NCLEX Review Guide: Chickenpox (Varicella)

Varicella-Zoster Virus (VZV)

• Varicella (chickenpox) is caused by the varicella-zoster virus, a highly contagious herpes virus that remains dormant in nerve ganglia after initial infection.
• Transmission occurs through respiratory droplets and direct contact with vesicular fluid from skin lesions.
• Incubation period is typically 10-21 days, with patients most contagious 1-2 days before rash appears until all lesions are crusted over.

Disease Progression

• Prodromal phase: Low-grade fever, malaise, anorexia, and headache occur 24-48 hours before rash appears.
• Rash characteristics: Begins as small red macules that progress to papules, then fluid-filled vesicles, and finally crusted lesions.
• Lesions appear in successive crops over 3-4 days, with different stages present simultaneously on the body.
• Distribution typically starts on trunk and spreads to face and extremities, with intense pruritus being a hallmark symptom.

Isolation & Comfort Measures

1. Implement airborne and contact precautions immediately upon admission
2. Place patient in negative pressure room if hospitalized
3. Maintain isolation until all lesions are crusted and dry (typically 5-7 days)
4. Provide comfort measures for pruritus management

• Pruritus management: Cool compresses, calamine lotion, oatmeal baths, and antihistamines help reduce itching and prevent secondary bacterial infection.
• Avoid aspirin due to risk of Reye's syndrome; use acetaminophen for fever and discomfort.
• Keep fingernails short and clean to prevent scratching and secondary infection of lesions.
• Encourage adequate fluid intake and monitor for signs of dehydration, especially in young children.

Potential Complications

• Secondary bacterial infections are most common complications, particularly Group A Streptococcus and Staphylococcus aureus affecting skin lesions.
• Serious complications include pneumonia, encephalitis, cerebellar ataxia, and thrombocytopenia, though these are rare in healthy children.
• High-risk populations: Immunocompromised patients, pregnant women, newborns, and adults experience more severe disease and complications.

Vaccination & Prevention

• Varicella vaccine is given as 2-dose series: first dose at 12-15 months, second dose at 4-6 years of age.
• Vaccine is contraindicated in immunocompromised individuals, pregnant women, and those with severe illness.
• Post-exposure prophylaxis with varicella-zoster immune globulin (VZIG) may be indicated for high-risk contacts within 96 hours of exposure.

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