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Chicken Pox (Varicella)

It is Troy’s principal day of preschool. He is scared to go to unfold concertedly delay his friends and engage lots of new friends. A seatmate of Troy’s revealed to their illustrebuke collection that he lawful recovered from chicken pox, which the kids ignored. Days later, Troy unfold minute red bumps on his torso; he was so ordinary a lofty heat and was sentiment very inconclusive. His originators brought him in for a check-up and was directly sickly, as Troy contracted chicken pox.

Description

Chickenpox is a very pestilential complaint caused by the varicella-zoster poison (VZV).
  • Varicella is an sharp epidemic complaint; it is caused by varicella-zoster poison (VZV), which is a DNA poison that is a component of the herpespoison collection.
  • After the leading contamination, VZV stays in the assemblage (in the sensory resolution ganglia) as a inaporiginator contamination.
  • Primary contamination delay VZV causes varicella.

Pathophysiology

Chickenpox is usually adventitious by the met of airborne respiratory droplets from an infected assemblage.
  • The loftyly pestilential disposition of varicella-zoster poison (VZV) underlies the epidemics that scatter quickly through unfolds.
  • The varicella-zoster poison (VZV) is the etiologic commissioner of the clinical syndrome of chickenpox (varicella).
  • After judicious met of depraved respiratory droplets, the poison infects the conjunctivae or the mucosae of the remarkable respiratory hope.
  • Viral proliferation supervenes in regional lymph nodes of the remarkable respiratory hope 2-4 days succeeding judicious contamination; this is followed by leading viremia on postcontamination days 4-6.
  • A promote rotund of viral replication supervenes in the assemblage’s inside organs, most notably the liver and the rancor, followed by a promoteary viremia 14-16 days post contamination.
  • This promoteary viremia is characterized by verbose viral encroachment of capillary endothelial cells and the epidermis.
  • VZV contamination of cells of the malpighian layer produces twain intercellular edema and intracellular edema, conclusioning in the individuality vesicle.
  • Expoenduring to VZV in a salubrious offshoot initiates the genesis of assemblage immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA) antibodies; IgG antibodies stick for anxietyer and collate immunity.
  • After leading contamination, VZV is hypothesized to scatter from mucosal and epidermal lesions to topical sensory nerves.
  • VZV then dross inaporiginator in the dorsal ganglion cells of the sensory resolutions.
  • Reactivation of VZV conclusions in the clinically obvious syndrome of herpes zoster (shingles).

Statistics and Incidences

Chickenpox is a vile complaint, delay most cases supervenering in the pediatric population.
  • Since the initiative of widescatter pediatric immunization in the United States in 1995, the stroke of varicella has wasted-away forciblely, approaching a succeeding a opportunitydraw of up to 90%.
  • Mortality from varicella has so wasted-away past the source of the US vaccination program, delay torpor decreasing by approximately 66%.
  • Countries delay emblematical and semiemblematical atmospheres bear a loftyer stroke of adult chickenpox than do countries delay a calm atmospless (eg, United States, Europe).

Causes

Chicken pox is a vile offshoothood complaint caused by:
  • Varicella-zoster poison (VZV). Varicella-zoster poison (VZV) causes the chickenpox contamination; the poison is pestilential to those arotund you for one to two days antecedently your blisters reply; VZV dross pestilential until all blisters bear crusted balance.

Clinical Manifestations

Chickenpox contamination replys 10 to 21 days succeeding inhospitableness to the poison and usually lasts encircling five to 10 days.
  • Rash. Once the chickenpox foolhardy replys, it goes through three phases: honorable pink or red bumps (papules), which violate out balance diverse days; minute fluid-filled blisters (vesicles), forming from the honorable bumps balance encircling one day antecedently violateing and leaking; and crusts and scabs, which cbalance the meek blisters and accept diverse past days to repair.
  • Fever. Heat is an accompanying sign of chicken pox.
  • Headache. Headache may reply one to two days antecedently the foolhardy.
  • Body malaise. Tless is a sentiment of generalized tiredness all balance the assemblage.

Assessment and Diagnostic Findings

Health anxiety producers could preparedly diagnose varicella by doing a clinical duty.
  • Polymerase tie reaction (PCR) testing. The most sentient process for establishing a separateity of varicella is the use of PCR to discover VZV in peel lesions (vesicles, scabs, maculopapular lesions).
  • IgM testing. IgM testing is considerably close sentient than PCR testing of peel lesions; commercial IgM endeavor may not be current and unfaithful denying IgM conclusions are not uncommon; a assured IgM ELISA conclusion, although postulatory of a leading contamination, does not except re-contamination or reactivation of inaporiginator VZV.
  • Paired sharp and convalescent sera. Paired sharp and convalescent sera showing a four-fold run in IgG antibodies bear praiseworthy specificity for varicella, but are not as sentient as PCR of peel lesions for diagnosing varicella.
  • Blood testing. Most offshootren delay varicella bear leukopenia in the principal 3 days, followed by leukocytosis; noticeable leukocytosis may declare a promoteary bacterial contamination but is not a dependable sign; forcible elevations of alanine aminotransferase (ALT) supervene in 20-50% of offshootren and adolescents delay varicella intricate by hepatitis, but elevations repay to ordinary delayin one month in closely all cases.
  • Tzanck spatter. A Tzanck spatter involves scraping the ignoble of the lesions and then staining the scrapings to demonstrebuke multinucleated hercules cells; the closeness of multinucleated hercules cells suggests a herpes poison contamination but is not specific for varicella-zoster poison.
  • Immunohistochemical staining. Immunohistochemical staining of peel lesion scrapings can establish varicella.

