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Varicella

Zoster
Infection

Christelle Brookshiel Joy D. Marba, RN An infectious case


Maria Rachel Ann M. Dagupan, RN study
Donita Rose R. Candido, RN
Mistletoe R. Sanchez, RN
Sheila O. Mabalot, RN

Varicella Zoster Infection


Also

known as Chickenpox
Acute disease cause by a DNA virus.
Highly contagious
Most common in children.
Easily transmissible through airborne,
droplets, direct contact with blisters

Statistics reveals
Worldwide

distribution
Common on crowded places.
10th most common childhood disease in
the Philippines.

MORBIDITY: 10 Leading Causes, Number and Rate


5-Year Average (2003-2007) & 2008

Diseases

5-Year Average
(2003-2007)

2008*

Number

Rate

Number

Rate

1,647,178

1840.6

2. Acute Lower Respiratory Tract Infection and Pneumonia

683,443

837.90

780,199

871.8

3. Bronchitis/Bronchiolitis

593,284

732.50

519,821

580.8

4. Hypertension

371,467

457.60

499,184

557.8

5. Acute Watery Diarrhea

581,611

712.70

434,445

485.4

6. Influenza

381,371

470.40

362,304

404.8

7. TB Respiratory

111,418

137.30

96,497

107.8

8. Acute Febrille Illness ***

22,225

27.60

35,381

39.5

9. Diseases of the Heart

36,240

44.60

32,541

36.4

10. Chickenpox

29,197

40.40

25,677

28.7

1. Acute Respiratory Infection **

CNGH
3

cases April
1 case on the first week of
April
2 cases by the end of April

General Objective

knowledge, skills
and the right attitude in the
Acquisition of the

management of patients diagnosed with


Varicella Zoster Infection.

Address the primordial


needs and problems

associated with this diagnosis with the best


medical and nursing intervention available.

Specific Objectives
To

reveal the general assessment


including the nursing history obtained
objectively from our chosen patient.

To

discuss the etiology, risk factors and


clinical manifestations of Varicella
Zoster Infection as it relates to the
actual experiences of the subject and
the management involved.

To

develop an effective nursing intervention

To

deliver effective nursing care to patient.

To

develop appropriate discharge plan of the


patient.

Significance of the
Study
This

study will provide a brief discussion


regarding Varicella Zoster infection its
prognosis and management.

Significance of the
Study
To patient: to promote understanding of the
disease process; its prognosis and nursing and
medical management.
To the professionals: as a reference in
planning an effective management of patients
diagnosed with Varicella Zoster Infection.
To the society: as a reference in the
investigation of suspected Varicella Zoster
infection as well as the preventive measures and
precautions to be considered in case of living in a
susceptible community.

Scope and Limitation


Conducted

at Ward 3 of Camp Navarro


General Hospital.
The information was gathered from the
patient through an interview, from the
on-duty Health care providers who
rendered medical and nursing
management.

CLIENT PROFILE

NAME: PATIENT ISO


AGE: 23 YEARS OLD
ADDRESS: TUMAGA, ZAMBOANGA CITY
GENDER: MALE
MARITAL STATUS: MARRIED
OCCUPATION: SOLDIER

BRANCH OF SERVICE: PHILIPPINE NAVY

RANK: S1YN

UNIT ASSIGNMENT: NISF, PN, BAGONG CALARIAN,


Z.C.

LENGTH OF SERVICE: 6 YEARS

CLIENT PROFILE
BIRTH

DAY: 09 MARCH 1991


BIRTH PLACE: BARANGAY TUMAGA, Z.C.
NATIONALITY: FILIPINO
RELIGION: BORN AGAIN
DIALECT SPOKEN: TAGALOG, CHAVACANO
EDUCATIONAL ATTAINMENT: COLLEGE LEVEL
HEIGHT: 54
WEIGHT: 69 kg

CLIENT PROFILE
CHIEF COMPLAINTS:
ON and OFF FEVER X 4 DAYS;
RASHES AT FACE AND LEGS X 4 DAYS
SORE THROAT and ITCHINESS
BODY PAIN PS: 7/10

MEDICAL IMPRESSION: VARICELLA ZOSTER


INFECTION

DATE and TIME of ADMISSION: 01 1300H


MARCH 2015
DATE AND TIME OF DISCHARGE: 16 MARCH 2015

FINAL DIAGNOSIS: VARICELLA

CONCEPT OF HEALTH, ILLNESS AND HOSPITALIZATION

health

is very important aspect of human


being because without good health, one
cannot fully perform his duties and
responsibilities.
He was a little bit sad because of his
condition. However, he doesnt lose hope
because he knew that with proper treatment
his condition will be alleviated. He was a little
bit disappointed too because he believes that
this condition is just for children but then he
still contracted the disease.

