Nursing Care Plan (NCP) for Varicella / Chickenpox
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Outline
Lesson Objectives for Varicella (Chickenpox)
- Understanding Varicella:
- Define varicella, commonly known as chickenpox, as a highly contagious viral infection caused by the varicella-zoster virus (VZV) and characterized by a distinctive rash.
- Transmission and Incubation Period:
- Explain the mode of transmission of varicella, typically through respiratory droplets, and describe the incubation period from exposure to the onset of symptoms.
- Clinical Manifestations:
- Identify the clinical manifestations of varicella, including the characteristic itchy vesicular rash, fever, malaise, and respiratory symptoms.
- Complications and High-Risk Groups:
- Recognize potential complications of varicella, especially in high-risk groups such as pregnant women, immunocompromised individuals, and newborns, and understand the importance of vaccination for prevention.
- Management and Prevention:
- Outline management strategies for varicella, including supportive care for symptoms, antiviral medications in certain cases, and emphasize the significance of vaccination for prevention.
Pathophysiology of Varicella (Chickenpox)
- Virus Entry and Replication:
- Varicella is caused by the varicella-zoster virus (VZV), a member of the herpesvirus family. The virus enters the respiratory tract, primarily through inhalation of respiratory droplets, and replicates in the mucosal epithelium.
- Viremia and Dissemination:
- After replicating in the respiratory mucosa, the virus enters the bloodstream, leading to viremia. VZV then disseminates to various organs, including the skin, causing characteristic lesions.
- Skin Lesions and Vesicle Formation:
- VZV infects skin cells, leading to the formation of vesicles filled with clear fluid. The vesicles appear in crops, progressing from macules to papules and eventually forming itchy vesicles.
- Immune Response and Crust Formation:
- The immune response is triggered, leading to the clearance of the virus. As vesicles rupture, the fluid is released, and crusts form on the skin. The entire process contributes to the characteristic rash.
- Latency and Reactivation:
- After the acute infection, VZV establishes latency in sensory ganglia. Later in life, the virus can reactivate, causing herpes zoster (shingles), characterized by a painful rash along a dermatome.
Etiology of Varicella (Chickenpox)
- Varicella-Zoster Virus (VZV):
- The primary etiological agent is the varicella-zoster virus, a DNA virus belonging to the herpesvirus family.
*Note*
- Human-to-Human Transmission:
- Varicella is highly contagious and primarily transmitted through respiratory droplets expelled by infected individuals during coughing or sneezing.
- Direct Contact:
- The virus can also spread through direct contact with the fluid from vesicles or by touching contaminated surfaces.
- Incubation Period:
- The incubation period of varicella is typically 10 to 21 days from exposure to the appearance of symptoms.
- Vaccination and Immunity:
- Vaccination, such as the varicella vaccine, plays a crucial role in preventing varicella and reducing the severity of the disease. Immunity following natural infection or vaccination provides protection against future episodes.
Desired Outcome for Varicella (Chickenpox)
- Resolution of Symptoms:
- Achieve the resolution of varicella symptoms, including fever, pruritic vesicular rash, and malaise.
- Prevention of Complications:
- Prevent complications associated with varicella, particularly bacterial skin infections, pneumonia, and central nervous system involvement.
- Patient Comfort and Well-being:
- Ensure patient comfort by managing itching and discomfort associated with the rash, promoting rest, and addressing any distressing symptoms.
- Education on Contagious Period:
- Educate the patient and caregivers about the contagious period of varicella and the importance of isolation until the lesions crust over, minimizing the risk of transmission.
- Promotion of Hydration and Nutrition:
- Promote adequate hydration and nutrition to support the patient’s overall well-being during the illness.
Varicella / Chickenpox Nursing Care Plan
Subjective Data:
- Intense itching
- Body aches
- Loss of appetite
- Fatigue
- Headache
Objective Data:
- Fever
- Presence of papules/and vesicles
- Crusts/scabs on skin
Nursing Assessment for Varicella (Chickenpox)
- Clinical History:
- Obtain a detailed clinical history, including the onset of symptoms, exposure to varicella, and any pre-existing medical conditions that may increase the risk of complications.
- Skin Assessment:
- Perform a thorough skin assessment to identify the characteristic vesicular rash, noting the distribution, progression, and any signs of secondary bacterial infection.
- Temperature Monitoring:
- Monitor the patient’s temperature regularly to detect and manage fever promptly.
- Respiratory Assessment:
- Assess respiratory status, especially in high-risk individuals, to detect signs of pneumonia, a potential complication of varicella.
