MEDICAL SURGICAL NURSING-I

UNIT-XII

NURSING MANAGEMENT OF PATIENT WITH

COMMUNICABLE DISEASES

TOPIC: CHICKEN POX

Mrs.S. TAMIL SELVI M.Sc(N)

PROFESSOR
 LEARNING OBJECTIVES

• t the end of the class students can able to

- Describe the definition, incidence and epidemiology of chicken pox

-State down the mode of transmission and incubation period

-Understand the pathophysiology ,signs and symptoms and phases of

chicken pox

- Enumerate the laboratory diagnoses and complication of chicken pox

- List down the treatment ,nursing management and preventive

measures
 INTRODUCTION

• Varicella – zoster virus (vzv) is a DNA virus of the herpes virus

family.

• It causes two diseases

• Varicella (chicken pox) ,the primary infection.

• And herpes zoster(shingles), a secondary infection due to a

reactivation of latent varicella infection in the dorsal root
ganglia.
 DEFINITION

• Chickenpox is a very contagious infection caused by the

varicella-zoster virus.

• It is also known as vericelia.

• Characterised by the vascular rash, that may be

accompanied by the fever and malaise.
 INCIDENCE

Chickenpox is primarily a disease of the temperate

regions where it occurs throughout the year, commonly
in children between 1 and 14 years of age.

The prevalence of the disease in these areas is

13–16/1000 people per year.
 EPIDEMIOLOGY

• Chickenpox is largely a childhood disease, with more

than 90% of cases occurring in children younger than 10
years. The disease is benign in the healthy child, and
increased morbidity occurs in adults and immuno
compromised patients.
 MODE OF TRANSMISSION

• Person to person by direct contact,

• Droplet or airborne spread of vesicle fluid,

• Secretion of the respiratory tract of chicken pox cases,

• Vesicle fluid of patients with herpes zoster,

• Indirectly through articles freshly soiled by discharges from vesicle and

mucous membranes of infected people,

• Varicella in unvaccinated persons is one of the most readily

communicable diseases, especially in the early stages of the eruption.
 INCUBATION PERIOD

• 10-21 days

• Commonly 14-16 days

• May be prolonged as long as 28 days after passive

immunization against varicella

• And may be shortened in the immunodeficient (8-21days)

 PATHOPHYSIOLOGY

• After initial inhalation of contaminated respiratory droplets the

virus infects the conjunctive or the mucosa of the 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 post infection 4-6 days.
• A second round of viral replication occurs in the body's internal
organs mostly in the liver and the spleen. Followed by a second
viremias 14-16 days post infection. The secondary viremia is
characterized by diffuse viral invasion of capillary endothelial
cells and the epidermis
• The secondary viremia is characterized by diffuse viral invasion
of capillary endothelial cells and the epidermis infection may
involve localized blood vessels of the skin resulting in necrosis
and epidermal haemorrhage.

• The evolution of disease the vesicular fluid becomes cloudy

because of the recruitment of polymorphonuclear leucocytes
and the presence of degenerated cells and fibrin.

• Ultimately, the vesicles either rupture and release their fluid

(which includes infections virus) or are gradually reabsorbed.
SIGNS AND SYMPTOMS
 PHASES OF CHICKEN POX

The disease has 4 phases

• Incubation period (phase)

• Prodromal period (phase)

• Exanthem period (phase)

• Reconvalescence period (phase)

 INCUBATION PERIOD (phase)
• The incubation period of chicken pox ranges from 10-21 days but is
usually 14-17 days .
• During these period patient is asymptomatic

Pro dromal period. (Pre – eruptive stage )

• A few patients develop a prodrome 1-2days before onset of the

exanthem.The prodromal symptoms inadolescents and adults are

nausea, loss of appetite, aching muscles, and headache.

• Onset of symptoms usually is sudden, with mild or moderate fever

malaise

• This stage is lasts for about 24 hours in children and 2-3 days in
 Exanthem period (phase) Eruptive stage
The skin lesions – the hallmark of the infection
This stage is characterized by the
 Rapid evolution
 Pleomorphism
 Fever
The rash begins as multiple small red bumps (papules) that look like
pimples or insect bites.

These lesions are small and have an erythematous (erythematous

macules) base with a diameter of 5-10mm.

These blisters can spread to cover much of the skin, and in some cases
also may be found inside the mouth. nose ,ear and rectum.
 Reconvalescence period (phase)
Finally, these open wounds crust over and turn into scabs.
As they heal, new bumps appear.

LABORATORY DIAGNOSES

Examination of vesicle fluid under electron microscope.

Scrapings of the floor of the vesicles colored by glemsa ( tzanck smear)

Four fold rise in antibody titre

Detection of viral DNZ by PCR

Fluorescent antibody to membrane antigen.

ELISA
 COMPLICATION OF CHICKEN POX

• Bacterial infections of the skin and soft tissues in

children, including Group A streptococcal infections

• Infection of the lungs (pneumonia)

• Infection or inflammation of the brain (encephalitis,

cerebellar ataxia)

• Bleeding problems (hemorrhagic complications)

 TREATMENT
Oral antiviral

• When given to immuno competent patients within 24 hours of the

rashes onset, slightly decrease symptom duration and severity.

Indications

• Oral valacyclovir, famciclovir, or acyclovir should be given to healthy

people at risk of moderate to severe disease, including patients

• 12 years of age or older

• With skin disorders (particularly eczema)

• With chronic lung disease

Prevention

Infection provides lifelong protection.

Potentially susceptible people should take strict precautions to avoid

people capable of transmitting the infection

Vaccination

• A live-attenuated varicella vaccine is available in 3 formulations

• Standard dose varicella vaccine.

• Combination measles-mumps-rubella-varicella (MMRV) vaccine.

• Higher dose vaccine used to prevent herpes zoster

 REFERENCES

• Centers for Disease Control and Prevention (cdc.gov).

16 November 2011. Archived from the original on 4
February 2015. Retrieved 4 February 2015.

• cdc.gov. 16 November 2011. Archived from the original

on 4 February 2015. Retrieved 4 February 2015.