NSG 6435 Final Exam Study guide.[ 2022]
Know normal and abnormal findings; know expected risks, complications, signs/symptoms; physical
exam findings; how to diagnose, treat, manage, educate patients/guardians, patho, and pharm for the
following:
Varicella
Expected risks:
Never had the vaccine, never exposed to Varicella. More severe in adolescents and adults
than younger children.
Those at risk include (MayoClinic 2019):
• Newborns of unvaccinated mothers or mother who never had chickenpox
• Adolescents and adults
• Pregnant women who haven’t had chickenpox or the vaccine
• Smokers
• Immunocompromised (chemo, HIV, ect.)
• Long term steroid use (as seen with asthma or COPD)
Complications:
Severe – cerebellar ataxia, encephalitis, viral pneumonia, hemorrhagic conditions (CDC,
2016). Secondary bacterial infections, pneumonia, encephalitis, hepatitis, and Reye syndrome
(Hay, Levin, Deterding, Abzug, & Sondheimer, 2014, p.271)
Other – septicemia, toxic shock syndrome, necrotizing fasciitis, osteomyelitis, bacterial
pneumonia, septic arthritis (CDC, 2016)
Physical findings (Signs/Symptoms):
Fever, loss of appetite, h/a, malaise (MayoClinic, 2019). Classic triad of low grade fever,
malaise, and rash (Papadopoulos, 2018).
“Dew drops on a rose petal”; Rash – classic appearance, starts on scalp, face, or trunk
Rash has 3 phases (MayoClinic, 2019):
1) raised pink bumps (papules), which break out over several days;
2) small fluid-filled blisters (vesicles), which form in about one day and then break and
leak;
3) Crusts and scabs, which cover the broken blisters and take several more days to heal.
,NSG 6435 Final Exam Study guide.[ 2022]
How to Diagnosis; Treatment; Management; Pharma
Diagnosis is based on S/S and presentation. Bloodwork and cultures of lesions can be done to
confirm chickenpox (MayoClinic, 2019).
In younger children, symptomatic treatment only (Tylenol/Ibuprofen for fever, etc)
(Papadopoulos, 2018).
Adolescents and adults, at increased risk, need a more aggressive treatment that can include
PO or IV Acyclovir. Varicella-zoster immunoglobulin can be use in highly susceptible
individuals (Papadopoulas, 2018).
Management includes (Cleveland Clinic, 2018):
• Cool, moist rag to rash
• Keep temperature down
• Try to prevent child from scratching (cut fingernails)
• Use lotion with an antihistamine on the rash and/or give OTC antihistamines
• Give cool bath or shower daily (can also give an oatmeal bath).
Education
Child can return to school 7 days after rash appears, does not have to wait until scabs are
healed (Cleveland Clinic, 2018).
Chickenpox is contagious for about 2 days before a rash appears and is contagious until the
vesicles have crusted over (roughly 1 week) (Nemours, 2019).
Keep child away from those at risk (newborns, pregnant women, elderly,
immunocompromised).
, NSG 6435 Final Exam Study guide.[ 2022]
Anyone who has had chickenpox has the potential to have shingles later in life (Nemours,
2019).
Someone with shingles can spread chickenpox but not shingles to those that have never had
chickenpox or the vaccine (Nemours, 2019).
Patho
Acquired by inhaling airborne droplets from an infected host and infects the conjunctivae and
mucosa of upper respiratory tract (Papadopoulos, 2018).
Humans are only known vector for chickenpox.
Viral proliferation in lymph node 2-4 post initial infection followed by primary viremia 4-6
post infection (Papadopoulos, 2018).
Measles
Expected risks:
Has a 90% secondary infection rate (Chen, 2019). Can affect people of all ages, although
primarily thought of as a childhood illness (Chen, 2019).
Complications:
Rash can become hemorrhagic and can be fatal due to disseminated intravascular coagulation
(DIC) (Hay et al., 2014, p. 515).
Bacterial superinfection and viral complications can manifest as a URI, obstructive laryngitis,
otitis, diarrhea, mastoiditis, cervical adenitis, bronchitis, transient hepatitis, and pneumonia
(Hay et al., 2014, p. 515).
