NCLEX Review Guide: Pediatric Infectious Diseases - Varicella (Chickenpox)

Varicella-Zoster Virus (VZV)

• Varicella is a highly contagious viral infection caused by the varicella-zoster virus, primarily affecting children under 12 years old. The virus remains dormant in nerve ganglia after initial infection and can reactivate later as herpes zoster (shingles).
• Transmission occurs through respiratory droplets and direct contact with vesicular fluid, making isolation precautions essential for hospitalized patients.
• Incubation period ranges from 10-21 days, with patients being contagious 1-2 days before rash appears until all lesions are crusted over.

Characteristic Rash Progression

• Classic "dewdrop on rose petal" appearance describes the clear vesicles on erythematous base that characterize varicella lesions.
• Rash progression follows specific stages: macules → papules → vesicles → pustules → crusts, with all stages present simultaneously.
• Distribution is centripetal, beginning on trunk and face, then spreading to extremities with higher concentration on covered areas.

Associated Symptoms

• Prodromal symptoms include low-grade fever (100-102°F), malaise, anorexia, and mild headache occurring 24-48 hours before rash.
• Intense pruritus (itching) increases risk of secondary bacterial infection from scratching, requiring vigilant skin care and nail trimming.

Isolation Precautions

1. Implement airborne and contact precautions immediately upon admission
2. Place patient in negative pressure room if available
3. Ensure all staff wear N95 respirators and gloves when entering room
4. Maintain isolation until all lesions are crusted and dry (typically 5-7 days)

Symptom Management

• Calamine lotion and cool compresses provide topical relief for pruritus while maintaining skin integrity and preventing secondary infection.
• Oral antihistamines (diphenhydramine) may be prescribed for severe itching, but avoid topical antihistamines due to sensitization risk.
• Never give aspirin to children with varicella due to Reye's syndrome risk - use acetaminophen for fever management instead.

Potential Complications

• Secondary bacterial skin infections are most common complication, particularly with group A streptococcus or staphylococcus aureus.
• Rare but serious complications include pneumonia, encephalitis, and cerebellar ataxia, requiring immediate medical intervention.
• Hemorrhagic varicella may occur in immunocompromised patients, presenting with blood-filled vesicles and increased morbidity risk.

High-Risk Populations

• Immunocompromised children, pregnant women, and neonates require special consideration and may need antiviral therapy (acyclovir).
• Varicella-zoster immune globulin (VZIG) should be given within 96 hours of exposure to high-risk individuals who lack immunity.

NCLEX Success Strategies

• Remember the "dewdrop on rose petal" description - this classic phrase frequently appears in NCLEX questions about varicella identification.
• Focus on isolation timing: contagious period extends from 1-2 days before rash until ALL lesions are crusted, not just when fever resolves.
• Prioritize safety: airborne/contact precautions are always the first nursing action when varicella is suspected.

• ☐ I can describe the characteristic appearance and progression of varicella rash
• ☐ I understand isolation precautions and duration for varicella patients
• ☐ I know contraindications for aspirin use in viral infections
• ☐ I can identify high-risk populations requiring special management
• ☐ I understand when patients are no longer contagious