IMMEDIATE FACTOR THAT BROUGHT


ABOUT ILLNESS
he

contracted the disease from one of


his colleagues who also had a previous
Varicella Zoster Infection four days prior
the signs and symptoms became
evident.

COMPREHENSIVE HISTORY
4

days prior to Admission:

on and off fever, sore throat, rashes


that started from the face and later
invaded his lower extremities, itchiness
and body malaise
- No meds taken at home.

PAST MEDICAL HISTORY


fully

Last

immunized as a child.

hospitalization

2010 at Manila Naval Hospital


chief complaints: Fever and body Malaise
Treatment received: Paracetamol and
antibiotics.
Patient cant remember exact diagnosis.
No known Allergy

FAMILY AND SOCIAL HISTORY


Hypertension

from his father


Diabetes and kidney diseasemother
Heart disease - grandmother

Physical Assessment
SCALP/

HAIR
all areas and is free from masses,
lumps, and dandruff with no areas of
tenderness upon palpation.
Hair - evenly distributed.
Some parts show Varicella lesions
on the ventral part of the head.

Physical Assessment
FACE
Oval

in shape, symmetrical and no


involuntary muscle movement.

There

are varicella lesions evident


on the left and right cheek of the
patient.

HEALTH PERCEPTION- HEALTH MAINTENANCE PATTERN

Patient

perceives health as important. He


verbalized that he is healthy and was fully
immunized as a child. If he is not feeling
well, he takes medications like over-thecounter drugs.
He verbalized that before he was admitted
he feels at ease and sleep for about 7-8
hours yet it still depends on his assigned
duties. He seeks medical assistance on a
clinic or hospital

NUTRITIONAL PATTERN
normal

meal pattern
eats fruits and vegetables. He has a
good appetite with no difficulty in
chewing and swallowing food.
drinks approximately 7-9 glasses of
water everyday
Hypoallergenic diet upon admission.

ELIMINATION PATTERN
defecate

everyday usually in the

morning.
He sometimes experiences some
difficulty in defecating yet he just eat
fruits high in fiber like papaya and ripe
mangoes to facilitate his elimination
pattern.
He urinates 3-5 times a daily during
hospitalization.


ACTIVITY- EXERCISE PATTERN
independent

in performing activities of
daily living such as feeding, general
mobility, toileting, bathing, grooming
and home maintenance.
He also has a routine 20-30 exercise
composed of jogging and walking once
or twice a week.
Spends his leisure time by playing
games on his phone during confinement


COGNITIVE- PERCEPTUAL PATTERN
Patient

is well oriented with his name,


time, place, date, family members.
Patient is conscious and coherent.
During

hospitalization, patient doesnt


have any changes in his senses.

SLEEP- REST PATTERN


has

an average of 7-8 hours of sleep


most of the time.
His sleeping schedule depends on his
work schedule.


SELF-PERCEPTION SELF- CONCEPT PATTERN
the

patient describes himself active and


a healthy individual. He is the
breadwinner of the family.

During

the hospitalization, the patient


verbalized that he wanted to go home
and go back to his work in his usual
routine.

ROLE-RELATIONSHIP PATTERN
nuclear
married

family structure

for more than one year and is a


father of a six month old child.

SEXUAL- REPRODUCTIVE PATTERN


patient

verbalized that he is not


experiencing any problems involving
reproductive system and their sexual
relationship

COPING- STRESS PATTERN


The

patient verbalized that if they


encounter problems, they solve it as a
family and stated that every time he
feel stressful, he usually open up and
talk to his wife.

VALUE- BELIEF PATTERN


Born

Again Christian.

He stated that faith is very important


and religion guides him to strengthen
his faith to God. According to him, he
draws his strength from God which gives
him the willpower to continue and enjoy
living.

Anatomy and
Physiology

The immune System

Infection occurs when a pathogen


invades body cells and reproduces.