- Neurological Assessment:
- Conduct a neurological assessment, particularly in severe cases, to identify any signs of central nervous system involvement.
- Pain and Itch Assessment:
- Assess the patient’s pain and itching levels associated with the rash, implementing measures to relieve discomfort and prevent scratching.
- Psychosocial Assessment:
- Evaluate the patient’s psychosocial well-being, addressing any anxiety or emotional distress related to the illness, especially in pediatric patients.
- Family and Community Assessment:
- Assess the patient’s living environment and educate family members on the contagious nature of varicella to prevent further spread within the household and community.
Implementation for Varicella (Chickenpox)
- Symptomatic Relief:
- Provide interventions to relieve symptoms, including administering antipyretics for fever, using cool compresses to soothe itching, and maintaining a comfortable environment.
- Isolation Precautions:
- Implement appropriate isolation precautions to prevent the spread of varicella, especially in healthcare settings and among vulnerable populations.
- Hydration and Nutrition:
- Encourage and monitor adequate fluid intake to prevent dehydration. Promote a well-balanced diet to support the patient’s nutritional needs during the illness.
- Antiviral Medication (if applicable):
- In certain cases, antiviral medications may be prescribed, especially for high-risk individuals or those with severe cases. Administer antiviral medications as prescribed and monitor for any side effects.
- Education on Home Care:
- Provide education to the patient and caregivers on proper home care, including hygiene practices, medication administration, and signs of complications. Emphasize the importance of completing the isolation period.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Perform complete physical assessment | Get baseline to determine effectiveness of interventions. Note stage of disease: active, fluid filled blisters or scabbed and crusted lesions. |
| Monitor vital signs | Fever often accompanies a chickenpox outbreak. Other changes in vital signs can indicate development of systemic infection. |
| Assess skin for signs of secondary infection | Itching leads to scratching and scratching leads to open wounds which are a breeding ground for bacteria and infection. |
| Trim nails or cover hands of infants and toddlers | Keeping the nails short or covered helps prevent scratches in the skin that can lead to infection. |
| Encourage rest | When the body is resting, more energy can be devoted to healing. This can also help to minimize fatigue and discomfort. |
| Manage itching | cool compresses
baths with oatmeal or cornstarch Helps relieve itching and soothe irritating skin |
| Administer medications appropriately | Oral antivirals
Oral antihistamine Oral or rectal acetaminophen Topical calamine ** Avoid giving aspirin or other salicylates to children with viral illnesses due to risk for Reye’s Syndrome** Antiviral (acyclovir) medications may help lessen the severity or shorten the duration of the disease Antihistamines (diphenhydramine) are given to relieve itching Acetaminophen is often given to treat fever and pain Calamine lotion, cream or gel may be applied to help relieve itching and discomfort |
| Encourage hydration | Water is better than sugary drinks to maintain hydration, even if child has little appetite. Children may be more responsive to popsicles for replacement of fluid and electrolytes. |
| Provide education for patient and parents regarding:
Preventing the spread of disease Infection control Vaccines When to return to school / daycare |
The virus can be spread to others until all lesions have crusted over, therefore, the child should not return to school or daycare until they are no longer contagious, even if feeling better.
Good hand hygiene can help spread infection. Varicella vaccine may be given 3-5 days after exposure (before symptoms begin) to prevent or lessen the severity of the disease. All children over 12 months of age should be vaccinated |
Evaluation for Varicella (Chickenpox)
- Resolution of Symptoms:
- Evaluate the patient’s clinical status, focusing on the resolution of symptoms such as fever, rash, and malaise.
- Prevention of Complications:
- Monitor for and assess the prevention of complications associated with varicella, including secondary bacterial infections and respiratory complications.
- Patient Comfort and Well-being:
- Assess the patient’s comfort level and overall well-being, ensuring that interventions effectively manage itching and discomfort.
- Adherence to Isolation Precautions:
- Evaluate the patient’s and caregivers’ adherence to isolation precautions to prevent the spread of varicella to others.
- Education Effectiveness:
- Assess the effectiveness of patient and caregiver education by evaluating their understanding of home care measures, medication administration, and the importance of completing the isolation period.
