Varicella

Treatment-General

Airborne and contact precautions until lesions are dry and crusted Standard precautions Cool compresses

Treatment-Diet

Increased fluid intake

Overview-Causes

Varicella zoster herpesvirus

Nursing Considerations-Monitoring

Vital signs, especially temperature Skin integrity, including the status of lesions and severity of pruritus Hydration status, including fluid balance Signs and symptoms of secondary infection Response to treatment Energy level Interaction with others Pain Sensory function

Overview-Complications

With scratching due to severe pruritus: infection, scarring, impetigo, furuncles, and cellulitis Cerebellar ataxia Encephalitis Otitis media Reye syndrome Pneumonia Myocarditis Bleeding disorders Arthritis Nephritis Hepatitis Acute myositis Post-herpetic neuralgia

Overview

An acute, highly contagious viral infection Caused by the same virus that causes chickenpox, thought to become latent until the sixth decade of life or later, causing herpes zoster (shingles) Transmissible through airborne droplets, direct contact, and indirect contact Congenital varicella possible in infants whose mothers had acute infections in the first or early second trimester

Treatment-Medications

Antipyretics or analgesics, such as acetaminophen or ibuprofen, for fever and discomfort Local or systemic antipruritics, such as antihistamines (for example, diphenhydrAMINE hydrochloride or hydrOXYzine hydrochloride) and oatmeal or colloidal baths Acyclovir (Zovirax) to decrease fever duration and shorten viral shedding (initiatied within 24 hours of symptom onset); famciclovir or valacyclovir as second-line agents Varicella zoster immune globulin for immunocompromised patients to achieve passive immunization Varicella vaccine for susceptible individuals exposed to the virus who have not received the full two-dose series. Topical capsaicin for pain associated with postherpetic neuralgia.

Nursing Considerations-Associated Nursing Procedures

Blood pressure assessment Contact precautions Health history interview and physical assessment Intake and output assessment Oral drug administration Pulse assessment Respiration assessment Standard precautions Temperature assessment Topical skin drug application Venipuncture

Nursing Considerations-Nursing Diagnoses

Disturbed body image Fatigue Hyperthermia Impaired skin integrity Readiness for enhanced knowledge Risk for imbalanced fluid volume Risk for infection Social isolation

Assessment-Physical Findings

Fever of 101° to 103° F (38.3° to 39.4° C) Crops of small, erythematous macules on the trunk or scalp Macules progressing to papules and then clear vesicles on an erythematous base (so-called "dewdrops on rose petals") (see The rash of varicella) Vesicles becoming cloudy and breaking easily; then scabs forming Rash that spreads to the face and, rarely, to the extremities Rash containing a combination of red papules, vesicles, and scabs in various stages Ulcers on mucous membranes of the mouth, conjunctivae, and genitalia Motor weakness

Nursing Considerations-Nursing Interventions

Institute airborne and contact precautions until lesions have dried and crusted. Consider susceptible patients who are exposed to the virus to be at risk and potentially infectious for 21 days. Observe an immunocompromised patient for manifestations of complications, such as pneumonitis and meningitis, and report any manifestations immediately. Administer varicella-zoster immune globulin as ordered within 10 days of exposure; administer the varicella virus vaccine within 72 hours of exposure. Give antipyretics and antihistamines as ordered. Ensure the use of safety measures to reduce the risk of injury related to the sedative effects of antihistamines. Assist with energy-conservation measures as necessary. Encourage frequent rest periods, and cluster care activities to provide for rest. Provide for diversionary activities. Allow the patient to verbalize feelings and concerns related to the condition and the need for infection-control precautions. Provide clear explanations and answer any questions. Assist with positive coping strategies, promote active participation in care and decision making, and point out positive aspects about the patient to foster feelings of control and self-esteem. Encourage increased fluid intake. Offer fluids frequently, based on the patient's preferences. Ensure that the patient's nails are short to reduce the risk of scarring and secondary infection from scratching. Provide skin care comfort measures, such as cool compresses, calamine lotion, cornstarch, oatmeal or colloidal baths, or showers. Prevent exposure to pregnant women.

Assessment-History

Recent exposure to someone with chickenpox Malaise Headache Anorexia Pruritus Cough Pain Paresthesia

Treatment-Activity

Rest periods when fatigued

Overview-Incidence

Since the initiation of immunization, rates have declined dramatically. Chickenpox can occur at any age. This disease occurs worldwide and is endemic in large cities, with outbreaks occurring sporadically. Chickenpox equally affects all races and both sexes. Seasonal distribution varies; in temperate areas, the incidence is higher during late winter and spring.

Patient Teaching-General

disorder, diagnosis, underlying cause, and treatment, including pharmacologic and nonpharmacologic measures that varicella infection confers lifelong immunity; that a second attack is rare, but a subclinical infection can occur and become latent, recurring years later as herpes zoster likelihood of spontaneous and complete recovery, which typically occurs within a few weeks, with the rash resolving in 2 to 3 weeks prescribed medication therapy, such as antiviral agents, topical agents, and antipyretics possible adverse effects of medication therapy signs and symptoms of secondary bacterial infections, such as severe skin pain and burning, and the need to notify a practitioner if any occur need for meticulous hygiene to prevent spreading infection to other body parts need to avoid scratching lesions application of topical agents, such as calamine lotion, or proper use of oatmeal or colloidal baths need to keep nails trimmed short to prevent scarring and secondary infection from scratching need for routine immunization

Nursing Considerations-Expected Outcomes

verbalize feelings about changed body image report or demonstrate an increased energy level remain afebrile exhibit improved or healed lesions or wounds demonstrate the skin care regimen maintain adequate fluid balance remain free from signs of secondary infection interact with family and peers to decrease feelings of isolation.

Diagnostic Test Results-Laboratory

The virus can be isolated from vesicular fluid within the first 4 days of the rash; a Tzanck smear from scraping of the vesicles reveals multinucleated giant cells. A Giemsa stain may distinguish the varicella zoster virus from the vaccinia variola virus. Serum samples contain antibodies 7 days after onset of symptoms. Serologic testing differentiates rickettsial pox from varicella. White blood cell count may be normal, low, or mildly increased; marked leukocytosis suggests a secondary infection.

Overview-Pathophysiology

The virus is transmitted via aerosolized droplets from nasopharyngeal secretions of an infected person or by direct contact with fluid in vesicular skin lesions. Localized replication of the virus occurs (probably in the nasopharynx), leading to seeding of the reticuloendothelial system and development of viremia. Diffuse and scattered skin lesions result with vesicles involving the corium and dermis with degenerative changes (ballooning) and infection of localized blood vessels. Necrosis and epidermal hemorrhage result; vesicles eventually rupture and release fluid or are reabsorbed. The incubation period lasts approximately 10 to 21 days The infection is communicable from 1 to 2 days before lesions erupt until after the vesicles crust over. After primary infection, the virus remains dormant in the sensory nerve roots; if reactivated, the virus travels through the sensory nerve to the skin, producing a vesicular eruption along the distribution of the nerve from one or more dorsal root ganglia (dermatome).