Medical Management

Primary varicella contamination in the salubrious offshoot is a rather compassionate complaint that requires signatic therapy simply.

Pharmacologic Therapy

The signs of chickenpox in the pediatric population can be treated topically and delay verbal commissioners.
  • Antiviral therapy. The sequence use of acyclovir or valacyclovir in salubrious offshootren is recommended by the AAP if it can be consecrated delayin 24 hours succeeding the foolhardy principal replys in offshootren older than 12 years, those delay continuous cutaneous or pulmonary disorders, those on long-tern salicylate therapy, and offshootren receiving corticosteroids.
  • Varicella zoster immune globulin. Varicella zoster immune globulin (VariZIG by Cangene) was approved by the FDA in December 2012; it is declared for lofty-occasion individuals delayin 10 days (ideally delayin 4 days) of chickenpox inhospitableness; this commissioner subjugates complications and the torpor rebuke of varicella, not its stroke.
  • Antibiotic therapy. Suspicion of promoteary bacterial contamination should boccasion future organization of tentative antibiotic therapy until the conclusions of refinement studies behove available.

Nursing Management

Treatment approaches involve supportive measures, antiviral therapy, government of varicella zoster immune globulin (VZIG), and matter of promoteary bacterial contamination.

Nursing Assessment

Assessment of a offshoot delay chicken pox involves the behindcitedcited:
  • History vestibule. The fact should draw if a fresh outbreak of chickenpox in the homogeneity has supervenered and if any inhospitableness to varicella at unfold, daycare, or unformed race components has supervenered.
  • Immunizations. It should so be noted whether the offshoot has previously accepted varicella vaccine or if the offshoot is immunocompromised (including fresh systemic steroid use) to succor train matter.
  • Immunocompromised offshoot. mmunocompromised offshootren frequently bear distressing and intricate varicella, and their torpor rebuke is loftyer than that in immunocompetent offshootren.

Nursing Diagnosis

Based on the duty grounds, the greater nursing diagnoses are:

Nursing Anxiety Planning and Goals

Desired outcomes for a offshoot delay chicken pox involve:
  • Client succeed be commodious as declarationd by the force to intermission.
  • Client or anxietygiver succeed verbalize needed counsel touching the complaint, signs and signs, matter, and mitigated complications of varicella zoster.
  • Client succeed sojourn unobstructed of promoteary contamination, as declarationd by uninjured peel delayout redness or lesions.
  • Client succeed bear minimal occasion for complaint transmission through the use of entire providences.
  • Client succeed verbalize sentiments encircling lesions and continues daily activities.
  • Client succeed demonstrebuke assured assemblage picture, as declarationd by the force to seem at, chat encircling, and anxiety for lesions.

Nursing Interventions

Interventions for a offshoot delay chicken pox involve:
  • Patient education. Educate originators encircling the concern and protection of the Varicella Zoster vaccine.
  • Manage pruritus. Manage pruritus in patients delay varicella delay calm compresses and certain bathing; animated soaks and oatmeal or cornstarch baths may subjugate longing and produce self-satisfaction.
  • Trim fingernails. Trimming the offshoot’s fingernails and having the offshoot bear mittens opportunity quiescent may subjugate scratching.
  • Dietary measures. Advise originators to produce a unmeasured and just victuals to the offshoot; some offshootren delay varicella bear subjugated propensity and should be encouraged to accept enough fluids to retain hydration.

Evaluation

All goals are met as declarationd by:
  • Client is commodious as declarationd by the force to intermission.
  • Client or anxietygiver verbalized needed counsel touching the complaint, signs and signs, matter, and mitigated complications of varicella zoster.
  • Client sojourned unobstructed of promoteary contamination, as declarationd by uninjured peel delayout redness or lesions.
  • Client had minimal occasion for complaint transmission through the use of entire providences.
  • Client verbalized sentiments encircling lesions and continues daily activities.
  • Client proved assured assemblage picture, as declarationd by the force to seem at, chat encircling, and anxiety for lesions.

Documentation Guidelines

Documentation for a offshoot delay chicken pox involves:
  • Temperature and other duty findings, including essential signs and particularize of mentation.
  • Characteristics of lesions or requisite.
  • Causative and contributing factors.
  • Impact of requisite on separate picture and anxietyerstyle.
  • Current or fresh antibiotic therapy.
  • Plan of anxiety.
  • Teaching sketch.
  • Responses to interventions, education, and actions performed.
  • Attainment or proficiency towards desired outcomes.
  • Modifications to sketch of anxiety.

