Nursing Care Plan for Varicella / Chickenpox

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Pathophysiology

Varicella, more commonly known as chickenpox, is a viral infection that causes an itchy rash with small blisters on the skin and flu-like symptoms. Chickenpox is highly contagious and usually affects children. A red, intensely itchy rash is the hallmark sign of chickenpox and may develop anywhere on the body including the scalp, mouth, arms, legs, trunk and genitals. Symptoms normally begin within 10 – 21 days after exposure to the virus and lasts 1-2 weeks. The varicella vaccine is routinely given to children at the ages of 12 months and 4 years old and is highly effective in preventing the disease.

Etiology

Chicken pox is caused by the varicella-zoster virus that is transmitted through respiratory droplets. Direct contact with papules and vesicles (not crusts) can also spread the virus. Neonatal varicella is when the mother develops chickenpox during pregnancy and it is spread across the placenta to the fetus. The patient is contagious within 48 hours after exposure and may continue to spread the virus until all spots crust over. Anyone who has not had chickenpox or the varicella vaccine can become infected with exposure to chickenpox or shingles which comes from the same virus. After having chickenpox once, the body creates antibodies to the disease and the virus becomes dormant in the nerve tissue.

Desired Outcome

Patient will remain comfortable and able to rest; patient will not develop secondary infection.

Varicella / Chickenpox Nursing Care Plan

Subjective Data:

  • Headache
  • Loss of appetite
  • Fatigue
  • Body aches
  • Intense itching

Objective Data:

  • Fever
  • Presence of papules and vesicles
  • Crusts and scabs on skin

Nursing Interventions and Rationales

  • 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 with cool compresses or tepid baths with oatmeal or cornstarch

 

To help relieve itching and soothe irritated 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

 


References

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