Nursing Guide to Chickenpox: Nursing Diagnosis, Interventions, & Care Plans

Chickenpox (varicella) is an infectious disease caused by the varicella-zoster virus (VZV), a member of the herpesvirus family. It’s characterized by an itchy, blister-like rash, fever, and discomfort. Chickenpox is highly contagious and typically affects children under the age of 12, but it can also occur in adults, where it tends to be more severe. Transmission occurs through direct contact with the lesions or via airborne droplets. After recovering from chickenpox, the virus becomes dormant and may reactivate later in life as shingles. 

Etiology and epidemiology 

Chickenpox is mainly spread through close contact with an infected person or through respiratory droplets. Individuals are infectious one to two days before the rash ever appears and until all lesions have crusted over. The incubation period ranges from 10 to 21 days after exposure. 

• Risk factors: Unvaccinated individuals, newborns, pregnant individuals, immunocompromised individuals, and adults are at higher risk for complications, including pneumonia, encephalitis, and bacterial infections of the skin.
• Vaccination: The introduction of the varicella vaccine has significantly reduced the incidence of chickenpox (prevents 82% of infections with one dose). It’s typically given in two doses during childhood, providing long-term immunity.  Immunization within three days of exposure may improve outcomes in children.  The Advisory Committee on Immunization Practices (ACIP) recommends adults older than 60 years of age are vaccinated to avoid herpes zoster. 

Worldwide, chickenpox remains a significant public health concern in countries with low vaccination rates. In areas with high vaccination coverage, cases are sporadic but can still occur, especially in unvaccinated or immunocompromised individuals. 

Chickenpox ICD-10 code 

• B01.9: Varicella without complication 

Source: ICD10data.com (https://www.icd10data.com/ICD10CM/Codes/A00-B99/B00-B09/B01-/B01.9) 

Chickenpox Diagnosis 

Diagnosis of chickenpox is primarily clinical, based on characteristic symptoms and physical examination. Diagnostic methods include: 

• History and physical exam: The typical presentation of chickenpox includes a fever followed by a red, itchy rash that progresses through papules, vesicles, and crusted lesions. The rash initially appears on the face, chest, or back and then spreads to other areas of the body. The rash typically occurs in crops and lesions are in different stages.
• PCR testing: Polymerase chain reaction (PCR) testing of skin lesions or bodily fluids (such as blood or cerebrospinal fluid) can confirm the presence of varicella-zoster virus, especially in atypical or severe cases.
• Serologic testing: Antibody tests can be used to confirm past exposure or immunity, particularly in pregnant or immunocompromised individuals. 

Management 

Management of chickenpox is based on the patient’s age, health status, and severity of the infection. Treatment typically focuses on symptom relief, but antiviral medications may be necessary for high-risk patients. 

General treatment of chicken pox 

• Symptom management:
• Antihistamines: Oral antihistamines (e.g., diphenhydramine) can help alleviate itching.
• Topical treatments: Calamine lotion and oatmeal baths can provide relief from itching.
• Antipyretics: Acetaminophen is recommended to reduce fever. Avoid aspirin in children due to the risk of Reye's syndrome.
• Antiviral therapy:
• Acyclovir is the antiviral of choice for individuals at risk of severe disease, such as immunocompromised patients, pregnant women, and adults. Early initiation (within 24 hours of rash onset) is most effective in reducing the severity and duration of symptoms.
• Valacyclovir or famciclovir are also options for adults or individuals unable to take acyclovir. 

Complications 

• Bacterial infections: Secondary bacterial infections of skin lesions (commonly caused by Staphylococcus aureus or Streptococcus pyogenes) may require antibiotics.
• Pneumonia, encephalitis, and hepatitis: These are rare but serious complications, more common in adults, pregnant individuals, and immunocompromised individuals, necessitating hospitalization and specialized care. 

