Chicken pox

OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING DHAMTARI

2. SUBJECT: -MEDICAL -SURGICAL NURSING
TOPIC: CHICKEN POX
PRESENTED BY-
OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING
DHAMTARI (C.G)

5. CHICKEN POX

6. Definition …
Chickenpox, also known as varicella, is a
highly contagious disease caused by the initial
infection with varicellazoster virus (VZV).
The disease results in a characteristic skin rash
that forms small, itchy blisters, which
eventually scab over.

7. INTRODUCTION
CHICKEN POX IS HIGHLY
CONTAGIOUS AND IS GENERALLY A
DISEASE OF CHILDHOOD WHICH
SPREAD BY INHALATION OF INFECTIVE
DROPLET OR CONTACT WITH LESION
AFTER 10 –20 DAYS.THIS DISEASE IS
MORE COMMON IN AGE GROUP OF 5 –
10 DAYS.

8. DEFINITION
 IT IS A ACUTE HIGHLY
INFECTIOUS DISEASE CAUSED BY
VARICELLA-ZOSTER [V-Z] VIRUS.IT IS
CHARACTERISED VESICULAR RASH
THAT MAY BE ACCOMPANIED BY
FEVER AND MALAISE.
[K.PARK]

10. DEFINITION
CHICKENPOX IS HIGHLY CONTAGIOUS
DISEASE,PRESENTING WITH SUDDEN
ONSET OF LOW FEVER,MILD
CONTITUTIONAL SYMPTOMS,A
CENTRIPETAL PLEOMORPHIC RASH
APPEARING ON THE FIRST DAY OF THE
ILLNESS AND A RELATIVELY SHORT
COURSE OF ILLNESS.

11. INCUBATION PERIOD
USUALLY 14-16
DAYS,ALTHOUGH EXTREME AS WIDE
AS 7-21 DAYS HAVE BEEN REPORTESD.

12. INFECTIVE PERIOD
1 DAY BEFORE TO 5 DAYS AFTER
APPEARANCE OF RASH.

13. ETIOLOGY
CHICKEN POX IS CAUSED BY
VARICELLA ZOSTER VIRUS
THE INFECTION IS HIGHLY
CONTAGIOUS
THE VIRUS IS SPREAD BY DROPLET
ROUTE
THE INCUBATION PERIOD IS ABOUT
FORTNIGHT

14. TRANSMISSION
IT IS TRANSMITTED FROM
PERSON TO PERSON BY DROPLET
INFECTION AND BY DROPLET NUCLEI.

16. PATHOPHYSIOLOGY
PRIMARY INFECTION
TRANSMISSION IS MOST LIKELY BY RESPIRATORY ROUTE
FOLLOWED BY LOCALISED REPLICATION AT AN INDIFINED
SITE
THE OCCURRENCE OF VIREMIA IN PATIENT WITH CHICKEN
POX WITH SUPPORTED BY THE DIFFUSE AND SCATTERED
NATURE OF THE SKIN LESION
VESICLES INVOLVE THE CORIUM AND DERMIS WITH
DEGENRATIVE CHANGES CHARECTERISED BY BALLONING
MULTYNUCLEATED GAINT CELL AND EOSINOPHILIC
INTRANUCLIAR INCLUSIONS

17. CONTINUE……..
LOCALISED BLOOD VESSELS OF THE SKIN ,
RESULTING IN NECROSIS AND EPIDERMAL
HEMORRHAGE
VESICULAR FLUID BECOMES CLOUDY WITH THE
RECRUITMENT OF POLYMORPHONUCLEAR
LEUKOCYTES DEGENERATED CELLS AND FIBRIN

18. CONT………..
RECURRENT INFECTION
IT IS PRESUMED THAT VIRUS INFECTS THE
DOREAL ROOT GANGLIA DURING CHIKEN POX,
WHERE IT REMAINS LATENT UNTIL REACTIVATED
LUNG INVOLVEMENT IS CHARACTERISED BY
INTERSTITIAL PNEUMONITIS MULTINUCLEATED
GAINT CELL FORMATION ,INTRANUCLEAER
INCLUSIONS,AND PULMPONARY HEMORRHAGE

