is also important, etc.

WRITING

W – Work with a coach.

Practice is one way to enhance your writing skills. However, it would be ideal if you practice with a teacher or IELTS coach that will correct your output. You can never be prepared to combat the IELTS writing tasks without receiving feedbacks on your writing errors. For those who are in a tight budget and cannot afford to hire an IELTS coach, you can work on your own but be sure to have a good IELTS preparatory manual that will serve as your guide in honing of that writing ability.

R – Read through the instructions and questions carefully.

Aside from the main question, the point of issue often will ask you to address three or four things. Make sure to get these queries and discuss them in your answer.

I – Inspect your watch!

Keep track of your time! Monitor your own progress! Remember you only have one hour to finish both writing tasks. For those who have difficulty hitting the 60-minute mark for tasks 1 and 2, speed is developed by practicing constantly.

T – Think and write it out.

While rehearsing your writing ability, sit and write out tasks 1 and 2. Some people are not actually writing the brilliant ideas they were thinking while reading the question. Thus, a structured format approach should be utilized in this case. Repetitive writing can also be avoided if you practice, practice and practice.

I – Inscribe those words legibly!

Messy writing is not a criterion in marking your written output. However, if the examiner cannot read what you have written, then, you are not getting any mark either. Before taking the examination, my coach kept on reminding me about my writing because the words are too small and she had difficulty reading them. Keep in mind than an unreadable output means no mark at all!

N – No reason to start writing immediately for task 1.

Yes, I told you to keep track of your time. But don’t start writing immediately after looking at the graph or table and understanding what is asked and given. Before writing, make sure that you know what each axis represents and the units that are used. Even if you finished writing task 1 for 10 minutes but the data written is incorrect you will never hit your target mark.

G – Go for task 2 first!

Task 2 in the IELTS writing section is easier to compose and is worth more mark than task 1. I am not saying that you should ignore the other component in this section, but making sure you completed the part which weighs more points to your mark is a wise choice.

Phlebotomy

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Phlebotomy is a procedure that consists of venipuncture and withdrawal of blood. It is a safe outpatient method where blood is extracted from the vein through a cut or puncture. This procedure is performed by a nurse or technician called phlebotomist.

Purpose

Phlebotomy is performed for many reasons which include the following:

1. To obtain sample for analysis and diagnosis.
2. To treat polycythemia. Polycythemia is a condition where elevation or red blood cell volume is noted. Part of the treatment of this disorder is carrying out therapeutic phlebotomy.
3. To decrease the total blood volume of patients with pulmonary edema.
4. To remove blood from the body during blood donation.
5. To analyze blood substances contained in blood before clearing a person for blood donation.

Safety Guidelines

• Universal precautions are used with this procedure. Gloves should be worn when performing this procedure.
• Prior to blood collection it is important that the one performing the procedure is properly trained and identified as licensed phlebotomist.
• Properly identify your patient. Check the name tag and verify with the patient or nurse on duty.
• Supplies should be checked for their integrity.
• Label vials and tubes properly. Indicate date and time of extraction with the name of the patient clearly indicated.
• Needles should be immediately disposed in an approved sharps container. They never be recapped and should only be used once.
• Assess the patient for complications associated with the phlebotomy procedure.

Venipuncture Site Selection:

Although the larger and fuller median cubital and cephalic veins of the arm are used most frequently, the basilic vein on the dorsum of the arm or dorsal hand veins are also acceptable for venipuncture. Foot veins are a last resort because of the higher probability of complications.

Certain areas are to be avoided when choosing a site:

• Extensive scars from burns and surgery - it is difficult to puncture the scar tissue and obtain a specimen.
• The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema.
• Hematoma - may cause erroneous test results. If another site is not available, collect the specimen distal to the hematoma.
• Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. Otherwise, satisfactory samples may be drawn below the IV by following these procedures:
  
  • Turn off the IV for at least 2 minutes before venipuncture.
  • Apply the tourniquet below the IV site. Select a vein other than the one with the IV.
  • Perform the venipuncture. Draw 5 ml of blood and discard before drawing the specimen tubes for testing.
• Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. The line must be flushed first. When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis.
• Cannula/fistula/heparin lock - hospitals have special policies regarding these devices. In general, blood should not be drawn from an arm with a fistula or cannula without consulting the attending physician.
• Edematous extremities - tissue fluid accumulation alters test results.