Practice Quiz: Chicken Pox

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In Exam Mode: All questions are shown but the conclusions, replys, and rationales (if any) succeed simply be consecrated succeeding you’ve high the banter.

Practice Quiz: Chicken Pox

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Practice Mode: This is an interactive rendering of the Text Mode. All questions are consecrated in a solitary page and set-right replys, rationales or explanations (if any) are directly shown succeeding you bear separated an reply. No term proviso for this exam.

Practice Quiz: Chicken Pox

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Text Mode

Text Mode: All questions and replys are consecrated on a solitary page for lection and replying at your own stride. Be enduring to grapple-after a while a pen and Nursing essay to transcribe down your replys. 1. At which of the behindcitedcited ages would the nurse rely-on to bring the varicella zoster vaccine to a offshoot? A. At rise. B. 2 months. C. 6 months. D. 12 months. 1. Answer: D. 12 months. The varicella zoster vaccine (VZV) is a speed vaccine consecrated succeeding age 12 months.
  • Options A, B, and C: The principal dose of hepatitis B vaccine is consecrated at rise to 2 months, then at 1 to 4 months, and then intermittently at 6 to 18 months; DTaP is sequencely consecrated at 2, 4, 6, and 15 to 18 months and a booster at 4 to 6 years.
2. The promote overseer is sketchning the clinical assignments for the day. Which staff components can be assigned to anxiety for a client delay herpes zoster? Select all that apply A. The promote who never had German Measles. B. The promote who never accepted the varicella zoster vaccine. C. The promote who never had mumps. D. The promote who never had roseola. E. The promote who never had chicken pox. 2. Answer: A. The promote who never had German Measles, C. The promote who never had mumps, D. The promote who never had roseola. Herpes zoster (shingles) is caused by a reactivation of the varicella-zoster poison, the fruitful poison for chicken pox.
  • Option B: Individuals who bear not been unguarded to the varicella-zoster poison or who did not accept the varicella-zoster vaccine are capable to chickenpox.
  • Option E: Health workers who are unenduring of their immune foundation should bear varicella titers manufactured antecedently inhospitableness to a individual delay herpes zoster.
3. Opportunity afloat in a pediatric clinic, you accept a telephone fawn from the originator of a 10-year-old who is receiving chemotherapy for leukemia. The client’s sibling has chickenpox. Which of these actions succeed you intercept vestibule proximate? A. Teach the originators touching adjunction and airborne providence. B. Bring varicella-zoster immune globulin to the client. C. Prepare the client for adit to a peculiar ground in the hospital. D. Educate the originator encircling the set-right use of acyclovir (Zovirax). 3. Answer: B. Bring varicella-zoster immune globulin to the client. Varicella-zoster immune globulin government can frustrate the unfoldment of chickenpox in lofty-occasion clients and succeed typically be prescribed.
  • Option A: Adjunction and airborne providences succeed be implemented to frustrate the scatter of contamination to other offshootren if the offshoot unfolds varicella.
  • Options C and D: Hospitalization and acyclovir therapy may be required if the offshoot unfolds a varicella-zoster poison contamination.
4. The client delay varicella succeed most mitigated bear an dispose for which state of medication? A. Antibiotics. B. Antipyretics. C. Antivirals. D. Anticoagulants. 4. Answer: C. Antivirals. Varicella is chicken pox. This herpes poison is treated delay antiviral medications.
  • Options A and D: The client is not treated delay antibiotics or anticoagulants.
  • Option B: The client strength bear a heat antecedently the foolhardy replys, but when the foolhardy replys, the region is usually bygone, so reply B is loose.
5. Which of the behindcitedcited matter measures should be implemented for a offshoot delay leukemia who has been unguarded to the chickenpox? A. No matter is declared. B. Acyclovir (Zovirax) should be launched on inhospitableness. C. Varicella-zoster immunoglobulin (VZIG) should be consecrated delay the declaration of complaint. D. VZIG should be consecrated delayin 72 hours of inhospitableness. 5. Answer: D. VZIG should be consecrated delayin 72 hours of inhospitableness. Varicella is a deadly organism to a offshoot delay leukemia. VZIG, consecrated delayin 72 hours, may favorably change the sequence of the complaint.
  • Options A and B: Giving the vaccine at the onslaught of signs wouldn’t mitigated wane the cruelty of the disorder.
  • Option C: Acyclovir may be consecrated if the offshoot unfolds the complaint but not if the offshoot has been unguarded.
Related topics to this examine train:

Further Reading

Recommended media and books for pediatric nursing:
  1. PedsNotes: Nurse's Clinical Pocket Train (Nurse's Clinical Pocket Guides)
  2. Pediatric Nursing Made Incredibly Easy
  3. Wong's Essentials of Pediatric Nursing
  4. Pediatric Nursing: The Critical Components of Nursing Care

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