19. CLINICAL MANIFESTATION
SIGN AND SYMPTOMS
1. IMPAIRED APPETITE
2. NEW LESIONS MAY ERUPT FOR 1-5 DAYS
3. IT IS PROMINENT ON THE FACE ,SCALP,AND
TRUNK BUT TO A LESSER EXTENT IT COMMONLY
INVOLVES THE EXTREMITIES
4. THE CRUST USUALLY SLOUGH IN 7-14 DAYS
5.GENERALLY MALISE, LOW GRADE FEVER
AND ANOREXIA FOR 24 DAYS
6. PRURITIS OF LESION MAY BE SEVERE AND
SCRATCHINGMAY CAUSE SCARRING
7. RASHES APPEARS

23. DIAGNOSTIC EVALUATION
PRODROME OF LOW GRADE FEVER
PLEMORPHIC ERUPTION OF
PAPULES,VESICLES, AND PUSTULES
TYPICAL “DEW DROP ON A ROSE PETAL
APPEARANCE
EXPOSURE 14-20 DAYS PREVIOUSLY
FEVER AND MALAISE JUST BEFORE OR WITH
ERUPTION
ELISA TEST
DIRECT FLOURESENT ANTIBODY KITS FOR
RAPID DIAGNOSIS

29. MEDICAL MANAGEMENT
MILD CASES-CALAMINE
LOTION[CHILDREN] ANTIHISTAMINES
SEVERE CASES -ACLYCLOR 800MG
PROPHYLAXIS LIVE ATTENATEAL
VACCINE IN SUSCEPTIBLE PATIENT
HYPERIMMUNO GLOBULIN IF AN
IMMUNOCOMPROMISED INDIVIDUAL IS
EXPOSED TO CHICKEN POX

30. CONTINUE……
GIVEN WITH IN 24-28 HOURS OF
EXPOSURE.
VERICELLA VACCINE -IT IS
RECOMMENDED AT ANY VISIT AT OR
AFTER AGE 12 MONTHS FOR
SUSEPTIBLE PERSON AGED >13 YEARS
SHOULD RECIVE TWO DOSES GIVEN AT
LEAST 4 WEEKS APART

33. TREATEMENT
ACETAMINOPHEN
SOOTHING BATHS
LOTIONS
ANTIHISTAMINES
PREVENTING SCRATCHING
ACYCLOVIR
OTHER ANTI VIRALS

34. 1)ACETAMINOPHEN
PATIENT WITH
CHICKENPOX TYPICALLY HAVE VIRAL
TYPE PRODROMAL SYMPTOMS SUCH AS
HEADACHE,FEVER,FATIGUE AND
MUSCLE ACHES.THESE SYMPTOMS CAN
BE TREATED WITH DOSES DETERMINED
BY THE WEIGHT OF THE PATIENT.
2)SOOTHING BATHS
FREQUENT BATHS ARE
SOMETIMES HELPFUL TO RELIVE
ITCHING .

35. ADDING FINELY GROUND
OATMEAL SUCH AS AVEENO CAN HELP
DECREASES ITCHING.
3)LOTIONS
THE MOST COMMON LOTION USED
FOR CHICKEN POX IS CALAMINE LOTION
4) ANTIHISTAMINES
IT IS USED TO CONTROL SEVERE
ITCHING .
DEIPHENHYDRAMINE (BENADRYL)
& HYDROXYZINE IS AVAILABLE BY
PRESCRIPTION .

36. THE NEWER ANTI HISTAMINES SUCH AS
LORATADINE ,CERTIZINE & FEXOFENADINE
(ALLEGRA) CAN BE USED TO CONTROL
ITCHING BUT DONOT CAUSE DROWSINESS.
5)PREVENTING SCRATCHING
ALL CHILDRENS WITH CHICKEN POX
SHOULD HAVE THEIR NAILS TRIMMED
SHORT.
SMALL CHILDREN MAY HAVE TO
WEAR MITTENS TO REDUCE SCRATCHING.
6)ACYCLOVIR
IT IS AN ANTI VIRAL DRUG THAT MAY
BE USED TO TREAT CHICKENPOX .