Description of Procedure

In this procedure, blood is extracted from a vein on the back of the hand or over the antecubital fossa. However, some tests require blood to be taken from an artery. In blood transfusion, donors are placed in a semirecumbent position and the skin over the antecubital fossa is carefully cleansed with an iodine preparation or antiseptic solution. A tourniquet or elastic band is applied around the arm to retain blood in the area and make the veins visible. After the phlebotomist selects an appropriate vein for blood extraction, venipucture is performed. – A needle is inserted into the vein and the tourniquet is released.

The appropriate amount of blood to be withdrawn widely varies. Blood donation and therapeutic phlebotomy require larger amount of blood than blood analysis. Blood donors usually give about 450 to 500 ml of blood per session. For laboratory analysis, the volume of blood needed depends on the type of test performed. Approximately, one or more 5 to 10 ml tubes of blood are withdrawn.

Withdrawal of 450 ml of blood takes less than 15 minutes. After the needle is removed, the donor is asked to hold the involved arm straight up and apply firm pressure on the site with sterile gauze for about 2 to 3 minutes or until the bleeding stops. The phlebotomy technician then places a bandage on the site.

Instructions After the Procedure

• Within 1 to 2 minutes the donor is asked to remain in the position until they feel able to sit up. If weakness or faintness is experienced, the donor should rest for a longer time.
• Foods and fluids are given when the donor sits up and is asked to remain for another 15 minutes.
• Heavy lifting should be avoided for several hours.
• Smoking should be avoided for an hour.
• Alcoholic beverages should be avoided for 3 hours.
• For 2 days, fluid intake should be increased and balanced diet should be practiced for 2 weeks.

NOTE: Always observe aseptic technique to protect your patient and yourself.

Health Assessment

A. Health Assessment in General
1. Purposes of Health Assessment

• Data collection 
• Supplement, confirm or refute historical data 
• Identify changes in client’s status 
• Evaluate the outcomes of care 

2. Components of Health Assessment: history and physical exam
History:
I. Chief complaint

• Location 
• Quality 
• Quantity 
• Precipitating or aggravating factors 
• Duration 
• Associated findings 

II. General health status
III. Medical history
IV. Family history
V. Social history
VI. Occupation
VII. Activity level
VIII. Sleep
IX. Nutrition
X. Medications; including substance use/abuse
XI. Psychosocial factors

Physical Exam: Skills
I. Inspection

• Process of observing the differences between normal physical signs and deviations 
• Requires knowledge of normal physical signs throughout the lifespan 

Principles of inspection

• In good lighting and with whole body partly visible 
• Observe each area for size, shape, color and position 
• Compare body parts bilaterally for symmetry 

II. Palpation

• Use touch to assess resistance, resilience, roughness, texture and mobility 
• Palpation may be either light or deep in pressure:

1. Use light palpation to determine tenderness 
2. Deep palpation usually depresses the area by 1 to 2 inches; use it to examine specific organs 

•  Use palmar surface of fingers to determine position, texture, size, consistency and pulsation; also presence and shape of mass 
• Use back of hand to test temperature 
• Use palm of hand to sense vibration 

III. Percussion

• Tap the body with fingertips: to detect fluid or to assess location, size, density and borders of organs 
• Tapping the body produces vibration and sound waves which you hear as percussion tones 

Methods

• Direct: striking the body surface with two fingers 
• Indirect: striking the middle finger of the non-dominant hand on the back surface with the fingers of the dominant hand rather than the body surface, while keeping the palm and remaining fingers of the body 
• Character of percussion sounds depends on the density of the tissue being percussed 

Percussion Sounds:

• Tympany: drum like, loud, high pitch, moderate duration; usually found over space containing air such as the stomach 
• Resonance: hollow sound of moderate to loud intensity; low pitch, long duration; usually heard over the lungs 
• Hyperresonance: booming sound of very loud intensity; very low pitch, long duration; usually heard in the presence of trapped air (such as emphysematous lung) 
• Flatness: flat sound of soft intensity; high pitch, short duration; usually heard over muscles 
• Dullness: thud-like sound of soft intensity; high-pitch, moderate duration; usually heard over solid organs (such as heart, liver) 

IV. Auscultation

• Listening (with unassisted ear or stethoscope) to sounds made by the body 

Assess presence of sound and their character 

• Frequency (high or low pitch) 
• Loudness (loud or soft) 
• Quality (blowing, gurgling, booming, thud-like, hollow or flat) 
• Duration (short, moderate or long) 

