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Modifiable Environment Vaccination

Chicken Pox Inhalation of airborne respiratory droplets from infected host (Varicella Zoster Virus) Infects the conjunctivae or the mucosae of the upper respiratory tract (2nd-4th day) Viral proliferation in regional lymph nodes

Non-modifiable Age Gender Immunosupressed

Production of IgG, IgM, IgA antibodies

Cell-mediated immune responses limit scope and duration of infection

Primary Viremia (4th-6th day) Viral Replication in the bodys internal organs (liver & spleen) Secondary Viremia (14th-16th day) Viral invasion of capillary endothelial cells and the epidermis Infection of malphigian layer Spread towards local sensory nerves Remains latent in the trigeminal & dorsal root ganglia

Intercellular edema Intracellular edema

If later years present immunosuppression, there will be reactivation of virus

Vesicles (rash) Infection of peripheral nerves

Inflammation of dorsal ganglia

Targets peripheral segement

Infiltrates dorsal root neurons Hinders dorsal horn celluilar metabolism Impaires nerve function Pain

Rash

Demyelination Fibrosis

Medical & Nursing Management

Chicken Pox (Varicella)


Treatment Modalities:

Zovirax 500mg/tablet, 1 tab 2x a day for seven days must be administered Oral acyclovir 800 mg 3x a day for five days must also be given Oral antihistamine can be taken to symptomatic pruritus Calamine lotion will ease itchiness Salicylates must not be given Antipyretics for fever.

Nursing Management:
1. Prevention of secondary infection of the skin lesions through hygienic

2. 3. 4. 5. 6.

care of the patient Attention should be given to nasopharyngeal discharges and disinfection of cloths and linen by sunlight or boiling Cut fingernails short and wash hands more often in order to minimize bacterial infections; may be introduced by scratching Calamine lotion over rashes Antipyretics for fever Isolation of patient; cannot be confined in general hospital; isolated until all lesions have become encrusted.

Vaccine

Varicella vaccine is recommended for postexposure administration for healthy unvaccinated persons without other evidence of immunity. Administration of varicella vaccine to exposed susceptible person 12 months of age, as soon as possible within 72 hours and possibly up to 120 hours after exposure, may prevent or modify disease and is recommended if there are no contraindications to use.

Use of Varicella Zoster Immune Globulin (VZIG)


In certain circumstances, postexposure prophylaxis with VZIG is recommended. The decision to administer VZIG to a person exposed to varicella should be based on 1) whether the person is susceptible, 2) whether the exposure is likely to result in infection, and 3) whether the person is at greater risk for complications than the general population. Persons at greater risk for severe complications who are not candidates for varicella vaccination who may benefit from postexposure prophylaxis with VZIG include:

susceptible immunocompromised persons (including people being treated with chronic corticosteroids 2 mg/kg of body weight or a total of 20 mg/day of prednisone or equivalent) o susceptible pregnant women o newborns whose mothers had onset of varicella within 5 days before and 2 days after delivery o preterm infants at 28 weeks gestation whose mothers are susceptible to varicella o preterm infants at <28 weeks gestation or 1,000 g birth weight, regardless of maternal history or serostatus. VZIG provides maximum benefit when administered as soon as possible after exposure, but may be effective if administered as late as 96 hours after exposure. If administration of VariZIG does not appear possible within 96 hours of exposure, administration of immune globulin intravenous (IGIV) should be considered as an alternative (IGIV should also be administered within 96 hours of exposure).
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Treatment

Oral acyclovir is not recommended for routine use in healthy children with varicella but should be considered for otherwise healthy people at increased risk for moderate to severe disease, e.g., persons aged >12 years; people with chronic cutaneous or pulmonary disorders; receiving long-term salicylate therapy; and receiving short, intermittent or aerosolized courses of corticosteroids. Intravenous antiviral therapy, when administered within 24 hours of onset of rash is recommended for immunocompromised persons, including patients being treated with chronic corticosteroids.

Herpes Zoster (Shingles)


The aims of treatment are to limit the severity and duration of pain, shorten the duration of a shingles episode, and reduce complications. Symptomatic treatment is often needed for the complication of postherpetic neuralgia Analgesics People with mild to moderate pain can be treated with over-the-counter analgesics. Topical lotions containing calamine can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as morphine. Once the lesions have crusted over, capsaicin cream (Zostrix) can be used. Topical lidocaine and nerve blocks

may also reduce pain. Administering gabapentin along with antivirals may offer relief of postherpetic neuralgia Antiviral drugs inhibit VZV replication and reduce the severity and duration of herpes zoster with minimal side effects, but do not reliably prevent postherpetic neuralgia. Of these drugs, acyclovir has been the standard treatment, but the new drugs valaciclovir and famciclovir demonstrate similar or superior efficacy and good safety and tolerability. The drugs are used both as prophylaxis (for example in AIDS patients) and as therapy during the acute phase. Antiviral treatment is recommended for all immunocompetent individuals with herpes zoster over 50 years old, preferably given within 72 hours of the appearance of the rash. Complications in immunocompromised individuals with herpes zoster may be reduced with intravenous acyclovir. In people who are at a high risk for repeated attacks of shingles, five daily oral doses of acyclovir are usually effective. Steroids Orally administered corticosteroids are frequently used in treatment of the infection, despite clinical trials of this treatment being unconvincing. Nevertheless, one trial studying immunocompetent patients older than 50 years of age with localized herpes zoster, suggested that administration of prednisone with aciclovir improved healing time and quality of life Nursing Management:
1. Prevention of secondary infection of the skin lesions through hygienic

care of the patient 2. Antipyretics for fever 3. Cut fingernails short and wash hands more often in order to minimize bacterial infections; may be introduced by scratching