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MS > Chickenpox, Shingles, and Measles > Flashcards

Chickenpox, Shingles, and Measles Flashcards

1
Q

It is highly contagious viral illness that causes an itchy rash & is followed by a vesicular eruption on the skin. it usually occurs during your childhood but you can get it at any time in your life

A

Chickenpox

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2
Q

What is the infectious agent of chickenpox?

A

varicella zoster virus

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3
Q

How many days before the rash appears, as red spots which turns to blisters & spreads to the rest of the body?

A

Within 1 or 2 days

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4
Q

What is the pathophysiology of Chickenpox/Varicella?

A
  • Acquired by inhalation of infectious respiratory secretions or by direct contact with skin lesions.
  • VZV enters the host through the respiratory tract and conjunctiva. It replicates at the site of entry in the nasopharynx and in regional lymph nodes. A primary viremia occurs 4 to 6 days after infection and disseminates the virus to other organs, such as the liver, spleen, and sensory ganglia. Further replication occurs in the viscera, followed by a secondary viremia, with viral infection of the skin. Virus can be cultured from mononuclear cells of an infected person from 5 days before to 1 to 2 days after the appearance of the rash.
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5
Q

What is incubation period?

A

Time from the moment of exposure to an infectious agent until signs and symptoms of the disease appear.

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6
Q

What is the incubation period of chickenpox?

A

10 to 21 days or may be prolonged after passive immunization

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7
Q

When is the patient with chickenpox capable of transmitting the disease?

A

day before the eruption of the first lesion up to 5 days after the appearance of crust

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8
Q

What is an antiviral medication that prevents viruses from dividing and multiplying?

A

Acyclovir

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9
Q

When is Acyclovir taken?

A

As soon as possible:
o Three days of a shingles rash
o Within 24 hours of a chicken pox rash

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10
Q

What is an antiviral medication that slows the growth and spread of the herpes virus to help the body fight the infection?

A

Valacyclovir

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11
Q

What is the health teching for a patient taking valacyclovir?

A
  • stop taking when you have any signs of serious side effect such as fever, easy bruising, bleeding, red spots on the skin, bloody diarrhea, vomiting, pale or yellow skin, weakness, fainting, or urinating less than usual
  • can take with or without food
  • drink plenty of water after taking it
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12
Q

What is an antiviral medication that helps the sores heal faster, keeps new sores from forming, and decreases pain/itching, and decrease the risk of the virus spreading to other parts of the body and causing serious infections?

A

Famciclovir

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13
Q

What are the two types of anti-histamine drugs?

A

H-1 receptor antagonists/H-1 blockers (allergy)
H-2 receptor antagonists/H-2 blockers (GI conditions)

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14
Q

What are the Health Teachings for a patient with Chickenpox/ Varicella?

A
  • Rest
  • Cut their nails
  • Wear cotton gloves to prevent further infections/wound
  • Instruct patient to use calamine lotion or 5% aluminum acetate to soothe vesicles and rashes
  • Proper hand hygiene to avoid spreading the virus
  • Instruct patient to have an oatmeal bath
  • Instruct patient to use ice pack to numb the nerves to prevent pain
  • Encourage diversionary activities and relaxation techniques to ensure restful sleep and alleviate discomfort
  • Instruct patient to make carrot/coriander soup to treat chickenpox since it is rich in antioxidants to help in the healing process
  • Instruct patient to drink ginger to reduce itching since they have anti-bacterial property
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15
Q

What is caused by the same virus responsible for chickenpox? It occurs in people who have had chickenpox after several years?

A

Herpes Zoster/Shingles

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16
Q

What are the reasons why Shingles may become active?

A

aging
stress
suppression of the immune system (HIV, cancer)
certain medications (steroid, radiation therapy)

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17
Q

What is the infectious agent of Shingles?

A

Varicella Zoster Virus

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18
Q

How can someone get shingles?

A

o Can be spread from person with active shingles to a person who has never had chickenpox through direct contact with the rash
o Person exposed would develop chickenpox not shingles

19
Q

What is the pathophysiology of Shingles?