V. Olfaction

• Use of sense of smell to differentiate common body odors from abnormal ones 

Common odors include:

• Urine: ammonia 
• Skin: body odor 
• Body wastes: feces, vomitus 
• Mouth: halitosis 

VI. Physical exam 

1. Equipment 

2. Client positions 

3. Reporting general appearance and behaviors 

• Gender and race 
• Age 
• Obvious signs of distress 
• Body type 
• Posture 
• Gait 
• Body movements 
• Hygiene 
• Dress 
• Affect and mood 
• Speech 

4. Vital signs 

5. Height and weight

6. Body temperature 

• Range: 36 to 38 degrees Celsius (98.6 to 100.4 degrees Fahrenheit) 
• Measure core temperature: rectum, tympanic membrane, esophagus or urinary bladder 
• Measure surface temperature: skin, axilla or mouth 

Body temperature normally varies with:

• Age 
• Exercise 
• Hormone level 
• Circadian rhythm (time of day) 
• Stress 
• Environment 

Equipment needed for physical exam

• Client gown 
• Drapes 
• Stethoscope 
• Gloves 
• Percussion hammer 
• Sphygmomanometer (blood pressure gauge and cuff) 
• Thermometer 
• Tape measure 
• Cotton swabs 
• Flashlight 
• Tongue depressor 
• Scale 
• Lubricant 
• Eye chart 
• Miscellaneous: safety pin, ruler, paper towels

Health and Health Promotion

HEALTH
A. Definitions of health vary

• Traditional definition: freedom from disease 
• 1958 World Health Organization definition: “state of complete physical, mental and social well-being and not merely the absence of disease and infirmity” 

B. Health belief model

• Psychological and behavioural theory 
• Attempts to explain individual health behaviours 
• Health behaviours

1. The individuals perception of susceptibility of illness 
2. The individuals perception of seriousness of the illness 
3. The likelihood that the person will take preventive action 

• Modifying Factors

1. Cultural beliefs 
2. Economics 
3. Political factors 
4. Social factors 
5. Personal beliefs 

Health Promotion
A. Definitions

1. Health Promotion Behaviour is a behaviour in which the client views health as a goal and engages in behaviours designed to achieve or maintain that goal 
2. Health Care includes prevention, early detection, treatment and rehabilitation for clients with potential for or existing illness or disability 
3. Healthy Lifestyle can increase or maintain client’s level of wellness and functional ability 
4. Health Screening (for risk factors or illness) can prevent or minimize illness and disability 
5. Disease Prevention Behaviors are behaviours designed to decrease the likelihood/risk of illness 

• Primary prevention 

1. Health promotion and disease prevention 
2. Applied to clients considered physically and emotionally healthy
3. Example: exercise programs, healthy diet 

• Secondary prevention 

1. Early detection of illness 
2. Focuses on individuals who are experiencing health problems and illness and who are at risk for problems and illnesses and who are at risk for complications 
3. Activities are directed at diagnosis and prompt treatment 
4. Example: breast self examination, cholesterol screening 

• Tertiary prevention 

1. Prevention of further deterioration in disease or disability 
2. Occurs when a defect or disability is permanent and irreversible
3. Activities are directed at rehabilitation 
4. Example: alcoholics anonymous 

B. Primary Health Care

• Accessible, community-based or work-based health care services based on principle of universal access, which ensures health care for all individuals regardless of employment or insurance status
• Health Security Act of 1993 offered universal access to basic hospital, preventive, physician and long-term services. It included these seven services:

1. Physical examinations
2. Screening tests 
3. Diagnosis and treatment of common acute illness 
4. Management of chronic illnesses 
5. Liaison with community resources 
6. Provision of prenatal care 
7. Identification of need for specialty referrals 

• Providers include physicians and advanced practice nurses such as: nurse midwives and nurse practitioners
• Services provided through a managed care model
• Specialty services provided and reimbursed only after referral from the primary care provider
• Primary care settings include:

1. Health maintenance organizations (HMOs) 
2. Public health departments 
3. Occupational health clinics 
4. Schools 
5. Nurse managed clinics 
6. Collaborative practice settings 

C. Health Promotion Model

• Developed by Nola Pender 
• Health promotion depends on seven factors of cognition-perception