Prevention 

• Vaccination: The varicella vaccine is the most effective preventive measure against chickenpox. It is part of the routine childhood immunization schedule.
• The first dose is given to children from ages 12 to 15 months, and a second dose at age four to six years.
• Unvaccinated adults, particularly healthcare professionals, or those at higher risk, should also be vaccinated.
• Post-exposure prophylaxis: For non-immune individuals exposed to chickenpox, varicella vaccine within three to five days of exposure, varicella-zoster immune globulin (VZIG), for patients who can’t get vaccine (immunocompromised people, pregnant people without evidence of immunity, some neonates) can be administered within 10 days of exposure to reduce the severity of the disease. Acyclovir can also be used for prophylaxis in certain cases. 

Chickenpox nursing care plan 

Nursing considerations 

Nurses should focus on alleviating discomfort, preventing complications, and educating patients and caregivers on preventing the spread of the infection. 

Assessment 

• Skin assessment: Regularly assess the rash for signs of secondary bacterial infection, such as increased redness, swelling, or pus.
• Complications: Be vigilant about monitoring symptoms of respiratory distress, neurological changes (e.g., confusion, seizures), or high fever that could indicate pneumonia or encephalitis.
• Pain and itching: Assess the patient's level of discomfort and effectiveness of symptom relief measures. 

Nursing diagnosis/risk for 

• Risk for impaired skin integrity related to itching and scratching
• Risk for infection related to open vesicles and scratching
• Impaired comfort related to fever, pruritus, and rash
• Risk for fluid volume deficit related to fever and decreased oral intake 

Interventions 

• Skin care: Apply soothing lotions like calamine and encourage lukewarm oatmeal baths to reduce itching. Keep nails trimmed to prevent skin damage from scratching.
• Infection control: Implement standard and airborne precautions to prevent the spread of the virus to others, especially in healthcare settings. Teach patients about the importance of covering the mouth and nose when coughing or sneezing and maintaining good hand hygiene.
• Hydration and nutrition: Encourage increased fluid intake, particularly if the patient has a fever or is reluctant to eat due to mouth sores (which sometimes accompany chickenpox).
• Fever management: Administer antipyretics as prescribed and educate the patient to avoid aspirin in children to prevent Reye's syndrome.
• Education: Teach patients or caregivers how to recognize signs of complications, such as persistent high fever, difficulty breathing, or confusion. 

Expected outcomes 

• The patient’s skin will remain free of secondary bacterial infections.
• The patient will experience reduced discomfort from itching and fever.
• The patient or caregiver will demonstrate understanding of proper isolation procedures to prevent the spread of the virus.
• The patient will maintain adequate hydration and nutrition throughout the illness. 

Individual/caregiver education 

• Isolation: Instruct patients to remain isolated at home until all lesions have crusted over, usually about seven to 10 days after the rash first appears.
• Skin care: Teach caregivers how to care for the rash to reduce itching and prevent infection.
• Medication adherence: Ensure patients understand how to take antiviral medications if prescribed and to complete the full course.
• Vaccination: Educate patients and families about the importance of the varicella vaccine for prevention of chickenpox. 

Resources 

Centers for Disease Control and Prevention (CDC): This agency offers detailed information on chickenpox, including vaccination and management guidelines. 
Website: https://www.cdc.gov/chickenpox/ 

World Health Organization (WHO): This organization provides global guidance on the prevention and control of chickenpox. 
Website: https://www.who.int/ 

American Academy of Pediatrics (AAP): This association provides resources for pediatricians and parents on the care and prevention of chickenpox in children. 
Website: https://www.aap.org/ 

References 

1. Centers for Disease Control and Prevention. (n.d.). Chickenpox (Varicella). Retrieved from https://www.cdc.gov/chickenpox/ 
2. World Health Organization. (n.d.). Chickenpox: Preventing and controlling. Retrieved from https://www.who.int/ 
3. American Academy of Pediatrics. (n.d.). Chickenpox: Care and prevention. Retrieved from https://www.aap.org/ 
4. Ayoade F, Kumar S. (2022). Varicella-zoster virus (Chickenpox). In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448191/