Summary NSG 6435 FINAL EXAM STUDY GUIDE SUMMER 2022 UPDATE GRADE A+ SOLVED

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. 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). 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).