A

After primary infection, VZV may persist in a dormant state in the dorsal nerve root ganglia
Presented by painful vesicular eruptions along the areas of distribution of dermatomes (sensory nerves) from one or more posterior ganglia. After the infection, VZV will stay in the body as latent infection inside the nerve cells near the brain and spinal cord. When the body’s cellular immunity declines, this latent virus becomes reactivated and travels to the skin by way of the peripheral nerves where it will then replicate and result to small rashes with fluid filled blisters.

20
Q

Why should steroids not be stopped abruptly?

A

Steroid is an anti-inflammatory drug and an immunosuppressant which decreases the activity of the antibodies and WBCs, and this will inhibit the production of cortisol by your adrenal gland since it is suppressed. When you suddenly stop taking steroids, the adrenal gland will start to fail and will be inactive for that duration that you are taking the steroids. As a result, patient will not have sufficient cortisol production which is crucial for the cells to live since the adrenal cortex is suppressed. Thus, leading to Addisonian crisis which makes you prone to infections.

21
Q

What is auto immune diseases?

A

It is when the immune system (wbcs and antibodies) migrate to the injured areas but is not able to differentiate the bacteria/virus since they have the same characteristics so they will phagoticyze the cells and destroy the normal tissue cells

22
Q

What is the Nursing Management for Shingles?

A
  • Keep the patient in strict contact precaution
  • Apply cool, wet dressings with NSS to pruritic lesions
  • Do not puncture & open the blisters
  • Void contact with the skin lesions of persons with known herpes zoster infection
  • Encourage adequate rest
  • Provide the patient with a diversionary activity to take his mind off the pain & pruritus
  • Prevent entrance of microorganisms into the lesions, especially if broken
23
Q

What is a Nursing Diagnosis for Chickenpox/Shingles?

A

Impaired Skin Integrity related to infection of the skin secondary to Herpes Zoster infection
1. Assess the patient’s skin on his/her whole body
a. To determine the severity of herpes zoster infection and if there are areas that require special attention or wound care
2. Wash with warm water the affected area and apply calamine lotion
a. To relief of itchiness
3. Administer antiviral oral medication as prescribed by the doctor
a. To prevent the spread of rash and further infection
4. Educate patient about proper skin care like an oatmeal bath or baking soda
a. To soothe the skin from itchiness
5. Advise patient to avoid scratching the lesions or rashes
a. To prevent the affected areas from worsening
Risk for infection related to contagious skin infection
1. Isolate the patient in his/her room since the appearance of blisters
a. To prevent the disease from spreading to those who have not have chickenpox before
2. Administer anti-viral medication as prescribed
3. Educate the patient about proper hand washing and proper wound hygiene
a. To maintain cleanliness of the affected areas and prevent worsening and spread of infection
4. Trim the patient’s fingernails
a. To prevent the patient from harboring more bacteria to the infected skin and spread of bacteria

24
Q

What is inactivated rapidly by heat, UV light, lipid solvents such as ether and chloroform and extreme degrees of acidity and alkalinity? It is highly infectious illness caused by a virus.

A

Measles

25
Q

How long does measles/rubeola can be infectious?

A

about 9 to 10 days. communicable 4 days before & 5 days after the appearance of rashes

26
Q

What are the early manifestations of measles/rubeola?

A

respiratory, fever, transitory rash (macular or urticarial) + fever

27
Q

What symptoms are seen in the prodromal period of measles/rubeola?

A

prodromal conjuctivitis + lacrimation, worsened cough, Koplik spots

28
Q

How come there are Koplik spots in people with measles/rubeola?

A
  • Bluish appearance is due to the collar of dilated veins around the submucosal gland duct, and the white portion is likely due to the destruction of cells of the glandular epithelium
  • Height of eruption = skin eruption appears and starts spreading
  • As the skin rash progresses, spot on the mucosa loses its characteristic appearance and becomes discrete = red background with numerous bluish white specks scattered on the surface
29
Q

What is the pathognomonic sign of measles?

A

Koplik spots

30
Q

When does the Koplik spots appear and when does it disappears?

A

Appears 2 days before the rash and disappears within 48 hours of rash onset

31
Q

What are the symptoms in the exanthem period of measles/rubeola?

