The document provides a comprehensive overview of nursing management for patients with chickenpox and smallpox, detailing definitions, causative agents, risk factors, transmission modes, symptoms, diagnosis, treatment, and prevention methods. It emphasizes the importance of vaccination, patient education, and supportive nursing interventions while comparing the two diseases in terms of their clinical manifestations and management. Additionally, it includes specific medical management strategies for chickenpox and highlights the historical context of smallpox eradication and current treatments.

1. UNIT XII- NURSING MANAGEMENT OF
PATIENTS WITH COMMUNICABLE
DISEASES

3. CHICKEN POX AND
SMALLPOX
By
Krishna Priya C V
M.Sc Nursing 1st year

4. OBJECTIVES
 Definition
 Causative agent
 Risk factors
 Mode of transmission
 Infectious period
 Pathophysiology
 Signs and symptoms
 Diagnosis
 Treatment
 Complication and Prevention
 Nursing Management

5. COMMON TERMINOLOGIES
 INCUBATION PERIOD
It is the time taken for an infection to
appear its first signs and symptoms also called
latent period. It is a time elapse between exposure
to a pathogenic organism and when symptoms or
signs first appear.

6.  INFECTIOUS PERIOD
The infectious period is the time interval
during which a host (individual or patient) is infectious, i.e.
capable of directly or indirectly transmitting pathogenic
infectious agents or pathogens to another susceptible host.
The infectious period can start before, during, or after the
onset of symptoms, and it may stop before or after the
symptoms stop showing. It is also known as communicability
period, contagious period,

7. CHICKEN POX
 It is an infectious disease caused by a virus called
Varicella Zoster virus belongs to the Herpes virus family
 People who get the virus often develop a rash of spots
that look like blisters all over the bodies
 The blisters are small and sit on an area of red skin that
can be anywhere and they are of varying size.
 Most common in winter and spring

8. CAUSATIVE AGENT

9. SOURCE OF INFECTION
The virus is present in the nose and
throat secretions and lesions of the skin, mucous
membranes, and blood.

10. RISK FACTORS
 Environmental factors: It shows seasonal trends in
temperature settings and in most tropical settings with peak
incidence during winter and spring.
 A person who hasn’t already had chickenpox or hasn’t had the
chickenpox vaccine.
 People who smoke.

11.  Pregnant women who haven't had chickenpox or
the vaccine.
 People whose immune system is weakened
 Mainly in children below the age of 10 years

12. MODE OF TRANSMISSION

13. INFECTIOUS PERIOD
A person who is infected with
chickenpox can spread the virus even before
he or she has any symptoms. Chickenpox can
spread from 2 to 3 days before the rash
appears until all the blisters have crusted
over.

14. PATHOPHYSIOLOGY

16. Inhalation of respiratory droplets
Virus infect upper respiratory tract mucosa
Viral proliferation in the regional lymph node of the
URT[ 2-4 days after initial infection]
Virus enters the blood
PRIMARY VIREMIA leads to fever, malaise,fatigue

17. Virus starts to target lymphocytes in order to multiply
and spread even further
Viral replication in other organs [ liver and spleen]
Stage of secondary viremia at 14-16
days
Diffuse viral invasion of capillary endothelial cells and the epidermis
Viral infection of epidermal cells produces both intracellular
and intercellular edema resulting in vesicle

18. After primary infection, VZV spreads from mucosal
and epidermal lesions to local sensory nerve
VZV remains latent in the dorsal ganglion cells of
sensory nerves
In adults if it gets reactivated leads to infection of nerves
and dermatomes
Syndrome of Herpes Zoster or Shingles

19. SIGNS AND SYMPTOMS
PRE-ERUPTIVE STAGE [ BEFORE THE ONSET OF RASHES]
 Mild or moderate fever usually 1-2 days before the onset of
rashes 100-101 Fahrenheit
 Pain in the back
 Shivering and malaise
 Loss of appetite
 Headache
 Sore throat

20. ERUPTIVE STAGE
In children, Rash is often the first sign it comes on the day fever
starts usually during the secondary viremia stage [14- 16 days ]
1. DISTRIBUTION:
Rashes are symmetrical they first appear on the trunk where it
is abundant, then come on arms, face, and legs where it is less
abundant. Rashes also appear on the mucosal surface of the
buccal and pharyngeal.

22. RAPID EVOLUTION
The rashes advance quickly through the stages
of Macule [small patches of skin that are altered in colour
but not elevated], Papules [ elevated solid lesion of skin less
than 1 cm ] Vesicles[ a thin-walled sac filled with a fluid,
usually clear and small less than 1 cm ] with in 24 hours.
The vesicles may form a crust without going
to pustular stage. Usually, they are superficial in site ,with
easily ruptured wall

26. PLEOMORPHISM
A characteristic feature of the rashes in
chickenpox is pleomorphism. That is all stages of rash
[papules, vesicles, and crusts] present simultaneously at one
time in the same area. This is due to rashes appearing
continuously for 4-5 days in the same area

27. The incubation period of chicken pox is about 15
days [range 7-21 days]

29. DIAGNOSIS
• Chickenpox can be diagnosed with its classical symptoms
through physical examination
• Microscopic examination of the skin lesion can be done
for laboratory confirmation of the disease
• Examination of vesicle fluid under an electron microscope
• Detection of viral DNA by PCR [ Polymerase Chain
Reaction ]
• Serology to assess antibodies usually [IgG present against
VZV virus]

30. TREATMENT
MEDICAL MANAGEMENT
1. Analgesics, such as paracetamol and ibuprofen
are prescribed to relieve the pain.
2. Calamine lotion is used in relieving the itching
during chickenpox.
3. Antihistamines such as benadryl, to ease
symptoms.

31. 4. Acyclovir In children, 2-16 years of age, the oral dosage is
20 mg/kg 4 times a day for 5 days, (maximum of 800 mg 4
times a day) Adults can receive upto 800 mg 5 times a day
5. Varicella zoster immunoglobulin: Given within 72 hours of
exposure has been recommended for prevention 1.25-5 ml
given IM.

32. COMPLICATIONS and PREVENTION

34. NURSING MANAGEMENT
 Educate patient and family members about the
importance and safety of varicella zoster vaccine.
 Perform a complete physical assessment.
 Monitor the vital signs of the patient.
 Isolate the patient for at least 6 days after the
onset of rash.

35.  Instruct family members to frequently change the
cloths of patient which is soiled by the secretion
from the lesion.
 Instruct patient to cover his/her mouth while
coughing or sneezing.
 Provide a full and unrestricted diet to the patient
 Wear a PPE or have the patient wear a mask to
prevent respiratory spread.

36.  Instruct patient to trim his/her nails to prevent
injury while scratching lesion. Advice to avoid
rubbing or scratching of the lesion
 Manage itching with calamine lotion or cool
compresses
 Disinfect material contaminated by nasal and
throat secretion and wound
 Patient is advised to consume plenty of fluids
 Administer medicines as ordered by physician

37. SMALLPOX

38. STOCK PILES
Since 1984, small pox virus has been held in just
two places in world at
United States Centre for disease control and
prevention laboratory in Atlanta, Vector laboratory
Russia
Due to bioterrorism now they invented Antiviral
drug Tecovirimat [July2018 ] and Brincidovir [2021]

39. Smallpox is an acute contagious disease caused by
variola virus, a member of the ortho- poxvirus
family. Naturally occurring smallpox was eradicated
worldwide by 1980

40.  Smallpox is caused by the variola virus, a member of
the orthopoxvirus family.
 It is easily transmitted from person to person by
direct contact or inhalation of respiratory droplets.
 Spread through contaminated clothing and bedding.
 In contact with an infected person who coughs or
sneezes
 Affect all ages and both gender
ETIOLOGY

41. RISK FACTORS
 Exposure to contaminated aerosolized particles.
 Contaminated body fluid
 Physical contact with someone who has small pox

42. FORMS OF SMALL POX
 Variola major - the most serious and most
common form of small pox. It produces an
extensive rash and fever.
 VARIOLA MINOR – It is less common and less
serious form of small pox

43. PATHOPHYSOLOGY
Inhalation of the droplets
Viral replication in mucosa
Viremia
Dissemination to the skin and organs

44. Incubation phase (7-12 days )
Toxemia phase
Appearance of the symptoms

45. CLINICAL MANIFESTATION
 Discomfort
 Fever
 Headache
 Back pain
 Flat and red spots on hands, face, forearm and on
the trunk later on
 Lesions change into small blisters which the turn
into pus and scab in the later phase which leaves
scar

46. CHARACTERISTICS SMALL POX CHICKEN POX
INCUBATION
PERIOD
7-17 days 7-21 days
Fever 2-4 days before rash 1-2 days before rash
Evolution of rash Slow, scabs begin to form
10-14 days after rash
appears
Rapid, scab begin to form
4-7 days after rash appear
Characteristic of rash Deep seated
It even contain Pustules
Only one stage of rash
may be seen at one time
Superficial
Pleomorphic
Causative agent Variola virus,orthopox Varicella Zoster virus,

47. SUMMARY

50. QUESTIONS
1) Mention any two risk factors of chickenpox?
2) What are the stages of chicken pox symptoms?
3) Mention any two medical management for chickenpox ?
4) Mention any two complications of chicken pox?
5) Difference between smallpox and chicken pox [two point]?

51. BIBLIOGRAPHY
TEACHER REFERENCES
1.Suddharth &Brunner. Textbook of Medical Surgical Nursing, 13th edition:
Wolter Kluwer publication; 2014.pgno 1450-1460.
2.Black JM, Hawks JH. Medical Surgical Nursing, 1st edition : Elseiver
publication;2019. pgno 1458-1489.
3.Sharma S,Sonia L. Medical Surgical Nursing, 1st edition : Elseiver
publication ;2016. pgno 720-725
4.Park K. Textbook of Preventive and Social Medicine,27th edition :Bhanot
publication ; 2020.pgno 480-490

52. STUDENT REFERENCE
1. Kaur,Ansari .Medical-Surgical Nursing, 2nd edition: PV
publication;2017.pgno 69-80
2. Sharma. Medical Surgical Nursing, 3rd edition :AITBS
publication ;2017 .pgno 90-96