Clinical Manifestations	Therapeutic Management Complications/	Nursing Considerations
Prodromal (catarrhal) stage: Fever and malaise, followed in 24 hours by coryza, cough, conjunctivitis, Koplik spots (small, irregular red spots with a minute, bluish white center first seen on buccal mucosa opposite molars 2 days before rash); symptoms gradually increase in severity until second day after rash appears, when they begin to subside Rash: Appears 3-4 days after onset of prodromal stage; begins as erythematous maculopapular eruption on face and gradually spreads downward; more severe in earlier sites (appears confluent) and less intense in later sites (appears discrete); after 3-4 days assumes brownish appearance, and fine desquamation occurs over areas of extensive involvement Constitutional signs and symptoms: Anorexia, malaise, generalized lymphadenopathy	Vitamin A supplementation Supportive: Bed rest during febrile period Antipyretics Antibiotics to prevent secondary bacterial infection in high-risk children Complications: Otitis media Pneumonia Bronchiolitis Obstructive laryngitis and laryngotracheitis Encephalitis	Isolation until fifth day of rash; if hospitalized, institute respiratory precautions Maintain bed rest during prodromal stage; provide quiet activity Fever: Instruct parents to administer antipyretics; avoid chilling; if child is prone to seizures, institute appropriate precautions (fever spikes to 104°F (40°C) between fourth and fifth days) Eye care: Dim lights if photophobia present; clean eyelids with warm saline solution to remove secretions or crusts; keep child from rubbing eyes; examine cornea for signs of ulceration Coryza/cough: Use cool mist vaporizer; protect skin around nares with layer of petrolatum; encourage fluids and soft, bland foods Skin care: Keep skin clean; use tepid baths as necessary
Prodromal stage: Fever, headache, malaise, and anorexia for 24 hours, followed by 'earache” that is aggravated by chewing Parotitis: By third day, parotid gland(s) (either unilateral or bilateral) enlarge(s) and reach(es) maximum size in 1-3 days; accompanied by pain and tenderness Other manifestations: Submaxillary and sublingual infection, orchitis, and meningoencephalitis	Symptomatic and supportive: Analgesics forpain and antipyretics for feverIntravenous fluid may be necessary for child who refuses to drink or vomits because of meningoencephalitis Complications: Sensorineural deafness Postinfcctious encephalitis Myocarditis Arthritis Hepatitis Epididymo-orchitis Sterility (extremely rare in adult males)	Isolation during period of communicability; institute respiratory precautions during hospitalization Maintain bed rest during prodromal phase until swelling subsides Give analgesics for pain; if child is unwilling to chew medication, use elixir form Encourage fluids and soft, bland foods; avoid foods that require chewing Apply hot or cold compresses to neck, whichever is more comfortingTo relieve orchitis, provide warmth and local support with tight-fitting underpants (stretch bathing suit works well)

Clinical Manifestations

Therapeutic Management Complications/

Nursing Considerations

Prodromal (catarrhal) stage: Fever and malaise, followed in 24 hours by coryza, cough, conjunctivitis, Koplik spots (small, irregular red spots with a minute, bluish white center first seen on buccal mucosa opposite molars 2 days before rash); symptoms gradually increase in severity until second day after rash appears, when they begin to subside

Rash: Appears 3-4 days after onset of prodromal stage; begins as erythematous maculopapular eruption on face and gradually spreads downward; more severe in earlier sites (appears confluent) and less intense in later sites (appears discrete); after 3-4 days assumes brownish appearance, and fine desquamation occurs over areas of extensive involvement

Constitutional signs and symptoms: Anorexia, malaise, generalized lymphadenopathy

Vitamin A supplementation

Supportive: Bed rest during febrile period

Antipyretics

Antibiotics to prevent secondary bacterial infection in high-risk children

Complications:

Otitis media

Pneumonia

Bronchiolitis

Obstructive laryngitis and laryngotracheitis

Encephalitis

Isolation until fifth day of rash; if hospitalized, institute respiratory precautions

Maintain bed rest during prodromal stage; provide quiet activity

Fever: Instruct parents to administer antipyretics; avoid chilling; if child is prone to seizures, institute appropriate precautions (fever spikes to 104°F (40°C) between fourth and fifth days)

Eye care: Dim lights if photophobia present; clean eyelids with warm saline solution to remove secretions or crusts; keep child from rubbing eyes; examine cornea for signs of ulceration

Coryza/cough: Use cool mist vaporizer; protect skin around nares with layer of petrolatum; encourage fluids and soft, bland foods

Skin care: Keep skin clean; use tepid baths as necessary

Prodromal stage: Fever, headache, malaise, and anorexia for 24 hours, followed by 'earache” that is aggravated by chewing

Parotitis: By third day, parotid gland(s) (either unilateral or bilateral) enlarge(s) and reach(es) maximum size in 1-3 days; accompanied by pain and tenderness

Other manifestations: Submaxillary and sublingual infection, orchitis, and meningoencephalitis

Symptomatic and supportive: Analgesics forpain and antipyretics for feverIntravenous fluid may be necessary for child who refuses to drink or vomits because of meningoencephalitis

Complications:

Sensorineural deafness

Postinfcctious encephalitis

Myocarditis

Arthritis

Hepatitis

Epididymo-orchitis

Sterility (extremely rare in adult males)

Isolation during period of communicability; institute respiratory precautions during hospitalization

Maintain bed rest during prodromal phase until swelling subsides

Give analgesics for pain; if child is unwilling to chew medication, use elixir form

Encourage fluids and soft, bland foods; avoid foods that require chewing

Apply hot or cold compresses to neck, whichever is more comfortingTo relieve orchitis, provide warmth and local support with tight-fitting underpants (stretch bathing suit works well)