If the response is quick and effective,


the infection will be eliminated or
contained so quickly that the disease
will not occur.

Disease

can occur when immunity is low


or impaired, when virulence of the
pathogen (its ability to damage host
cells) is high, and when the number of
pathogens in the body is great.

How Infection happens

Non-immunized
Stress

Varicella Zoster
Virus
Infected
person

No known
history of
VZV

HOST
Sneezing
Coughing
Contact with
blisters

4 days prior to admission

Upon Admission

Exposed to crowd

Lack of sleep

On and off fever


Rashes on face and legs
Sore throat and itchiness
Myalgia
Pain scale= 7/10
Same S&S with
increasing
severity

Signs and Symptoms

Hematology Result

COURSE IN THE WARD


Admission (01 1300H
March 2015

- A 23 year old male


from Barangay
Tumaga, Zamboanga
City
- chief complaints of
maculopapular lesions
from head to toe,
intermittent fever,
body pain and
itchiness of lesions
for 3 days.

COURSE IN THE WARD


Admission (01 1300H
March 2015

- following orders were


given: admit to
isolation ward, diet as
tolerated, increase
fluid intake,
respiratory/droplet
precaution, patient to
wear mask at all
times. Diagnostic
procedure order was
complete blood count.

COURSE IN THE WARD


Admission (01 1300H
March 2015

following therapeutics
such as Acyclovir 500
mg/tablet, 4 tablets
once a day per orem for
5 days and Paracetamol
500mg/tablet, 1 tablet
PRN for Temperature of
38.3 degrees Celsius.
Cpt C MC also ordered
for D5NSS 1 liter
regulated at 40-41
gtts/min for 3 cycles

COURSE IN THE WARD


1400H

Received by the
afternoon shift 3pm11pm NOD with
elevated body
temperature of 38
degrees Celsius and skin
warm to touch. Nursing
interventions were
rendered such us: cold
compress applied to
forehead, encouraged to
increase fluid intake,
regulated IVF fluid to its
desired rate and
Paracetamol 500 mg
tablet was given.

COURSE IN THE WARD


1600H

Hematology report was


relayed to MOD with
significant values of RBC
5.68x10/L, HGB 161 g/L,
PLT 98x10/L,
Lymphocytes 44.4%,
Granulocytes 47.7%

1800H
Latest temperature
recorded: 36.1 degrees
Celsius.

COURSE IN THE WARD


1 (02 0840H
March 2015

1500H

MOD ordered IVF of D5NSS


1 Liter to follow at 4041gtts/min for 3 cycles and
was noted by NOD.

Encouraged patient to
verbalize feelings and
concerns, placed on a
comfortable position,
advised not to prick
blisters. Encouraged to
practice personal hygiene
and observe proper
handwashing.

COURSE IN THE WARD


Patient complained of body

DAY 2 (03 0720H


March 2015

0830H

1100H

malaise. The following


intervention was rendered by
NOD: Assessed health status,
encouraged verbalization of
feelings and concerns,
provided well ventilated and
comfortable environment and
monitored patient at intervals.

MOD ordered IVF to follow of


D5NSS 1 Liter regulated at 4041gtts/min and was noted by
NOD.

MOD ordered further more IVF


to follow of D5LR 1 liter for
12hours for 2 cycles and was
noted by NOD.

COURSE IN THE WARD

DAY 3 (04 0720H


March 2015)

0800H

Patient complained of
itchiness all over body. The
following intervention was
rendered by NOD: Assessed
health status, encouraged
verbalization of feelings
and concerns, instructed to
increase fluid intake,
instructed to avoid
scratching of vesicles and
removal of crusts, advised
to practice personal
hygiene and handwashing,
monitored at intervals for
unusualities.
MOD ordered for IVF to be
consumed then discontinue
after last ordered cycle of
D5LR and was noted by

COURSE IN THE WARD

DAY 4-14 (05 0700H


March 2015 to 15 March
2015)

NOD focus of care was


towards promotion of
health and wellness and
the following interventions
were rendered to the
patient: Assessed health
status, encouraged
verbalization of feelings
and concerns, advised to
adhere health care
management for early
recovery, imparted health
teachings on personal
hygiene and handwashing,
provided a well ventilated
and comfortable
environment, due meds
given as ordered.

COURSE IN THE WARD


Day 15 (16 March 2015)

Patient was
discharged per MODs
order in fair condition
and upon
accomplishment of
clearance. Discharged
health teachings were
imparted and
acknowledged by the
patient.

