Varicella: Management and Complications (Pediatric Nursing)

by Paula Ruedebusch

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    00:00 How does it resolve? Well, it's self-limiting. This is a virus and it will go away.

    00:05 You can help your patient manage their chickenpox by having them increase their fluid intake.

    00:10 Remember, they don't feel well.

    00:11 They have a viral illness and they might have aches and fever.

    00:15 You wanna encourage rest.

    00:16 The patient can have acetaminophen for their fever but remember, there should be no aspirin given in anyone less than 18 years old to prevent against Reyes syndrome.

    00:26 Calamine lotion and another topical creams can help relieve the itching.

    00:30 Cool baths with baking soda or oatmeal can be soothing to the skin and you want to remind your patient to avoid a hot shower and avoid a hot bath because this will increase histamine release and increase their itching.

    00:43 So stay away from hot showers.

    00:45 Avoid scratching and this is to minimize the risk for secondary bacterial infections called empetigo.

    00:52 Remember, we're all covered in billions of bacteria and we need our skin to be intact.

    00:57 If the patient scratches their lesion, their normal flora, their normal staph, their normal strep that's covering their body can get in into a deeper area and cause impetigo or even cellulitis.

    01:08 Antiviral drugs and immunoglobulin should be administered in patients who have severe cases or in patients who get varicella and are immunocompromised.

    01:19 We can also manage this with hygiene measures.

    01:22 You wanna isolate the affected individuals.

    01:25 You wanna put this patient on contact and airborne precautions and this includes the nurse wearing eye protection including goggles or a splash shield, a gown, and a respirator like an N-95.

    01:38 You'll also wear gloves and you want to help avoid nosocomial or hospital transmission of varicella-zoster virus because while it might not be life-threatening for the patient, you may have other high risk patients and you don't want it to spread.

    01:52 Patients with varicella should be cared for by staff with evidence of immunity which means they are titer positive and they cannot get chickenpox.

    02:00 And a patient should be kept in a negative pressure room if possible.

    02:04 The room should be clean and the equipment should be clean with chlorine, bleach, detergents, and heat to be sure the virus is dead.

    02:11 We can also prevent varicella by vaccination.

    02:14 This is an attenuated live vaccine and it is incredibly effective. It's about 98% effective.

    02:21 So remember, there is that 2% of the population who can still get chickenpox but it's more likely to be a minor case.

    02:27 The routine vaccination scheduled in the United States in at least one year and then again around kindergarten at about 4-6 years.

    02:35 With the vaccine, the body will make antibodies to protect against the varicella-zoster virus.

    02:40 There are absolute exclusions though because this is a live vaccine.

    02:45 Absolute contraindications include pregnancy, patients who are immunocompromised, patients who are allergic to any of the ingredients in the vaccine, and any other live vaccine contraindication.

    02:59 When we're talking about varicella complications, the grip that is less likely to have complications are actually children and adolescence.

    03:07 The most susceptible are infants and then it skips over to adults, pregnant women, and immunocompromised patients.

    03:16 The complications of chickenpox are vast and include scarring.

    03:21 Now, this can be very serious.

    03:22 I've seen a lot of patients lately who are absolutely covered in chickenpox lesions and they'll come in, and they'll say, 'Do you think I'm gonna scar?' And these lesions can get quite deep.

    03:32 They're ulcerative lesions and so my answer is probably.

    03:36 This will probably scar and so we encourage them to decrease scratching to decrease the excoriations so that these lesions can try to heal but this can be very skin-altering.

    03:46 The patient can develop secondary bacterial infections and then remember, this is the break in the skin where the normal flora will enter and cause problems.

    03:55 It can also be inside like pneumonia, right? About 30% of adults who get varicella will also develop a pneumonia and this can be quite serious and this is a common cause for hospitalization in adults with chickenpox.

    04:09 Encephalitis can develop. That's inflammation of the brain.

    04:12 Cerebellar ataxia which is a defective muscular coordination.

    04:16 Transverse myelitis and this is inflammation along the spinal cord.

    04:21 The patient can develop Reye syndrome.

    04:23 Although this is rare, this is going to cause swelling in the liver and the brain.

    04:28 Remember shingles. This can develop as the second exposure to the virus and this can be life threatening. The patient can die.

    About the Lecture

    The lecture Varicella: Management and Complications (Pediatric Nursing) by Paula Ruedebusch is from the course Infectious Diseases – Pediatric Nursing.

    Included Quiz Questions

    1. Acetaminophen and increased fluid intake
    2. Intravenous immunoglobulin administration
    3. Calamine lotion and around the clock aspirin
    4. Hot showers to avoid scratching
    1. Negative pressure room, gown, gloves, N95 respirator, and eye shield
    2. Positive pressure room, gown, gloves, N95 respirator, and eye shield
    3. Negative pressure room, gown, gloves, mask and hair net
    4. Positive pressure room, face shields, hair net and gloves

    Author of lecture Varicella: Management and Complications (Pediatric Nursing)

     Paula Ruedebusch

    Paula Ruedebusch

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