37. IN UNCOMPLICATED CASES
ACYCLOVIR TAKEN 5 TIMES A DAY
HAS BEEN SHOWN TO CAUSE SHORTER
PERIODS OF NEW LESIONS FORMATION
AND MORE RAPID HEALING BUT ONLY
IF STARTED WITHIN 24-48 HRS OF THE
ONSET OF THE RASH.
7)OTHER ANTIVIRALS
THE ANTIVIRAL
MEDICATION
VALACYCLOVIR(VALTREX) AND
FAMCICLOVIR(FAMIR) USED TO BE
EFFECTIVE FOR CHICKENPOX.

38. NURSING MANAGEMENT
NURSING DIAGNOSIS
ACUTE OR CHRONIC PAIN RELATED TO
INFLAMATION OF CUTANIOUS NERVE
ENDING
IMPAIRED SKIN INTERGRITY RELATED
TO RUPTURE OF VESICLES
RISK FOR IMBALANCED NUTRITION
LESS THAN BODY REQUIREMENTS
KNOWLEDGE DEFICIET IS RELATED TO
THE DISEASE CONDITION

39. THE CHILDREN SHOULD REGULARLY TAKE
MEAL AND ENCOURAGE TO TAKE DIET
RICH IN PROTIEN,CALCIUM AND
POTTASIUM AND LOW IN SODIUM.
DIETARY MANAGEMENT

40. CONTINUE……
SYSTEMIC:
NEUROLOGICAL COMPLICATIONS
INCLUDE ACUTE CEREBELLAR
ATAXIA,GULLIAN-BARRE SYNDROME
,TRANSVERSE MYELITIS,OPTIC NEURITIS AND
FACIAL NERVE PALSY.
OTHERS:
ARTHRITIS,HEPATITIS,GLOMERULONEPHRITIS,
AND REYE’S DISEASE.
A MOTHER DEVELOP VERICELLA WITH IN 5
DAYS AFTER DELIVERY THE NEW BORN IS AT
GREAT RISK OF SEVERE DISEASE AND
SHOULD RECEIVE VERICELLA -ZOSTER
IMMUNO GLOUBLIN(VZIG)

41. PREVENTION
 IN MID 1995 A LIVE
ATTENUATED VACCINE FOR
VARICELLA WAS APPROVED AND
RELEASED COMMERCIALLY.
 IT IS RECOMMENDED FORT
ADMINISTEREDC TO ALL CHILDREN
OVER 12 MONTHS OF AGE WHO
HAVENOT HAVE CHICKENPOX.
 THIS VACCINE IS 85%
EFFECTIVE IN PREVENTING ILLNESS.

42. CONT……….
 CHILDREN RECEIVING THE
VACCINE SHOULDNOT TAKE ASPIRIN
FOR ATLEAST 6 MONTHS.
 VARICELLA ZOSTER
IMMUNO GLOBULIN IS EFFECTIVE IN
PREVENTING CHICKENPOX IN
EXPOSED SUSPECTIBLE
IMMUNOSUPPRESED INDIVIDUALS.

45. HEALTH EDUCATION
ISOLATE THE CLIENT BECAUSE
EXUDATE FROM THE LESION CONTAIN
THE VIRUS AND IT WILL CAUSE
TRANSMISSON.
PREVNTED THE CLIENT FROM
SCRATCHING AND RUBBING THE
AFFECTED AREA.
INSTRUCT THE CHILDREN TO WEAR
LIGHT WEIGHT LOOSE COTTON
CLOTHING AND TO AVOID WOOL AND
SYNTHETIC CLOTHING.

46. CONT……….
INSTRUCT THE CLIENT TO TAKE
OATMEAL BATH BY GRINDING DRY
OATMEAL INTO FINEPOWDER AND
ADDING ABOUT 2 CUPS TO THE BATH
WATER.
PROPER HANDWAWSHING SHOULD BE
DONE TO AVOID THE SPREAD OF
INFECTION.
APPLY CALAMINE LOTION INTO THE
BODY.
CUT THE NAILS SHORT IN THE
CHILDREN.

47. DHANYAVAAD
Thank You