Name of the
Drug

Classification

Mechanism of Action

Indication

Nursing
Considerations

Generic
Name:
Acyclovir
Brand
Name:
Herpex

Dosage:
200mg

Frequency:
4 tabs once a
day

Route:
Oral

Antiviral drug

The acyclovir is
converted to an active
form by the virus itself,
and the virus then uses
the active form of
acyclovir rather than
the nucleoside it
normally uses to
manufacture DNA, a
critical component of
viral replication.

Recurrent
genital Herpes
infection.

Assessment
History: Allergy to
acyclovir,

Herpes Zoster
infection
( Shingles)
Chickenpox( Va
ricella) PO

Teaching points
Oral acyclovir is not a
cure.

Side effects
nausea,
Vomiting, diarrhea and
headache. agitation,
confusion, rash

Contraindicat
ion:
hypersensitivit
y

Avoid sexual
intercourse while
visible lesions are
present.

You may
experience these
side effects:
Nausea, vomiting,
loss of appetite,
diarrhea;
headache,
dizziness.
Report difficulty
urinating, rash,
increased severity
or frequency of
recurrences.

Name of the
Drug

Classificatio
n

Generic
Analgesics
Name:
Antipyretic
Paracetamol
Brand
Names:
Fevergan
Classificati
on:
Dosage:
500 mg
Frequency:
PRN
Route: Oral

Mechanism of
Action

Indication

Nursing
Considerations

Decreases fever
by inhibiting the
effect of
pyrogens on the
hypothalamus by
Vasodilation.

Relief of
mild to
moderate
pain;
treatment of
fever

Assess patients
fever or pain;
type of pain,
location, intensity,
duration,
temperature and
diaphoresis.

Contraindic
ation
Relieves pain by
Hypersensiti
inhibiting
vity to the
prostaglandin
drug.
synthesis at the

CNS but does not Intolerance


to tartrazine
have anti(Yellow dye
inflammatory
action because of #5), alcohol,
its minimal effect sugar,
saccharin.
on peripheral
Allergy to
prostaglandin
acetaminop
synthesis.
hen

History: Allergy to
acetaminophen,
impaired hepatic
function, chronic
alcoholism,
pregnancy,
lactation
Give drug with
food if GI upset
occurs.
Discontinue drug
if hypersensitivity
reactions occur.

Problem list
Increased

body temperature
Impaired skin integrity
Knowledge deficit regarding Varicella
Zoster infection

Long term objective

the patient will no longer be afflicted by the


varicella virus and will not trigger the
reactivation of the virus inside the body
which can lead to a major complication
known as Herpes Zoster infection that is
more serious than the previous case. Also,
for the professionals- to be equipped with
the knowledge, skills and right attitude
needed to address the similar case in the
future.

Assessment

Nursing Diagnosis

Objective of care

Subjective
Elevated
At the end of
C. Nursing
cues:
bodyCare Plans
8 hours

temperature nursing
Maam ta
intervention
sinti man iyo
the Patient
caliente pati
will be able
duele el di
to maintain
mio cabesa
body
as verbalized
temperature
by the
within normal
patient.
range of

36C to 37.5
Objective
C
cues:
Skin warm to
touch
Temperature
of 38C.

Interventions

*Assess
health
condition of
the patient
*Provide a
wellventilated
environment
*Encourage
significant
others to
perform tepid
sponge bath
or cold
compress.
*Encourage
to increase
fluid intake.

Evaluation

At the end of
8 hours
nursing
intervention,
the patient's
latest body
temperature
is 36.1C.

Assessmen

Nursing

Objective

Diagnosis

of care

Evaluation
Interventio
ns
*Administere
d anti pyretic
medication as
ordered.
*Monitored
patients core
temperature
at frequent
intervals.

Assessment

Subjective
cues:

Manada ya ta
crisi butuy na
dimiyo cara
hasta na
dimiyo pi es
as verbalized

Objective
cues:
Presence of
vesicular
Lesions all over
the body. Some
of the lesions
are vesicles
filled
With serous
fluid; others are
darker in color.

Nursing

Objective of

Interventio

Diagnosis

Care

ns

Impaired skin
integrity
Related to
Varicella Zoster
Infection

At the end of
the patients
hospital stay
and series of
interventions
carried out, the
patients
skin lesions will
heal without
evidence of a
secondary
infection.

