Nursing care for patient with CHICKEN POX [Autosaved].pptx

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1. Nursing Management for patient with chicken pox disease

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.

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