Nursing management of childhood chickenpox infection.

Chickenpox is an extremely contagious infectious disease caused by varicella zoster virus (VZV). It is a common childhood illness characterised by an itchy vesicular rash and fever, which usually resolves spontaneously without medical intervention. Serious, and rarely fatal, complications can occur, including pneumonia, central nervous system infection, overwhelming secondary bacterial infections, especially with Group A streptococcus, and necrotising fasciitis. Therefore it is crucial that emergency department (ED) nurses can recognise the signs and symptoms that indicate deterioration. This article reviews best practice management of children with chickenpox, gives up-to-date guidance on the safe use of antipyretics, the avoidance of ibuprofen and discusses immunisation against VZV. It also includes implications for nursing practice and a case study that illustrates some of the challenges that ED nurses may encounter.

Varicella encephalitis.

Varicella or chickenpox is a common, generally benign contagious disease caused by the varicella-zoster virus. The high degree of communicability of chickenpox during early childhood (generally 2-8 years of age) can be appreciated by the presence of protective antibodies in 85-90% of children. Although considered to be a mild disease, reported cases of severe and life-threatening complications such as encephalitis have been reported. Treatment involves the use of antiviral agents such as acyclovir. The role of the nurse in the care of the child with varicella encephalitis is to assist a family toward a sense of structure and feeling of helping through prearranged teaching times, structured communication and promoting family involvement in every facet of the child's recovery.

Varicella exposure in a child at risk of being immunosuppressed.

The child with asthma and other atopic symptoms presents many management problems to the pediatric nurse practitioner (PNP) responsible for his or her care. When such a child has an exacerbation of asthma while concomitantly being at risk for contracting varicella after having received parenteral corticosteroids, the consequences can be devastating. The many decisions the PNP must make include modifications to current medications to keep the primary illnesses under control while considering prophylactic and other therapeutic measures to make certain that the threats to the health of the child and the family from varicella are minimized. A case example is used to illustrate the decision-making process in such a situation. Guidelines are drawn from the recent literature, including the recent guidelines on asthma management from the National Heart, Lung and Blood Institute/National Asthma Education and Prevention Program.

Chickenpox.

Although often dismissed as a minor childhood illness, chickenpox is potentially very serious if contracted by certain vulnerable adults, pregnant women or neonates. This Update examines the course of the illness and implications for nurses.