1. Importance of health to the person 
2. Perceived control of health 
3. Perceived self-efficacy 
4. Definition of health 
5. Perceived health status 
6. Perceived health benefits from the health-promoting behaviour 
7. Perceived barriers to the health-promoting behaviour 

D. Risk Factors – probability of acquiring a particular health problem

• Varies with age, race, ethnicity, gender 
• Risk increases with certain lifestyle choices, such as smoking, occupation, diet, environment 
• Modifiable risk factors include occupation and diet 
• Non-modifiable risk factors include race and age 
• Examples: Risk factors are important in

• Coronary artery disease 
• Cancer 
• Colon cancer 

1. Over 50 years of age 
2. Family history of colon polyps or cancer 
3. Urban living 
4. Diet high in fats and low in fiber

• Tuberculosis 

1. History of exposure to person with TB 
2. History of travel or living outside United States 
3. History of prison time 
4. HIV infection 
5. Cancer chemotherapy 
6. Malnutrition 
7. Homelessness 
8. History of IV drug use 
9. Medical workers

• Diabetes: candidates for screening 

1. Strong family history of diabetes mellitus 
2. Markedly obese 
3. Obstetrical history of babies weighing over nine pounds at birth 
4. Obstetrical history of miscarriage or fetal death 
5. Pregnant women between 24-48 weeks gestation 
6. History of gestational diabetes

E. Screening recommendations for the average American

• Cholesterol – once every five (5) years if normal age 45 and older 
• In women: mammography 
• In women: the first Papanicolau smear at the onset of sexual activity and/or over age 19, annually
• In men: prostate-specific antigen – annually 50 years of age or at age 40 for those at risk
• For colon cancer:

1. Digital rectal exam every year after the age of 40
2. Guiac test for occult blood every year after the age of 50
3. Proctoscopy every three (3) to five (5) years after the age 50 after two negative annual exams
4. Colonoscopy

• Tuberculosis skin tests: intradermal injection of antigen
• Diabetes: fasting plasma glucose, ideally eight (8) to twelve (12) hours fast
• Vision: after age 39, medical eye exam every three (3) to five (5) years
• Hearing: candidates for screening include:

1. Family history of childhood hearing impairment
2. Perinatal infection (rubella, herpes, cytomegalovirus)
3. Low birth weight infants
4. Chronic ear infection
5. Down syndrome

HEALTH PROMOTION PROGRAMS AND HEALTH SCREENING

I. Blood Pressure Screening

• Screening should be done annually beginning at age 21 for both males and females
• Screening for children and adolescents is also recommended but optimal interval has yet to be determined
• Auscultatory method with a properly calibrated and fitting cuff should be used
• Person should be seated quietly in a chair for at least five minutes with feet on the floor and arms supported at heart level
• At least two measurements should be done, two minutes apart
• Pre-hypertensive individuals (SBP 120-139 and DBP 80-89) should be counseled on lifestyle modifications such as weight reduction, exercise, diet and smoking cessation
• SBP >140 and/or DBP >90 should be referred to a health care provider for antihypertensive drug therapy

II. Breast Self-Examinations

• Should be started by age twenty
• Done at the same time of the month - preferably seven days after onset of the menstruation cycle; if no menstruation cycles, do at the same time of each month
• Technique should be reviewed by a health care provider to ensure effectiveness
• Limited effectiveness, but when done regularly helps a woman understand how her breast normally feel
• Most changes are benign, but unusual or spontaneous changes should be checked by a health care provider without delay. These include:

1. lump or thickening (breast or underarm)
2. red or hot skin
3. orange peel skin
4. dimpling or puckering
5. itch or rash, especially in nipple area
6. retracted nipple
7. change in direction of nipple
8. bloody or spontaneous discharge
9. unusual pain
10. a sore on the breast that does not heal

III. Risky Behaviors - assist in assessment of behaviors that impact the health of individuals in the following developmental stages

