Nursing Care Plan (NCP) for Varicella / Chickenpox

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Outline

Pathophysiology

Varicella, more commonly known as chickenpox, is a viral infection that causes an itchy rash with small blisters on the skin and flu-like symptoms. Chickenpox is highly contagious and usually affects children. A red, intensely itchy rash is the hallmark sign of chickenpox and may develop anywhere on the body including the scalp, mouth, arms, legs, trunk and genitals. Symptoms normally begin within 10 – 21 days after exposure to the virus and lasts 1-2 weeks. The varicella vaccine is routinely given to children at the ages of 12 months and 4 years old and is highly effective in preventing the disease.

Etiology

Chicken pox is caused by the varicella-zoster virus that is transmitted through respiratory droplets. Direct contact with papules and vesicles (not crusts) can also spread the virus. Anyone who has not had chickenpox, or the varicella vaccine can become infected with exposure to chickenpox or shingles which comes from the same virus. After having chickenpox once, the body creates antibodies to the disease and the virus becomes dormant in the nerve tissue.

Desired Outcome

Patient will remain comfortable and able to rest; patient will not develop secondary infection.

Varicella / Chickenpox Nursing Care Plan

Subjective Data:

  • Intense itching 
  • Body aches 
  • Loss of appetite 
  • Fatigue 
  • Headache

Objective Data:

  • Fever
  • Presence of papules/and vesicles 
  • Crusts/scabs on skin

Nursing Interventions and Rationales

 

Nursing Intervention (ADPIE) Rationale
Perform complete physical assessment Get baseline to determine effectiveness of interventions. Note stage of disease: active, fluid filled blisters or scabbed and crusted lesions.
Monitor vital signs Fever often accompanies a chickenpox outbreak. Other changes in vital signs can indicate development of systemic infection.
Assess skin for signs of secondary infection Itching leads to scratching and scratching leads to open wounds which are a breeding ground for bacteria and infection.
Trim nails or cover hands of infants and toddlers Keeping the nails short or covered helps prevent scratches in the skin that can lead to infection.
Encourage rest When the body is resting, more energy can be devoted to healing. This can also help to minimize fatigue and discomfort.
Manage itching  cool compresses

baths with oatmeal or cornstarch 

Helps relieve itching and soothe irritating skin 

Administer medications appropriately Oral antivirals

Oral antihistamine

Oral or rectal acetaminophen

Topical calamine

** Avoid giving aspirin or other salicylates to children with viral illnesses due to risk for Reye’s Syndrome**

Antiviral (acyclovir) medications may help lessen the severity or shorten the duration of the disease

Antihistamines (diphenhydramine) are given to relieve itching

Acetaminophen is often given to treat fever and pain

Calamine lotion, cream or gel may be applied to help relieve itching and discomfort

Encourage hydration Water is better than sugary drinks to maintain hydration, even if child has little appetite.  Children may be more responsive to popsicles for replacement of fluid and electrolytes.
Provide education for patient and parents regarding:

Preventing the spread of disease

Infection control

Vaccines

When to return to school / daycare

The virus can be spread to others until all lesions have crusted over, therefore, the child should not return to school or daycare until they are no longer contagious, even if feeling better.

Good hand hygiene can help spread infection.

Varicella vaccine may be given 3-5 days after exposure (before symptoms begin) to prevent or lessen the severity of the disease.

 All children over 12 months of age should be vaccinated

Writing a Nursing Care Plan (NCP) for Varicella / Chickenpox

A Nursing Care Plan (NCP) for Varicella / Chickenpox starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

  • https://www.mayoclinic.org/diseases-conditions/chickenpox/symptoms-causes/syc-20351282
  • https://my.clevelandclinic.org/health/diseases/4017-chickenpox
  • https://www.cdc.gov/chickenpox/about/index.html
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Transcript

Hi everyone. Today, we are going to be creating a nursing care plan for varicella chickenpox. So, let’s get started first. We’re going to talk about the pathophysiology of varicella chicken pox. Varicella, which is more commonly known as chickenpox is a viral infection that causes an itchy rash with small blisters on the skin and flu-like symptoms. Some nursing considerations. You want to do an assessment, vital signs, managing the itching, administering any medications, encouraging re and educating the parent and or caregiver. Some desired outcomes. The patient will remain comfortable and able to rest. The patient will not develop any sort of secondary infection. 

