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Chicken Pox and Scarlet Fever template

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Description of Chicken Pox (Varicella)A highly contagious viral illness characterized by the development of pruritic vesicles and papules on the skin, scalp, and less commonly, on mucous membranes
Risk Factors for Chicken PoxIncubation period is about 2 weeks No prior hx of varicella, no vaccination Immunocompromised pts
Assessment Findings in Chicken PoxProdrome Phase: Fever, Malaise, Anorexia, Abdominal Pain, Headache Rash Phase: Crops of lesions begin on trunk, become vesicles, then scabs in 6-10 hours; Successive crops appear over the next several days; Lesions may be found on any mucosal membrane: mouth, larynx, vagina
Prevention of Chicken PoxVaccination: 12m to 12y - given as single vaccination 13y and up - given as 2 vaccinations 4-8 wks apart Most contagious period is 2 days prior to appearance of rash and up to crusting of ALL lesions Passive immunization with VZIG with 4 days of exposure for immunocompromised pts If unable to administer VZIG within timeframe, consider acyclovir to decrease duration and time of viral shedding
Nonpharmacologic Management of Chicken PoxSupportive Therapy Good hygiene to prevent bacterial secondary infxn Cut fingernails short in young children to decrease incidence of bacterial infxns from scratching Tepid baths for tiching
Pharmacologic Management of Chicken PoxAntipruritics Antipyretics - DO NOT give Aspirin due to increased risk of Reye's syndrome with varicella pts
Pregnancy Considerations in Chicken PoxDo not vaccinate pregnant women In pregnant women who have never had chickenpox or immunizations, avoid contact with recently vaccinated individuals for 6 weeks Fetal infxn following maternal infxn is 25% Increased incidence of pneumonia in women infected during pregnancy Congenital malformations seen in 5% of infants if mother was infected during first or second trimester
Expected Course of ChickenpoxComplete resolution in 2-3 weeks Lifelong immunity conferred after disease
Description of Scarlet FeverChildhood disease characterized by sore throat, fever, and a scarlet "sandpaper" rash
Risk Factors for Scarlet FeverAge 6-12 years Wound infection Burns
Assessment Findings in Scarlet FeverSore throat Headache Fever and chills Vomiting Erythematous tonsils usually covered with an exudate; pharynx may have exudate as well Petechiae on palate White coating on tongue which sheds by day 2 or 3 and leaves a "strawberry" tongue with shiny red papillae Fine sandpaper rash begins on chest and axillae, then appears on abdomen and extremities; blanchable Pastia's lines present (transverse red streaks in skin folds of antecubital space, abdomen, and axillae Desquamation from face which procededs over trunk and finally to hands and feet
Diagnostic Studies for Scarlet FeverThroat Culture Rapid Strep Antistreptolysin O confirms infection but not helpful for diagnosis
Prevention of Scarlet FeverAvoid contact with resp secretions of infected person Prophylactic PCN NOT recommended afte exposure to scarlet fever Antibiotic started within 10 days after onset effective in preventing Rheumatic Fever Antibiotic does not completely eliminate possibility of glomerulonephritis
Nonpharmacologic Management of Scarlet FeverSupportive Care Maintain hydration status
Pharmacologic Management of Scarlet FeverAntipyretics for fever PCN is drug of choice Cephalosporins are acceptable choice Erythromycin or advanced macrolides for PCN allergic pt
Expected Course for Scarlet FeverExcellent prgnosis after appropriate treatment

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