Teaching practice on chicken pox

2. CHICKEN POX
BY
D.JENEITTA PONMALAR
B.SC(N) 2ND YEAR
BISHOP’S COLLEGE OF
NURSING
DHARAPURAM

3. • Chicken pox is a highly contagious disease.
• Chicken pox is caused by a virus called Varicella
Zoster.
• People who get the virus often develop a rash of
spot that looks like blister all over their bodies.
• The blisters are small and sit on a area of red shin
that can be anywhere and they are of varying size.
CHICKEN POX

4. DEFINITION
• Chicken pox is an acute, highly contagious
disease caused by Varicella Zoster (VZV) .
• It is mainly affect the pediatric population.
• Most common in winter and spring

5. INCIDENCE
• Chicken pox is a common disease, with most
cases occurring in the pediatric population.
• Since the introduction of wide spread
pediatric immunization in the United States in
1995, the incidence of varicella has declined
significantly, approaching a decline of up to
90%
• Mortality from varicella has also declined
since the initiation of the US vaccination
program.

6. • Chicken pox is caused by the virus Varicella
Zoster Virus (VZV).
• It is a DNA virus
• It is a member of herpes family virus
• It causes two diseases:
varicella (chickenpox), the primary infection.
Herpes zoster (shingles), a secondary
infection.
ETIOLOGY OR
CAUSATIVE AGENT

7. • The period of communicability of
patients with Varicella is estimated
to range from 1 to 2 days before the
appearance of rash, and 4 to 5 days
thereafter.
Infectivity or
communicability

8. HOST
• Occurs Primarily among
children under 10 years.
• Both sexes & all races
infected equally

9. • Chickenpox shows a seasonal trend
in India, the disease occurring
mostly disease occurring mostly
during the first six months of the
year.
• Overcrowding favors its
transmission.
Environmental Factors

10. INCUBATION PERIOD
• Usually it ranges from 14-16 days.
• 10-21 days have also been
reported.

11. • Transmitted through coughing,
sneezing, sharing food or drink.
• Transmitted by liquid of blisters
formed on skin.
TRANSMISSION

12. • Newborns and infants whose mothers never
had chickenpox or the vaccine
• Adolescents and adults
• Pregnant women who haven't had chickenpox
• People who smoke
• People whose immune systems are weakened
by medication, such as chemotherapy, or by a
disease, such as cancer or HIV
• People who are taking steroid medications for
another disease or condition, such as asthma
RISK FACTORS

13. • Rash
• Loss of appetite
• COLD
• Fever
• Abdominal pain
• Head ache
• General feeling of illness
• Fatigue
• Sore throat
• Fever may be high for first few
days
SYMPTOMS

14. PATHOPHYSIOLOGY
Viral proliferation in regional lymph
nodes of the URT (2-4 days after
initial infection
Virus infects upper respiratory tract
Inhalation of respiratory droplets

15. Stage of primary viremia
Viral replication in other organs
(liver & spleen)
Stage of secondary viremia

16. Diffuse viral invasion of capillary
endothelial cells and the epidermis
VZV infection of the malphigian
layer produces both intercellular
edema and intracellular edema,
resulting in the characteristic
vesicle.

17. DAY 0-3
• Infection of conjunctivae and
mucosa of the upper respiratory
tract.
• Viral replication in regional lymph
nodes.
PATHOGENESIS

18. DAY 4-6
• Primary viremia, viral infection
in liver, spleen and other
organs.
DAY 10-12
• Secondary viremia
DAY 14
• Infection of skin and
appearance of vesicular rash
excoriation.

20. • Body first exposed creates antibodies
 IgM
 IgG
 IgA
 B & T memory cells are also created
• If the virus is in the body again the memory
cells will detect it.
• This will help a faster response.
• If there is a 2nd exposure, memory cells will
stimulate to create antibodies.
1ST EXPOSURE

22. STAGES OF
CHICKENPOX

23. INCUBATION PERIOD USUALLY(14-16
DAYS) PRODROME(1-3 DAYS)
VESICLES
PUSTULES
SCABS
RECOVERY TYPICALLY 7 DAYS
AFTER RASH APPEARS

24. • Bacterial infection of lesions
• Pneumonia
• Hospitalization : 3 per 1000 cases
• Death : 1 per 60000 cases
• CNS involvement leads to encephalitis,
transverse myelitis, Reye’s syndrome
• Myocarditis
• Nephritis
• Arthritis
COMPLICATION

25. Chicken pox during pregnancy may result:
• Congenital varicella syndrome
• Severe varicella syndrome
• Risk of neonatal death
CHICKENPOX DURING
PREGNENCY