And here I wanted to show you guys a picture. So, as you see, you’re going to see all of these little to tiny blisters all over the chest area here and mind you, these can appear anywhere on the body, but you see how there’s just a bunch everywhere. There’s some on the arms, on the torso, they can appear anywhere. So, we’re going to go ahead and get right into the cure plan. We’re going to be writing down some subjective data and some objective data. So, what are we going to see in a patient with varicella chickenpox? Well, one of the things they’re going to tell you, one of the main things is there’s going to be some intense itching. They’re going to be scratching a lot. They’re super, super itchy. One of the other things that’s very common is a fever, they are going to have a fever, and you’re going to see those red blisters and it could be anywhere on the body. 

Some other things that you’ll see, they’ll complain of some body aches, maybe a possible loss of appetite, some fatigue, headache, and you may see some crosser scabs on the skin. So, like later in the process of the varicella, some interventions that we’re going to be doing, so you want to perform a complete physical assessment of the patient. So, you want to make sure you’re looking head to toe to see if it’s anywhere on the arms, the torso, the legs, you want to note any sort of active filled blisters or scabbed or crusted lesions. You want to monitor their vital signs. Fever often accompanies a chickenpox outbreak. Other changes in vital signs can indicate a development of any sort of systemic infection. Another thing that we want to do, we want to assess the skin for any sort of science of secondary infection. So secondary infection itching ends up leading to scratching, scratching leads to having any other open wounds, which is breeding ground for bacteria and infection. So, you want to be sure to trim the nails down or keep them short on children to avoid any sort of secondary infection, another intervention we want to make sure we’re managing the itching 

Because we want to manage, uh, not having a secondary infection. So, you can be using any sort of cool compress, maybe some baths with some oatmeal or corn starch. That’s really soothing to the skin helps relieve that itch. And it’s just super, super soothing. Another intervention is administering any sort of medications. So, this would be your antivirals, or this would be any antihistamines, Some acetaminophen for fever or for pain and calamine lotion. 

You want to make sure to note you want to avoid giving or any other cell slates to children with viral illnesses due to the risk of race syndrome. So, antivirals, giving the antiviral medication may help with the lesions, the severity, or shorten the duration of the disease. Antihistamines are going to be given in order to relieve any sort of itching, then for the fever or for the pain and the calamine lotion. It can be applied to help relieve any itching and discomfort for the patient. Another invention we’re going to look at is encouraging rest. We want to encourage rest because when the body’s resting, more energy can be devoted to the healing process. This can also help minimize fatigue and any discomfort in the patient. Another intervention is making sure we’re educating the caregiver. So, education, you want to make sure you’re providing information on vaccines, uh, infection control how to prevent spreading the disease. And when the child is to return back to school or, or day, the virus can be spread to others until all the lesions have crusted over. Therefore, the child should not return to school or daycare until they’re no longer contagious, even if they’re feeling better. And obviously good hand hygiene helps with any sort of spreading of the infection to others. The varicella vaccine can be given three to five days after exposure or before symptoms begin in order to prevent or lessen the severity of the disease. And all children over 12 months of age should be vaccinated. 

So that’s our completed care plan. Let’s go into some of the key points here. So, in pathophysiology, varicella is a viral infection that causes an itchy rash with small blisters on the skin. Very, very common. It is caused by the varicella zoster virus. Some subjective and objective data, what you are going to see is intense itching, body aches, fever, any presence of those red blisters is just very, very common fatigue, headache, loss of appetite. You want to do a full assessment managing that itching so you want to see the stage of the disease are the active open blisters. Are they scabbed over? You want to assess vital signs, manage itching with cool compresses, oatmeal, baths, or cornstarch. You want to give medications and do proper education. You want to give antivirals, antihistamines, acetaminophen, calamine lotions, super soothing, educate on how to prevent the spread, the vaccine, good hand hygiene. And when the child should be able to return to school and there you have it guys, a full completed care plan. We love you. Go out, be your best self today and as always, happy nursing!

 

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