Module 8

• Chickenpox (Varicella)


  Acute and highly contagious disease of viral etiology, characterized by vesicular eruptions on the skin and mucous membrane with mild constitutional symptoms
• Causative Agent


  Herpes Virus Varicellae, a DNA containing virus, closely identical to herpes zoster virus
• Herpes Virus Varicellae


  • Human beings are the only source of infection
• Incubation period


  10 - 21 days after exposure
• Mode of transmission


  1. Direct contact with patients who shed the virus from the vesicles

  2. Indirect contact, through linens or fomites

  3. Airborne, and droplet spread
• Period of communicability


  The patient is capable of transmitting the infection about a day before the eruption of the first lesion up to about five days after the appearance of the last crop of vesicles
• Clinical manifestations


  1. Pre-eruptive manifestations are mild fever and malaise

  2. Eruptive stage: Rash starts from the trunk, then spread to other parts of the body - centrifugal appearance of rashes

  3. Initial lesions are red papules where contents become milky and pus-like within 4 days

  4. In adult and bigger children, the lesions are widespread and more severe

  5. Rapid progression so that transition is completed in 6-8 hours

  6. Vesicular rashes are very pruritic

  7. All stages are present simultaneously before all are covered with scabs, known as "Celestial map"
• Stages of lesions


  • Macule
  • Papule
  • Vesicle
  • Pustule
  • Crust
• Diagnostic test


  Determination of V-Z virus through the complement fixation test<|>Determination of V-Z virus through Electron Microscopic examination of vesicular fluid
• Complications


  • Secondary infection of the lesions - furuncles, cellulitis, skin abscess, erysipelas
  • Meningoencephalitis
  • Pneumonia
  • Sepsis
• Treatment modalities


  1. Oral Acyclovir (Zovirax)

  2. Oral antihistamine for symptomatic pruritus

  3. Calamine lotion will ease itchiness

  4. Salicylates (Aspirin) must not be given for fever

  5. Paracetamol
• Nursing Management


  1. Respiratory isolation is a must until all vesicles have crusted

  2. Prevent secondary infection of the skin lesion through hygienic care of the patient

  3. Attention to nasopharyngeal secretions and discharges because these are highly infectious

  4. Linen must be disinfected under the sunlight or through boiling

  5. Cut finger nails short to prevent skin breakdown

  6. A child must wear mittens

  7. Provide activities to keep child occupied to lessen pruritus

  8. Observe oral and nasal care
• Preventive measures


  • Active immunization with live attenuated varicella vaccine
  • Avoid exposure to infected persons
  • Isolation of infected person
• Cholera (El Tor)


  Acute bacterial enteric disease of the GIT characterized by profuse diarrhea, vomiting, massive loss of fluid and electrolytes that could result to hypovolemic shock, acidosis, and death
• Causative Agent


  Vibrio cholerae and Vibrio coma, curved rods (coma shaped), gram negative (-) and motile with a single polar flagellum, can survive well at ordinary temperature and can grow well in temperature ranging from 22-40 degrees centigrade (or even in refrigerated foods), Choleragen is an enteroxin produced by organisms as they grow in the intestinal tract
• Pathognomonic sign


  Rice-watery stool
• Incubation period


  Ranges from few hours to five days; usually 1 to 3 days
• Period of communicability


  Communicable when stools are positive of entertoxins with carrier states
• Mode of transmission


  1. Fecal transmission passes via oral route from contaminated water, milk, and other foods

  2. Contaminated stools and vomitus

  3. Flies, soiled hands, and utensils also serve to transmit the infection
• Pathogenesis and Pathology


  1. Fluid loss is attributed to the enterotoxin

  2. The mucosal cell is stimulated to increase secretion of chloride, associated with water and bicarbonate loss

  3. The toxin acts upon the intact epithelium on the vasculature of the bowel, resulting in outpouring of intestinal fluids

  4. Fluid loss of 5 to 10% of the body weight resulting in dehydration and metabolic acidosis

  5. If treatment is delayed or inadequate, acute renal failure and hypokalemia become secondary problems
• Clinical manifestations


  1. Presence of acute, profuse, watery diarrhea without tenesmus or intestinal cramping

  2. Stool is brown initially, but some becomes pale gray, "rice watery" in appearance with an inoffensive, slightly fishy odor

  3. Vomiting occurs after diarrhea has been established

  4. Fluid loss of 1 to 30 L per day owing to subsequent dehydration and electrolyte loss

  5. Poor skin turgor and eyes are sunken into the orbit

  6. Skin is cold, fingers and toes are wrinkled, assuming the characteristic "washer-woman's-hand"

  7. Imperceptible radial pulse and unobtainable BP

  8. Cyanosis

  9. Aphonia which is the loss of voice but with whispered speech

  10. Tachypnea and deep respirations

  11. Diminished peripheral circulation

  12. Oliguria and/or anuria

  13. Temperature is normal at the onset but drops significantly when the patient is in shock

  14. Diarrhea stops when the patient is in deep shock

  15. Death may occur usually on the first or second day if not treated properly
• Principal deficits


  • Extracellular volume loss which can lead to severe dehydration, restlessness, and excessive thirst and circulatory collapse or shock "washer-woman's-hand"
  • Metabolic acidosis is due to loss of large volume of bicarbonate-rich stool that results in rapid respirations with intervals of apnea (Kussmaul respirations)
  • Hypokalemia due to massive loss of potassium in the stool AMB paralytic ileus
  • Renal failure occurs as a consequence of prolonged, untreated shock or unrelieved hypokalemia
  • Convulsions and tetany is probably caused by loss of magnesium
  • Hypoglycemia in untreated children who have been in stupor for several days
  • Corneal scarring in stuporous patient who has lost the "wink reflex"
  • Acute pulmonary edema may follow hydration in cases of uncorrected metabolic acidosis
• Diagnostic exams


  • Rectal swab
  • Darkfield or phase microscopy
  • Stool exam
• Modalities of treatment


  1. IV therapy of saline solution (Na, K, CI, HCO3 ions)

  2. Oral rehydration therapy (ORESOL, HYDRITES) unless contraindicated

  3. Intake and output measurement

  4. Antibiotics: Tetracycline, Furazolidone, Chloramphenicol, Cotrimoxazole
• Nursing Management


  1. Handwashing

  2. Enteric isolation

  3. Vital signs

  4. I&O

  5. Personal hygiene

  6. Proper disposal of excreta

  7. Concurrent disinfection

  8. Proper handling of foods

  9. Environmental sanitation
• Nursing Diagnosis


  • Altered nutrition: Less than body requirement
  • Altered tissue perfusion
  • Activity intolerance
  • Knowledge deficit
  • High risk for fluid volume deficit
  • Diarrhea
  • Impaired skin integrity