Know normal and abnormal findings; know expected risks, complications, signs/symptoms; physical
exam findings; how to diagnose, treat, manage, educate patients/guardians, patho, and pharm for the
following:
Varicella
Expected risks:
Never had the vaccine, never exposed to Varicella. More severe in adolescents and adults
than younger children.
Those at risk include (MayoClinic 2019):
• Newborns of unvaccinated mothers or mother who never had chickenpox
• Adolescents and adults
• Pregnant women who haven’t had chickenpox or the vaccine
• Smokers
• Immunocompromised (chemo, HIV, ect.)
• Long term steroid use (as seen with asthma or COPD)
Complications:
Severe – cerebellar ataxia, encephalitis, viral pneumonia, hemorrhagic conditions (CDC,
2016). Secondary bacterial infections, pneumonia, encephalitis, hepatitis, and Reye syndrome
(Hay, Levin, Deterding, Abzug, & Sondheimer, 2014, p.271)
Other – septicemia, toxic shock syndrome, necrotizing fasciitis, osteomyelitis, bacterial
pneumonia, septic arthritis (CDC, 2016)
Physical findings (Signs/Symptoms):
Fever, loss of appetite, h/a, malaise (MayoClinic, 2019). Classic triad of low grade fever,
malaise, and rash (Papadopoulos, 2018).
“Dew drops on a rose petal”; Rash – classic appearance, starts on scalp, face, or trunk
Rash has 3 phases (MayoClinic, 2019):
1) raised pink bumps (papules), which break out over several days;
2) small fluid-filled blisters (vesicles), which form in about one day and then break and
leak;
3) Crusts and scabs, which cover the broken blisters and take several more days to heal.
,NSG 6435 Final Exam Study guide.[ 2022]
How to Diagnosis; Treatment; Management; Pharma
Diagnosis is based on S/S and presentation. Bloodwork and cultures of lesions can be done to
confirm chickenpox (MayoClinic, 2019).
In younger children, symptomatic treatment only (Tylenol/Ibuprofen for fever, etc)
(Papadopoulos, 2018).
Adolescents and adults, at increased risk, need a more aggressive treatment that can include
PO or IV Acyclovir. Varicella-zoster immunoglobulin can be use in highly susceptible
individuals (Papadopoulas, 2018).
Management includes (Cleveland Clinic, 2018):
• Cool, moist rag to rash
• Keep temperature down
• Try to prevent child from scratching (cut fingernails)
• Use lotion with an antihistamine on the rash and/or give OTC antihistamines
• Give cool bath or shower daily (can also give an oatmeal bath).
Education
Child can return to school 7 days after rash appears, does not have to wait until scabs are
healed (Cleveland Clinic, 2018).
Chickenpox is contagious for about 2 days before a rash appears and is contagious until the
vesicles have crusted over (roughly 1 week) (Nemours, 2019).
Keep child away from those at risk (newborns, pregnant women, elderly,
immunocompromised).
, NSG 6435 Final Exam Study guide.[ 2022]
Anyone who has had chickenpox has the potential to have shingles later in life (Nemours,
2019).
Someone with shingles can spread chickenpox but not shingles to those that have never had
chickenpox or the vaccine (Nemours, 2019).
Patho
Acquired by inhaling airborne droplets from an infected host and infects the conjunctivae and
mucosa of upper respiratory tract (Papadopoulos, 2018).
Humans are only known vector for chickenpox.
Viral proliferation in lymph node 2-4 post initial infection followed by primary viremia 4-6
post infection (Papadopoulos, 2018).
Measles
Expected risks:
Has a 90% secondary infection rate (Chen, 2019). Can affect people of all ages, although
primarily thought of as a childhood illness (Chen, 2019).
Complications:
Rash can become hemorrhagic and can be fatal due to disseminated intravascular coagulation
(DIC) (Hay et al., 2014, p. 515).
Bacterial superinfection and viral complications can manifest as a URI, obstructive laryngitis,
otitis, diarrhea, mastoiditis, cervical adenitis, bronchitis, transient hepatitis, and pneumonia
(Hay et al., 2014, p. 515).
