chicken pox and small pox management.pptx

Chicken pox and small pox and it's management

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

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

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

4. 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 .

5. 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,

6. 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

7. CAUSATIVE AGENT

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

9. 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.

10. 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

11. MODE OF TRANSMISSION

12. 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 .

13. PATHOPHYSIOLOGY

14. 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

15. 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

16. 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

17. 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

18. 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.

19. 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

20. 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

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

22. 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]

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

24. 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.

25. COMPLICATIONS and PREVENTION

26. 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.

27. 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.

28. 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

29. SMALLPOX

30. 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 ]

31. 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

32. 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

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

34. 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

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

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

37. 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

38. 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 virus family Varicella Zoster virus, Herpes virus family

39. SUMMARY

40. QUESTIONS Mention any two risk factors of chickenpox? What are the stages of chicken pox symptoms? Mention any two medical management for chickenpox ? Mention any two complications of chicken pox? Difference between smallpox and chicken pox [two point]?

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

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