26. LAB DIAGNOSIS
• Lab diagnosis is usually not required.
• Laboratory confirmation of varicella or Herpes
Zoster (HZ) is by detecting VZV DNA using
Polymerase Chain Reaction (PCR) or isolating
VZV in cell culture from vesicular fluid, crusts,
saliva, cerebrospinal fluid.
• IgM testing
• Blood testing
• WBC count
• ALT ( elevated or not)
• Immunohisto chemical staining

27. MANAGEMENT
PHARMACOLOGICAL THERAPY
• Drugs used in the treatment of chicken pox
are ANTIVIRALDRUGS
,ANTIHISTAMINES & ANTIPYRETICS.
• Commonly used drug is ACYCLOVIR
available as ZOVIRAX in the market,
FAMICLOVIR available as FAMVIR.

28. • Antiviral medicines can be taken
orally intravenously or applied on
the skin.
• These are prescribed to people
with long term illness.
• Also other drugs are given to
reduce fever, COLD, itching,
irritation of the rash, sore throat
etc.
Contd…

29. Oral therapy with Acyclovir – 20
mg/kg/dose
Maximum: 800 mg/dose
4 doses per day X 5 days
should be used to treat
uncomplicated Varicella
ACYCLOVIR THERAPY

30. • Acyclovir guanine – 500 mg/m 8
hourly I.V. X 7 days.
Given within 72 hrs. prevents
progressive Varicella and visceral
dissemination in high-risk patients.
• Drug therapy does not interfere with
induction of immunity

31. • Acyclovir also useful for
treatment of Herpes zoster in
dose of 500 mg/m2 or 8
hourly.

32. NURSING
MANAGEMENT

33. NURSING
ASSESSMENT
• History collection
• Immunization
• Immuno compromised child

34. NURSING DIAGNOSIS
• Impaired Skin integrity related to
infection of the skin secondary to
varicella chickenpox, as evidenced by
maculopapular rashes, blisters, and/or
scabs
DESIRED OUTCOME:
The patient will re-establish
healthy skin integrity by following
treatment regimen for varicella
chickenpox

35. • Risk for infection related to damaged
skin tissue
DESIRED OUTCOME:
The patient will prevent spread of
infection to the rest of the body, as well
as cross-contamination to other people by
following treatment regimen for varicella
chickenpox

36. NURSING
INTERVENTIONS
• Patient education
• Manage pruritus
• Trim fingernails
• Dietary measures

37. CONTROL
OF
CHICKEN POX

38. • The spread of chickenpox can be prevented
by isolating affected individuals.
• Contagion is by exposure to respiratory
droplets, or direct contact with lesions,
within a period lasting from three days
before the onset of the rash, to four days
after the onset of the rash.
HYGINE MEASURES

39. • The chickenpox virus is
susceptible to disinfectants,
notably chlorine
bleach (i.e., sodium
hypochlorite). Like all enveloped
viruses, it is sensitive to drying,
heat and detergents

40. PREVENTION

41. Varicella – Zoster
Immunoglobulin (VZIG)
• Varicella-Zoster Immunoglobulin
(VZIG) given within 72 hours of
exposure has been recommended for
prevention of chicken pox.

42. • Chicken pox or Varicella Vaccine protect
70% - 90% of those people who are
vaccinated.
• Varicella vaccine contains live virus and so
is not recommended to children having
compromised immune system or severe
illness.
• The vaccine should not be given to children
who are allergic to neomycin or gelatin.
VACCINATION

43. • This vaccine is given to adult which also
prevents shingles.
• First dose is at between the ages of 12-
15 months and the second does is
between the ages of 4 and 6.
• SIDE EFECT of vaccine is redness or
soreness at the site of injection.
VACCINATION CONTD…

44. VACCINATION DOSE VACCINATION AGE
1st dose 12-15 months of age
2nd dose 4-6 years of age (may be
given earlier, minimum
gap of 3 months after the
1st dose)
People not been
vaccinated earlier or
Chicken Pox Vaccine
for adults
People 13 years of age and
older should get 2 doses at
least 28 days apart

45. SUMMARY
• Definition
• Incidence
• Etiology
• Infectivity or communicability
• Host
• Environmental factors
• Incubation period
• Transmission
• Risk factors
• Symptoms
• Pathophysiology
• Pathogenesis

46. • 1st exposure
• Stages
• Complication
• Chicken pox during pregnancy
• Lab diagnosis
• Management
Acyclovir therapy
• Nursing management
• Nursing assessment
• Nursing diagnosis
• Nursing intervention
• Control
• Hygine measures
• Prevention
• VZIG
• vaccination