• Adolescents (age 13-19)
• Eating disorders
1. Anorexia Nervosa - restrictive eating
2. Bulimia Nervosa - binge eating followed by purging
• Injury prevention
1. wearing of seat belts
2. wearing of helmets
3. sports injuries
4. homicide and suicide
• Substance abuse
1. tobacco
2. underage drinking
3. illicit drug use
• Sexual  behavior
1. number of sex partners
2. use of contraception
3. unintended pregnancy
4. exposure to sexually transmitted diseases
• Young Adult (age 20-35)
• Eating disorders - onset of obesity
• Injury prevention
1. Motor vehicle accidents
2. Occupational hazards
3. Homicide and suicide
• Substance abuse
1. tobacco
2. alcohol use
3. illicit drug use
• Sexual behavior
1. sexually transmitted disease - use of condoms
2. unintended pregnancy
• Stress
1. depression
2. Changing roles
• marriage
• beginning a new family
• starting a new job
• Middle Adult (age 35-65)
• Obesity
• Lack of exercise
• Substance abuse
1. tobacco
2. alcoholism
3. illicit drug use
• lack of preventative health care
• stress
1. job
2. family/divorce
3. acceptance of aging
• Older Adult (age 65 and older)
• Obesity
• Lack of exercise
• Substance abuse
1. tobacco
2. alcoholism
3. illicit drug use
• Injury prevention
1. falls
2. seatbelts
3. suicide
4. multiple medications

IV. Scoliosis Screening

• Recommendations vary but generally accepted to perform screening at onset of adolescence
• Significantly more prevalent in girls than boys
• Early intervention important because untreated scoliosis can lead to disfigurement, impaired mobility, and cardiopulmonary complications
• Technique - clothing should be removed from upper body

1. While standing, check adolescent for asymmetry of shoulders, scapula, hips or waist
2. Assess for misalignment of spinous processes - lateral curvature and convexity of thoracic spine indicate scoliosis
3. With feet together and legs straight, have adolescent bend forward until back is parallel to floor; check for prominence of ribs on one side only and hip and leg asymmmetry - chest wall on side of convexity is prominent and scapula on side of convexity is elevated

• Abnormalities are to be followed up by a health care provider and referral to orthopedist may be necessary for severe curvatures

V. Testicular Self-Examinations

• Monthly self-examination should begin in adolescence, since this is the highest risk group
• Best time to perform exam is during or after a bath or shower when the scrotum is relaxed
• Limited research to determine if regular examinations reduce death rate but they are strongly encouraged for men with risk factors such as

1. family history of testicular cancer
2. cryptochidism
3. previous germ cell tumor in one testicle

• Findings that should be reported to a health care provider include

1. hard lumps or nodules
2. change in size, shape or consistency of the testes

F. Compliance

• Definition: adherence to primary or secondary prevention recommendations
• Factors influencing compliance

1.  Personal meaning and perceptions: knowledge, values, beliefs, outcome expectations
2. Social factors: environmental context, social relationships, social support, societal norms, economic resources
3. Deficiencies in the health care system: access, costs, wait time, monolingual services

 G. Noncompliance

•  An individual’s informed decision not to adhere to a therapeutic recommendation
• Individual unable or unwilling to alter habitual behaviours or adopt new behaviours necessary to a prescribed therapeutic regimen 

TIMING OF MAMMOGRAMS 

• The National Cancer Institute (NCI) and the American Cancer Society differ in their recommendations for scheduling of mammograms 
• NCI recommends (2002): 

1. Women in their 40s should be screened every one (1) to two (2) years with mammography 
2. Women aged 50 and older should be screened every one (1) to two (2) years 
3. Women who are at higher than average risk of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and the frequency of screening 

• The ACS guidelines for the detection of breast cancer in asymptomatic women (2002): 

1. Women 40 years of age and older should have a mammogram every year 
2. Women 40 years and older should have a physical examination of the breast every year, performed by a health care professional, such as a physician, physician assistant, nurse or nurse practitioner. This examination should take place near and preferable before, the annual mammogram 
3. Women 20-39 should have a physical examination of the breast every three (3) years, performed by a health care professional such as physician, physician assistant, nurse or nurse practitioner 

• BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away 

POINTS TO REMEMBER:

• Measure vital signs when the client is at rest
• Compare both sides of the body for symmetry
• Assess the systems related to the client's major complaint first
• Offer rest periods if client becomes tired
• Culture and religious beliefs may play a role in observed differences
• Warm hands and equipment such as stethoscope before touching client 
• Tell client what you are going to do before touching client
• Normal variations exist among clients and there is a range of normalcy for all physical findings
• Maintain the client's privacy throughout the examination
• Control for environmental factors which may distort findings
• Check equipment prior to exam for functioning
• Consider growth and developmental needs when assessing specific age groups
• Integrate client teaching throughout the exam

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.