References
- https://www.mayoclinic.org/diseases-conditions/chickenpox/symptoms-causes/syc-20351282
- https://my.clevelandclinic.org/health/diseases/4017-chickenpox
- https://www.cdc.gov/chickenpox/about/index.html
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Transcript
Hi everyone. Today, we are going to be creating a nursing care plan for varicella chickenpox. So, let’s get started first. We’re going to talk about the pathophysiology of varicella chicken pox. Varicella, which is more commonly known as chickenpox is a viral infection that causes an itchy rash with small blisters on the skin and flu-like symptoms. Some nursing considerations. You want to do an assessment, vital signs, managing the itching, administering any medications, encouraging re and educating the parent and or caregiver. Some desired outcomes. The patient will remain comfortable and able to rest. The patient will not develop any sort of secondary infection.
And here I wanted to show you guys a picture. So, as you see, you’re going to see all of these little to tiny blisters all over the chest area here and mind you, these can appear anywhere on the body, but you see how there’s just a bunch everywhere. There’s some on the arms, on the torso, they can appear anywhere. So, we’re going to go ahead and get right into the cure plan. We’re going to be writing down some subjective data and some objective data. So, what are we going to see in a patient with varicella chickenpox? Well, one of the things they’re going to tell you, one of the main things is there’s going to be some intense itching. They’re going to be scratching a lot. They’re super, super itchy. One of the other things that’s very common is a fever, they are going to have a fever, and you’re going to see those red blisters and it could be anywhere on the body.
Some other things that you’ll see, they’ll complain of some body aches, maybe a possible loss of appetite, some fatigue, headache, and you may see some crosser scabs on the skin. So, like later in the process of the varicella, some interventions that we’re going to be doing, so you want to perform a complete physical assessment of the patient. So, you want to make sure you’re looking head to toe to see if it’s anywhere on the arms, the torso, the legs, you want to note any sort of active filled blisters or scabbed or crusted lesions. You want to monitor their vital signs. Fever often accompanies a chickenpox outbreak. Other changes in vital signs can indicate a development of any sort of systemic infection. Another thing that we want to do, we want to assess the skin for any sort of science of secondary infection. So secondary infection itching ends up leading to scratching, scratching leads to having any other open wounds, which is breeding ground for bacteria and infection. So, you want to be sure to trim the nails down or keep them short on children to avoid any sort of secondary infection, another intervention we want to make sure we’re managing the itching
Because we want to manage, uh, not having a secondary infection. So, you can be using any sort of cool compress, maybe some baths with some oatmeal or corn starch. That’s really soothing to the skin helps relieve that itch. And it’s just super, super soothing. Another intervention is administering any sort of medications. So, this would be your antivirals, or this would be any antihistamines, Some acetaminophen for fever or for pain and calamine lotion.
You want to make sure to note you want to avoid giving or any other cell slates to children with viral illnesses due to the risk of race syndrome. So, antivirals, giving the antiviral medication may help with the lesions, the severity, or shorten the duration of the disease. Antihistamines are going to be given in order to relieve any sort of itching, then for the fever or for the pain and the calamine lotion. It can be applied to help relieve any itching and discomfort for the patient. Another invention we’re going to look at is encouraging rest. We want to encourage rest because when the body’s resting, more energy can be devoted to the healing process. This can also help minimize fatigue and any discomfort in the patient. Another intervention is making sure we’re educating the caregiver. So, education, you want to make sure you’re providing information on vaccines, uh, infection control how to prevent spreading the disease. And when the child is to return back to school or, or day, the virus can be spread to others until all the lesions have crusted over. Therefore, the child should not return to school or daycare until they’re no longer contagious, even if they’re feeling better. And obviously good hand hygiene helps with any sort of spreading of the infection to others. The varicella vaccine can be given three to five days after exposure or before symptoms begin in order to prevent or lessen the severity of the disease. And all children over 12 months of age should be vaccinated.
So that’s our completed care plan. Let’s go into some of the key points here. So, in pathophysiology, varicella is a viral infection that causes an itchy rash with small blisters on the skin. Very, very common. It is caused by the varicella zoster virus. Some subjective and objective data, what you are going to see is intense itching, body aches, fever, any presence of those red blisters is just very, very common fatigue, headache, loss of appetite. You want to do a full assessment managing that itching so you want to see the stage of the disease are the active open blisters. Are they scabbed over? You want to assess vital signs, manage itching with cool compresses, oatmeal, baths, or cornstarch. You want to give medications and do proper education. You want to give antivirals, antihistamines, acetaminophen, calamine lotions, super soothing, educate on how to prevent the spread, the vaccine, good hand hygiene. And when the child should be able to return to school and there you have it guys, a full completed care plan. We love you. Go out, be your best self today and as always, happy nursing!
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