Varicella Zoster (chicken Pox)

Question 1

What is varicella zoster caused by?

Answer 1

Caused by varicella zoster virus, human herpes virus 3

Note: Lifelong latent infection occurs; reactivation results in herpes zoster (shingles), uncommon in childhood

Question 2

Transmission

Answer 2

direct contact with infected persons’ nasopharyngeal secretions or via air-borne spread, to a lesser degree by contact with unscabbed lesions. Highly contagious. Also transmitted from mother to fetus
• Peak incidence: late fall, winter, and spring
• Incubation period: 10–21 days, usually 14–16 days
• Communicable 1–2 days before the onset of rash until all vesicles have crusted over (about 3–7 days after the onset of rash)

Question 3

S/S

Answer 3

• Prodromal symptoms (fever, malaise, anorexia, headache, mild abdominal pain) may be present 24–48 hours before the onset of the rash. In children, rash is often the first sign of disease.
• Lesions often appear first on scalp, face, trunk, then extremities; initially intensely pruritic erythematous macules that evolve to papules and then form clear, fluid-filled vesicles.
• Vesicles eventually erupt, and then lesions scab and crust. A variety of lesions are present at one time.
• More severe in adolescents and adults than in young children

Question 4

Treatments

Answer 4

fever reduction, antipruritics, and skin care to prevent infection of lesions
• Antiviral therapy and varicella zoster immune globulin may be used in those considered to be at high risk (immunocompromised, pregnant women, and newborns exposed to maternal varicella). Routine antiviral therapy is not recommended for the treatment of uncomplicated varicella infection in otherwise healthy children.

Question 5

Complications

Answer 5

bacterial superinfection of skin lesions, thrombocytopenia, arthritis, hepatitis, cerebellar ataxia, encephalitis, meningitis, pneumonia, glomerulonephritis, congenital infection, and life-threatening perinatal infection

Question 6

Nursing Management

Answer 6

Comfort measures, such as antipyretics and antipruritics
• For those with exposure to susceptible persons, air-borne and contact precautions, from 8 to 21 days after exposure
• Children may return to school or child care once lesions have crusted.
• Air-borne and contact precautions in the hospitalized child for a minimum of 5 days after the onset of rash and as long as vesicular lesions are present.