CHICKEN POX (VARICELLA)

Presented by: Genesis M. Carandang BS Nursing III September 29, 2011 Mr. Robneil Dylan S. Dellosa, RN, MSN

 Chicken pox is an acute and highly contagious disease of viral etiology that is characterized by vesicular eruptions on the skin and mucous membrane with mild constitutional symptoms. It is also called as varicella. Infectious agent: Human(alpha) herpesvirus3(varicella-zoster virus)- a member of the Herpesvirus group.

Pathology:

 Incubation Period: From10-21 days with a mean of 14 days or 2 weeks Period of Communicability: The patient is contagious about a day before the eruption of rashes and continuous to be so up to the 5th or 6th day after the last scab formation or until all vesicles have become encrusted.

Epidemiology:
Chickenpox occurs mainly in children, although the incidence in older children and adults is rising in the UK and other western countries. There are epidemics every 1-2 years, usually in winter/spring. More than 90% of adults have natural immunity. Herpes zoster occurs mainly in middle or older age. Mortality is low, although it increases with age. There is an average of 26 deaths from chickenpox in England and Wales. INCIDENCE: Most frequent in childhood but it may occur at any age, including the neonatal period with peak age between 5 and 9 years old.

Infectious agent:
varicella-zoster virus . Susceptible host: Anyone who has never had chickenpox and has not yet received the chickenpox vaccine. Portal of Entry: By inhalation of tiny droplets or when their hands become contaminated with vesicle fluid from someone who is infected and they touch their eyes, nose and mouth before cleaning their hands. Symptoms of chickenpox infection: slight fever and rash with fluid-filled vesicles Reservoir: -found in the respiratory tracts of infected -also found in the fluid inside the blister-like vesicular rash once it appears. remains in the nervous system after the chicken pox resolves

CHAIN OF INFECTION
Mode of transmission: -It spreads from an infected person to another who has never had chickenpox on air currents when the infected person exhales tiny droplets that are inhaled by the non-immune person. -it can also spread by direct contact transmission in the vesicle fluid of a person with chickenpox rash -Pregnant women who are infected during pregnancy can pass the virus to their baby.

Portal of exit:
-it leaves an infected persons body through the mouth and nose in tiny droplets generated in the respiratory system and also in the fluid that is contained within the vesicles characteristic of the chickenpox rash.

 CLINICAL DIAGNOSIS:
Determination of V-Z virus through Complement Fixation Test. Determination of V-Z virus through Electron Microscopic Examination of vesicular fluid.

ASSESSMENT FINDINGS: -Fever -headache Malaise -headache -loss of appetite -vesicular rash -Myalgia

Nursing problems:
Hyperthermia Impaired tissue integrity Risk of infection Imbalanced nutrition less than body requirements Knowledge deficit

Infectious agent: identify clients who have signs and symptoms of chicken pox. Use airborne precautions, routine practices & contact precautions when entering clients room and providing direct care to clients. Precautions should remain in place until all lesions have crusted and dried. Health care providers should be immune to chickenpox.

Susceptible host: All health care providers should be aware of their immune status. Non-immune health care providers should receive vaccine. Within 96 hours of exposure, nonimmune health care providers may be prescribed varicella-zoster immune-globulin. Educate the client about the importance of hand hygiene. Promote the clients health and well-being by encouraging healthy lifestyle choices.

Reservoir: Place the client in a single room with special air handling system when possible. Educate the client to cover his mouth and nose during coughing and sneezing and wear a procedure mask when around others in a health care setting. Clean and disinfect the clients environment consistently and regularly. Educate the client about the importance of hand hygiene Vaccination

BREAKING THE CHAIN OF INFECTION:

Mode of transmission: Clean and disinfect the clients environment consistently and regularly. Dedicate the equipment to the client when possible or clean and disinfect equipment between uses on clients. Always perform hand hygiene. Health care providers should wear fit-tested, fit-checked high efficiency masks when entering the clients environment and apply gowns and gloves to provide direct care to the client.

Portal of entry: only immune health care providers should care for the client. Health care providers should wear fit-tested, fit-checked high efficiency masks when entering the clients environment and apply gowns and gloves to provide direct care to the client. Hand hygiene.

Portal of exit: Educate the client to cover his mouth and nose during coughing and sneezing and wear a procedure mask when around others in a health care setting. Encourage client to perform hand hygiene. Hand hygiene.

 MEDICAL MANAGEMENT: Acyclovir is the drug of choice. Oral anti-histamine to symptomatic pruritus Antipyretics- for fever Do not give salicylates NURSING MANAGEMENT: Respiratory isolation until all vesicles have crusted; Prevent secondary infection through proper hygiene; give attention to nasopharyngeal secretions; Cut fingernails short. PREVENTION: Primary: Active immunization with live attenuated varicella vaccine is necessary. Avoid exposure as much as possible to infected persons. Tertiary: Health education on how to prevent chicken pox.