Varicella – Chickenpox
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Outline
Overview
- Highly contagious viral infection, caused by varicella-zoster virus
- Itchy, blister like rash on the skin.
Nursing Points
General
- Contagious
- Until 6 days after start of rash
- Crusts have formed on all lesions
- Spread via direct contact and airborne spread
- After infection, virus remains dormant and can become reactivated to cause shingles
Assessment
- Fever
- Malaise
- Small, extremely itchy blisters
- 3 stages
- Papule (small, red, raised)
- Vesicle (fluid trapped under skin, bubble-like)
- Crust (scabbed over)
- Profuse on trunk
- Sparse on limbs
- 3 stages
Therapeutic Management
- Isolate child
- Initiate contact and airborne precautions
- Ensure there are no pregnant caregivers
- Promote skin integrity – prevent secondary skin infection
- Cut nails
- Apply mittens
- Calamine lotion
- Medications
- Acyclovir
- Give within 24 hours of rash appearance
- IVIG for immunocompromised patients
- Diphenhydramine
- To relieve itching
- Acyclovir
- Monitor for complications
- Varicella pneumonia
- Encephalitis
- Cellulitis
Nursing Concepts
- Immunity
- Infection Control
- Comfort
Patient Education
- Contagious until all vesicles turn into scabs
- Prevent scratching
- Do not give aspirin due to risk of Reye Syndrome
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Transcript
Hey you guys, in this lesson we are going to talk about chickenpox. Chickenpox is caused by the Varicella Zoster Virus, so sometimes it’s called Varicella.
Chickenpox is a very contagious viral infection. It causes a widespread, very itchy rash. Remember I said it’s caused by the varicella zoster virus- which is actually the same virus that causes shingles. So the virus can reactivate later in life causing shingles and this is most often seen after the age of 60.
The virus is spread through contact with the rash and through coughs and sneezes- so these patients actually need to be on standard, contact and airborne precautions.
It used to be, sort of like a right of passage to get the chickenpox as a kid- and parents would even have “chickenpox parties” to just get it out of the way! The CDC doesn’t recommend this, especially now that there is an immunization for chickenpox. The immunization is given between 12-15 months and again between 4-6 years, which is the same as the MMR.
The major symptoms to look for with chickenpox are fever and a rash.
The rash has 3 stages. It starts as a pustule (a small bump that looks kinda like a zit), then becomes a vesicle (fluid filled blister), which then bursts and crusts over. One important thing to know about chickenpox is that kids are infectious until ALL pustules have crusted over and are drying out.
As you can imagine and may even remember from childhood- kids with chickenpox can be pretty miserable and irritable. They aren’t sleeping well and just feel pretty awful.
First things first- if in the hospital, these patients have to be on contact and airborne precautions. If they are at home they need to stay away from school until all lesions are crusted over.
First things first- if in the hospital, these patients have to be on contact and airborne precautions. If they are at home they need to stay away from school until all lesions are crusted over.
The most important part our nursing care is promoting skin integrity. One of the biggest complications of chickenpox is cellulitis. So nails need to be kept short to prevent kids from scratching and breaking open their skin. If the skin is open they are way more likely to get a secondary infection! If not scratching doesn’t seem like a feasible goal then mittens on the hands may be necessary. Baths and calamine lotion are very helpful as well.
Medications that may be given for chickenpox are diphenhydramine for the itching, antipyretics for fever, and acyclovir. Acyclovir is an antiviral that should be given for severe cases of chickenpox and for patients with compromised immunity.
Complications that you need to be on the look out for are varicella pneumonia, encephalitis and cellulitis.
Your priority nursing concepts for a pediatric patient with chickenpox are immunity, infection control and health promotion.
Chickenpox is a very contagious disease caused by the varicella zoster virus. Patients with chickenpox in the hospital need to be on standard, contact and airborne precautions. The major symptom of chickenpox is an itchy rash that goes through three stages. Pustule, vesicle and then it crusts over.
Treatment should focus on skin care to prevent secondary skin infections. And in severe cases acyclovir may be given.
Complications that can happen are varicella pneumonia and cellulitis.
That’s it for our lesson on caring for pediatric patients with chickenpox. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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