CHICKENPOX

(VARICELLA)
JO HANNAH GERALDINE C. CERRO
BSN III
DEFINITION
• An acute & highly
contagious disease of viral
etiology that is characterized
by vesicular eruptions on the
skin and mucous membrane
with mild constitutional
symptoms.
HISTORY
• This disease was differentiated from smallpox in the sixteenth
century.
• The term “chicken pox” (derived from Latin cicer, a chick-pea)
originated in England.
• Varicella (little variola), by which name it is also known, was first
used by Vogel in 1764.
ETIOLOGY
• Herpesvirus varicellae a DNA-containing virus

1. Human beings are the only source of infection.

2. This is closely related or identical to herpes zoster virus.
SOURCE OF INFECTION
• Lesions of the skin and mucous membrane of infected
individuals.
• Dry crusts are not a source of infection.
MODE OF TRANSMISSION
• Primary method of transmission is by direct and droplet
infection.
• Transmission may occur 24-48 hours prior to the
appearance of the rash.
• After crusting the final crop of lesions, the disease is not
considered infectious.
MODE OF TRANSMISSION
• Direct contact with a patient who sheds the virus from the
vesicles.
• Indirect contact through linens or fomites and articles freshly
soiled by discharges from skin lesions or nose and throat
secretions.
MODE OF TRANSMISSION
• Airborne, or spread by aerosolized droplets from the
nasopharynx of ill individuals.
• High viral titers are found in the vesicles of chickenpox;
thus, viral transmission may also occur though direct
contact with these vesicles, although the risk is lower.
PATHOLOGY
• The lesions of this disease occupy the outer layer of the
epithelium, the fluid being confined in one compartment
(unilocular).
• The red areola which surrounds the pock is formed by
distended capillaries.
PATHOLOGY
• As the pock is absorbed, a scab forms which later is easily
detached.
• If the pocks are scratched off too soon, the process extends
deep into the skin and leaves a scab which becomes white,
and which may remain for years.
INCUBATION PERIOD
• Is usually from 13-16 days, but it may be as long as 24
days.
CLINICAL MANIFESTATIONS
• The prodromal period is short, usually not longer than 24
hours, but in adults 48 hours is not common.

• Malaise, Headache, Mild fever, Vague myalgia

CLINICAL MANIFESTATIONS
• In children, the first indication of the disease may be the rash.
• The skin rash occurs in successive crops over a period of about 3-5
days. Tends to concentrate in the trunk, neck, face and proximal
extremities.
• Eruptive stage
a. Rash starts on the trunk (unexposed area), then spreads to other
parts of the body.
b. Initial lesions are distinctively red papules whose contents become
milky and pus-like within four days.
CLINICAL MANIFESTATIONS
c. In adults and bigger children, the lesions are more widespread
and more severe.
d. There is rapid progression so that transition is completed in six
to eight hours.
e. Vesicular lesions are very pruritic.
f. All stages are present simultaneously before all are covered with
scabs, leading to the appearance known as “celestial map.”
g. The stages are
characterized as
follows:

• Macule
• Papule
• Vesicle
• Pustule
• Crust
COURSE OF THE DISEASE
Period of Invasion
• Not noticeable in young children
• Older children & adults may have fever, headache, malaise and
aching in the back and legs for 1-3 days before the skin lesions
appear
• Lesions of the mucous membrane of the mouth appear early,
and they rupture as soon as the vesicles form.
COURSE OF THE DISEASE
Period of Eruption
• First appears as a small papule surrounded by an areola of pink
discoloration
• This changes in a few hours to a round watery blister or vesicle,
the contents of which assume a milky appearance within 3-4
days
• These vesicles form crusts, which gradually dry into hard scales
and soon fall off, rarely leaving a scar unless they are scratched
or become infected.
COURSE OF THE DISEASE
• The first lesions may be seen on the chest, back, thigh, or in
the scalp.
• In 8-24 hours another set of them appears, and fresh crops
continue to appear for several days, so that papules,
vesicles, crusts, and scabs are found on several areas of
the body at the same time.
COMPLICATION
• Pregnant women and those with suppressed immune
system – at highest risk of serious complications
• Shingles – most common late complication
• Secondary infection of the lesions –
furuncles, cellulitis, skin abscess, erysipelas
COMPLICATION
• Meningoencephalitis
• Pneumonia
• Sepsis
• Conjunctivitis – acute stage
• Laryngitis
• Encephalitis Rare
• Gangrene of the extremities
DIFFERENTIAL DIAGNOSIS
• In the diagnosis of chicken pox other conditions must be
considered, such as smallpox, herpes zoster, the skin lesions of
secondary syphilis, erythema multiforme, skin rashes such as
impetigo contagiosa, acne, and pemphigus, and rashes due to
drugs such as bromides.
DIAGNOSTIC TEST
1. Determination of the V-Z virus through the complement
fixation test.
2. Determination of the V-Z virus through electron
microscopic examination of vesicular fluid.
PERIOD OF COMMUNICABILITY

• The period of infectivity extends from twenty-four hours

before the eruptions appears until probably not more than
six days after the appearance of the first crop of vesicles.
TREATMENT
• Oral acyclovir 800 mg 3x a day for five days must also be
given
• Oral antihistamine can be taken to symptomatic pruritus
• Calamine lotion eases itchiness
• Salicylates must NOT be given
TREATMENT
• Antipyretic might be given for fever
• Antihistamine must be given
• Rest
• Light diet
NURSING CARE
• During acute stage, bed rest is indicated with adequate hydration.
• Warm sponge baths, limiting the use of soap, may be soothing. Pat
rather than rub the skin dry, to avoid loosening the scabs.
• Application of antipruritic agents to relieve itching may provide
comfort. Calamine lotion containing phenol or carbolated petrolatum
may be used.
• If the patient is admitted to the hospital, he should be isolated until all
lesions have crusted.
NURSING CARE
• Cut fingernails short and wash hands more often to minimize
bacterial infections that may be introduced by scratching.
• A child must wear mittens.
• Provide activities to keep child occupied to lessen pruritus.
• Observe oral and nasal care as rashes may appear in the buccal
cavity.
NURSING CARE
• Attention should be given to nasopharyngeal secretions and
discharges. Linens must be disinfected under the sunlight or through
boiling.
• If lesions appear on the conjunctiva or in the mouth, warm boric acid
irrigations will relieve the irritation.
• Mild laxatives or enemas may be ordered, if necessary.
• A regular diet usually is ordered, care being taken to preserve the
alkaline balance. Fluids, especially fruit juices, should be offered
frequently.
NURSING CARE
• If furuncles occur, sulfadiazine or penicillin may be ordered.
• Concurrent – Articles soiled by discharges from lesions should
be properly cared for.
• Paper handkerchiefs should be burned.
• Terminal – The patient should be given a tub bath, shampoo,
and clean clothing, then removed to a clean unit. The unit used
during the illness should be thoroughly cleaned and aired for six
hours.
METHODS OF CONTROL
• Active immunization with live, attenuated varicella is necessary.
• The patient should be isolated during the period of
communicability, a minimum of seven days.
• Avoid exposures as much as possible to infected persons.