A

peak of respiratory symptoms and fever at 39.5C
erythematous and maculopapular rash
confluence prominent on the face

32
Q

What are nursing interventions for a patient with measles/rubeola?

A
  • During febrile stage, limit diet to fruit juices, milk, cereals, and water
    o Sugary foods increase the inflammation of the child
  • If patient is vomiting, small frequent feeding and small serving of iced juices
  • Follow standard and airborne precautions
  • Handle bed linens and fomites with care
  • Apply warm saline to the eyes to relieve irritation
  • Darkened the room of the patient to relieve photophobia
  • Care of the ears – mastoid infection
  • Do not use soap but instead bicarbonate soda in water to relieve itchiness
  • Do tepid sponges to relieve high temperature of the patient
33
Q

Patients usually have mild illness with symptoms: low grade fever, sore throat, rash that starts on the face and spreads to the rest of the body. Also known as “Three Day Measles”

A

German Measles/Rubella

34
Q

What is the period of communicability of German Measles?

A
  • One week before & 4 days after the onset of rashes
  • Highly communicable infants with congenital rubella may shed virus for more than a year after birth
35
Q

What are the symptoms of German Measles in prodromal period?

A
  • Low grade fever
  • Headache
  • Malaise
  • Mild coryza
  • Conjunctivitis
  • Cervical lymphadenopathy
36
Q

What are Forchheimer spots?

A
  • Small, red spots (petechiae) on the soft palate in 20% of patients with rubella
  • Precede or accompany the skin rash
  • Not diagnostic
37
Q

What are the laboratory findings for german measles?

A
  • Rubella specific IgM
    o Diagnostic acute infection
    o Appears within four days after onset of rash
    o Can persist up to 4-12 weeks
  • Rubella specific IgG
    o Long term marker of previous rubella infection
    o Begins to rise after the onset of the rash, peaks about 4 weeks later, lasts for life
38
Q

What is the risk of german measles?

A
  • 100% when maternal infection occurs on the first trimester of pregnancy
  • 4% in the second & third trimesters of pregnancy
  • 90% of congenital rubella cases excrete the virus at birth & are therefore infectious
  • 10% the virus remains contagious until the first year of age of the infected child
39
Q

What is the pathology of german measles?

A
  • Maternal viremia -transplacental infection-embolization of necrotic placental vascular endothelium-fetal infection
    o Placental infection does not always result in fetal infection particularly after the 1st trimester
40
Q

What is congenital rubella?

A
  • virus crosses the placenta
  • results in birth defects:
    o deafness
    o blindness
    o mental retardation
  • generalized growth retardation
    o most common manifestation apparent at birth
  • eye findings
    o cataracts
    o congenital glaucoma
  • hearing loss
    o most common manifestation
    o most important cause of non-genetic congenital hearing loss
    o average age of identification: 2 years
  • Neurologic
    o Meningoencephalitis – 10 to 20% of infants
  • Cardiovascular
    o PDA, Pulmonary Artery Stenosis
    o Myocarditis – most common cause of death
41
Q

What are the preventive measures for german measles?

A
  • Immunization contraindicated during pregnancy
  • Do not conceive 28 days after vaccination
  • Can cross placenta, infect fetus but do not produce defects
  • Inadvertent administration of vaccine during 1st trimester is not an indication for termination of pregnancy
  • Each patient should be counseled to avoid pregnancy for 28 days after vaccination because of the theoretical risk for vaccine virus affecting the fetus
  • If vaccination of an unknowingly pregnant woman occurs or if she becomes pregnant within 4 weeks after MMR, she should be counseled about the theoretical basis of concern for the fetus
  • MMR vaccination should not be a reason to terminate pregnancy
42
Q

What is the effect of gamma globulin to pregnant women?

A
  • Reduce frequency of symptomatic disease in mother
  • Little effect on frequency/severity of fetal and neonatal disease
43
Q

What are the nursing interventions for German Measles?

A
  • Follow airborne and contact precautions
  • Patient should be advised to rest in bed until fever subsides
  • Patients should stay away from school for 7 days from the appearance of rash & avoid contact with pregnant women

MS (4 decks)

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