*Assess
patients
condition

*Educate
patient on the
following:

Wash the
hands each
time the area is
touched.
Wash any
soiled clothes
or linens in
warm water
and soap.

Evaluation

At the end of
the patients
hospital stay
and series of
interventions
carried out,
The Patients
skin lesions are
dry and crusty,
with no new
blister
Formation.

Skin lesions
healed without
evidence of a
secondary
infection.

Assessment

Nursing Diagnosis

Objective of

Interventions

Care

*Use masks, special


clothing, and gloves for
all those who come into
the room and the patient
himself.
*Always wash hands
after touching the patient
or objects that may be
contaminated, and before
giving the action to other
clients.
*All contaminated items
disposed of or put into a
special place and labeled
prior to decontamination
or reprocessed back

*Educate patient to
always trimmed
fingernails and avoid
scratching the affected
areas.

*Take medications as
prescribed.

Evaluation

Assessment

Nursing
Diagnosis

Objective of
Care

Interventions

Evaluation

Subjective
cues:
Ara pa gayot
ya krisi
chickenpox
comigo,cosa
gaha yo debe
hace para
puede ayuda
di mio cuerpo

Deficient
knowledge of
the cause of
the skin
disorder and
recommended
Treatment.

At the end of 8
hours nursing
intervention
the Patient will
be able to
Verbalize
understanding
of the disease
process and
participate in
the treatment
plan.

Provide verbal
and written
instructions for
self-care.

At the end of 8
hours nursing
intervention
the Patient
acknowledged
the health
teachings
being imparted
to him.
Si,mas ya
puede yay o
intende el cosa
ta pasa na di
mio cuerpo. O
hala keda ya
iyo bueno

*Encourage
proper
hygiene.
*Teach how to
take care of
skin lesions.
*Wear a clean
cotton
undershirt
each day.
*Do not allow
other family
members to
use your
towels.

Assessment

Nursing Diagnosis

Objective of Care

Interventions

*Encourage clients to
avoid all forms of
friction (touched,
scratched by hand)
*Take medications as
prescribed

*Educate patient on
how to create a
cleansing solution.
Instructed patient to
mix one liter of water
with one teaspoon of
salt and use this as
cleanser.

Evaluation

Discharge Planning
MEDICATION

-Promotes adherence
measures by thoroughly
explaining the importance of
taking multivitamins to
improve immunity.

EXERCISES

-Organize patient care and activities to


maximize periods of uninterrupted rest.
-Advise to take adequate rest periods at
appropriate intervals to avoid fatigue.

TREATMENT

- Emphasize the importance of followup visits to the requesting physician.


- Emphasize the importance and
benefits of proper hand hygiene.

HEALTH
TEACHING

- Provide the benefits of a healthy lifestyle.


- Encouraged family members to seek
medical attention when suspected
reinfection occurs.
- Educated patient for possible signs of
Herpes Zoster infection and to seek
medical attention if noticed.
- Explain proceedings of proper disposal of
nose and throat discharges.
- Educated the importance of covering
mouth when coughing or sneezing and
avoiding crowded places.
- General health measures (adequate sleep,
proper diet and maintaining clean
surroundings)

OUT-PATIENT - Patient must report at a specified


time for his follow-up checkup in
order to monitor the disease
prognosis.

DIET

- Encouraged patient to include


consumptions of fruits and vegetables
regularly and how it improve the
immune system.

SPIRITUAL
NURSING

- Supporting religious practices.

Conclusion
Varicella Zoster Infection or commonly known as
Chickenpox is highly contagious disease caused by
herpes virus varicella, characterized by vesicular
eruptions on the skin and mucous membranes
usually with mild constitutional manifestations.
Because it is widely distributed, anyone can be
susceptible for contracting the disease even adults
has no excuse. Seeking consultation and taking the
proper management is essentially important as it
provides mutual benefit; to the patient, it will halt
the spread of the virus in the body which can lead to
serious complications and to the community for
minimizing the risk of contracting the disease from
the infected individual which can pose a larger
threat of a possible epidemiological outbreak.
Isolating the patient is considered and meticulous
handling of the case by following the infection
control protocol is a must. With proper management
of the disease, the patient can recover and restore

-ENDMuchisimas
Gracias!

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