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  1. RUBELLA Submitted by: Ali Ahmed Abdullah Supervisor: Dr. Luay Amjad Mahmood Group A
  2. Definition: Rubella, commonly called German measles, is a vaccine-preventable rash illness caused by the rubella virus. It is usually a mild disease, but can be severe in some cases. Rubella during pregnancy (congenital rubella) can cause severe complications to the fetus, such as birth defects, miscarriage, or fetal death. Rubella is differentiated from measles by the milder, more evanescent rash, milder and briefer constitutional symptoms, and absence of koplik spots, photophobia. image: koplik spots
  3. Transmission: transmission by direct or indirect contact with droplets , primarily by nasopharyngeal secretions , but also in blood, stool, and urine. Also transmitted from mother to fetus Peak incidence: late winter and early spring Incubation period: 12–23 days (usually 14) Communicable: 7 days before to 7 days after onset of rash Caused: by rubella virus primarily nasopharyngeal secretions of person with apparent or inapparent infection; virus also present in blood , stool , and urine Source:
  4. Who is at risk for rubella? Anyone who has not been vaccinated or has not previously had the disease is at risk. Rubella is spread by droplets from either sneezing or coughing. The germs that cause rubella live in the nose, mouth and throat, and are sprayed into the air when an infected person sneezes, coughs or talks. Other people nearby can then inhale the germs. Touching a tissue or sharing a cup used by someone with rubella also can spread the disease. Should children or others be excluded from child care, school, work or other activities if they have rubella Does past infection make a person immune? Yes. Past infection or past vaccination leads to lifelong immunity. Yes. Rubella is a highly contagious disease. ? How is rubella spread?
  5. Clinical Manifestations : * Rash usually first sign. *low-grade fever, malaise. * Mild pruritusq * Maculopapular rash that begins on face and spreads head to foot; disappears in same order it spread. *On the second day the rash may appear pinpoint. * Polyarthralgia and polyarthritis (rare in children but common in adolescents) * Forchheimer Spots sign (an enanthem observed in 20% of patients) * In older children: lymphadenopathy (retroauricular, posterior cervical, post occipital) 24 hours before the onset ot the rash; lasting up to 1
  6. 1-Clinical evaluation 2- examining the rash 3- checking for other symptoms, such as fever, swollen lymph glands 4- asking you if you’ve been in contact with someone who has rubella 5- Rubella Antibodies IgG Test Diagnosis:
  7. Nursing Assessment: 1- Obtain the history of the present illness, noting the onset of rash in relation to the onset of fever. 2- Note accompanying symptoms such as respiratory complaints. 3- Document known exposure to childhood diseases. 4- Note immunization status. 5- Inspect the skin for rash, noting the distribution, type, and extent of lesions.
  8. Nursing Management: 1- fever reduction, relief of discomfort, and protection of skin integrity. 2- Encourage hydration, suah as drinking plenty of fluids 3- Administer antipyretics and antipruritics as needed. 4- Nonpharmacologic interventions to reduce fever, such as tepid sponging and cool compresses, may be used. 5- Trim the child’s fingernails or cover hands with mittens, gloves, or socks if the rash itches to help prevent breaks in the skin, which can lead to discomfort and infection. 6- Care should be individualized based on the child’s and family’s response to the illness.
  9. _ Severe birth defects possible if mother is exposed and nonimmunized (especially in 1st trimester) Complication : _ encephalitis and thrombocytopenia (rare) _ Maternal rubella during pregnancy can result in miscarriage, fetal death or congenital malformations
  10. Treatment Treatment is supportive. No treatment necessary other than antipyretics for low-grade fever and analgesics for discomfort
  11. Prevention: 2- Isolation is recommended for 7 days after the onset of rash 3- Monitor rubella titer in pregnant adolescent. 4- Avoid contact with pregnant woman. 5- Educate children and their families on the importance of proper immunizations. 1- Active immunization: MMR (measles, rubella, mumps) vaccine received in two doses At their first birthday and 2nd dose at age of 18 months. 6-Routine hand washing
  12. 6- Assess immunization status at every healthy encounter. 7- Provide families with a written record of immunizations given. 8- Promptly recognize infectious diseases and provide child and family education regarding ways to prevent spread
  13. * Rubella immunization is recommended for all children at 12 to 15 months of age and at age of school entry or 4 to 6 years of age or sooner, according to the routine recommendations for the MMRV vaccine. * Increased emphasis should also be placed on vaccinating all unimmunized prepubertal children and susceptible adolescents and adult women in the childbearing age-group. * Postpubertal females without evidence of rubella immunity should be immunized unless they are pregnant; they should be counseled not to become pregnant for 28 days after receiving the rubella containing vaccine. Rubella Immunization Recommend:
  14. References: 1- kyle, T., & Carman, S. (2017). Essentials of pediatric nursing (4rd ed.). . 1009 - 1003 Wolters Kluwer.PP. 2- Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2019). Wong’s nursing care of infants and children (11th ed.). Elsevier.PP.206-226.
  15. 1- Vitamin A may be administered in significant amounts to children with this childhood communicable illness to decrease morbidity and mortality: A. Pertussis E. Genetic factors 2- Causes of congenital heart disease are all of them except ? B. Varicella C. Rubella D. Measles A. Infection disease (rubella) in early pregnancy B. mother age over 40 years D. Bacterial Infections. C. Chromosomal abbreviation 3- First dose of Measles, mumps, rubella (MMR) vaccine given to child : at age A. 4-6 years B. 15 months C. 12 months D. 9 months E. 6 months Questions: