Education

2. Definition
• Chickenpox - also known as varicella, is a highly
contagious viral infection caused by the varicella-
zoster virus (VZV).
• VZV is a DNA virus that is a member of the herpes
virus family.
• After the primary infection, VZV stays in the body
(in the sensory nerve ganglia) as a latent
infection.

3. Pathophysiology
• After initial inhalation of contaminated
respiratory droplets, the virus infects
the conjunctivae or the mucosae of the
upper respiratory tract.
• Viral proliferation occurs in
regional lymph nodes of the upper
respiratory tract 2-4 days after initial
infection; this is followed by primary
viremia on postinfection days 4-6.

4. Pathophysiology Cont …d
• A second round of viral replication occurs in
the body’s internal organs,
• most notably the liver and the spleen, followed
by a secondary viremia 14-16 days post-
infection.
• This secondary viremia is characterized by
diffuse viral invasion of capillary endothelial
cells and the epidermis.

5. Pathophysiology Cont …d
• VZV infection of cells of the malpighian
layer produces both
intercellular edema and intracellular
edema, resulting in the characteristic
vesicle.
• Exposure to VZV in a healthy child
initiates the production of host
immunoglobulin G (IgG), immunoglobulin
M (IgM), and immunoglobulin A (IgA)
antibodies; IgG antibodies persist for life
and confer immunity.

6. Pathophysiology Cont …d
• After primary infection, VZV is
hypothesized to spread from mucosal
and epidermal lesions to local
sensory nerves.
• VZV then remains latent in the dorsal
ganglion cells of the sensory nerves.
• Reactivation of VZV results in the
clinically distinct syndrome of herpes
zoster (shingles).

7. Incubation period
 7-21 days
Causative organism
 Caused by varicella zoster virus also called
human (alpha)herpes.

8. Sign & symptoms
In Children
• Itchy rash appearance on the head &
spreads down to the trunk & other body
parts
• The rash becomes raised, & blisters
form.
• Blisters may also form on mucous
memebranes, such as inside the mouth,
nose, throat, & vagina.

9. In Children cont…d
• The blister crust over & disappear within
about 10-14 days.
• Children may also have fever & tiredness
along with rash.

10. Sign & symptoms in adults
Pre-eruptive stage:
At the onset, low or moderate fever, feeling
cold, restlessness, backache etc.
Eruptive phase:
The rash are found on the body which are less
on the face & hands.
Different stages of rashes are ( macular,
papular, vesicular & scabal) found together.
This is the special characteristics of the
disease.
The eruptive stage lasts for 4-7 days.

11. Chickenpox Rash

12. Serious symptoms
 High fever
Vomiting
Diarrhoea
Head ache
Dehydration
Worsening of asthma

13. Complication
• Pneumonia
• Bleeding
• Encephalitis
• Serious disease of fetus in case of
pregnancy

14. Diagnosis
• S &S, typical spread of rash
• Polymerase chain reaction (PCR) testing. The most
sensitive method for confirming a diagnosis of
varicella is the use of PCR to detect VZV in skin lesions
(vesicles, scabs, maculopapular lesions).
• IgM testing. IgM testing is considerably less sensitive
than PCR testing of skin lesions;
• Blood testing. Most children with varicella have
leukopenia in the first 3 days, followed by
leukocytosis; marked leukocytosis may indicate a
secondary bacterial infection but is not a dependable
sign;

15. Medical Management
• Antiviral therapy. The routine use of
acyclovir or valacyclovir in healthy children if
it can be given within 24 hours after the rash
first appears in children older than 12 years,
• Varicella zoster immune globulin. Varicella
zoster immune globulin
• it is indicated for high-risk individuals within
10 days (ideally within 4 days) of chickenpox
exposure;
• this agent reduces complications and the
mortality rate of varicella, not its incidence.

16. Medical Management Cont….d
• Antibiotic therapy. Suspicion of a
secondary bacterial infection should
prompt the early institution of
empirical antibiotic therapy until the
results of culture studies become
available.

17. Nursing Management
Treatment approaches include:
• supportive measures,
• antiviral therapy,
• administration of varicella-zoster
immune globulin (VZIG), and
• management of secondary bacterial
infection.

18. Nursing Management
Nursing Assessment
• Assessment of a child with chicken pox
includes the following:
• History taking. if any exposure to varicella at
school, daycare, or among family
members has occurred.
• Immunizations - immunocompromised
children often have severe and complicated
varicella, and their mortality rate is higher than
that of immunocompetent children.

19. Nursing Assessment cont..d
 Vaccine is available as a single vaccine, also
as part of the MMRV vaccine (measles,
Mumps. Rubella and Varicella vaccine).
Route: Subcutaneous

20. Nursing Diagnosis
Based on the assessment data, the major nursing
diagnoses are:
• Hyperthermia related to viral infection.
• Impaired skin integrity related to mechanical
factors (eg stress, scratch, friction).
• Disturbed body image related to lesions on the
skin.
• Deficient knowledge about the condition and
treatment needs.
• Risk for infection related to damaged skin tissue.

21. Nursing Care Planning and Goals
Desired outcomes for a child with chicken
pox include:
• Client will be comfortable and able to rest.
• Client or caregiver will verbalize needed
information regarding the disease, signs and
symptoms, treatment, and possible
complications of varicella zoster.
• Client will remain free of secondary infection,
and intact skin without redness or lesions.

22. Nursing Care Planning and Goals …
• Client will have minimal risk for disease
transmission through the use of
universal precautions.
• Client will demonstrate positive body
image,

23. Nursing Interventions
Interventions for a child with chicken pox
include:
• Patient education. Educate parents
about the importance and safety of the
Varicella Zoster vaccine.
• Manage pruritus. in patients with
varicella with cool compresses and
regular bathing; warm soaks and
oatmeal or cornstarch baths may reduce
itching and provide comfort.

24. Nursing Interventions …
 Trim fingernails. Trimming the child’s
fingernails and having the child wear
mittens while sleeping may reduce
scratching.
 Dietary measures. Advise parents to
provide a full and unrestricted diet to the
child; some children with varicella have
reduced appetite and should be
encouraged to take sufficient fluids to
maintain hydration.

25. Evaluation
• The Nurse evaluate whether all goals are met
or not.
Documentation
Documenting all the assessment findings,
Plan of care, current or recent medical therapy,
response to the managements, attainment or
progress toward the desired out come,
modification to plan of care.