HOLY FAMILY COLLEGE OF NURSING

EVALUATION PERFORMA FOR SEMINAR/PRESENTATION

Name-
S.NO. CRITERIA ALLOTED MARKS OBTAINED MARKS
1. Lesson plan (organization and adequacy of content, 20
submission, planning)
2. Preparation of class 5
3. Introduction 5
4. Subject matter and depth of knowledge 5
5. A.V aids 30
6. Confidence 10
7. Language and voice 10
8. Grooming 5
9. Summary & conclusion 5
10. Punctuality 5

Total 100

Remarks:

Signature of the Supervisor:

 .

JUNIOR GROUP TEACHING

ON
COMMUNICABLE DISEASES
(Typhoid fever, Tuberculosis, Chickenpox)

.
IDENTIFICATION DATA

NAME :

CLASS :

SUBJECT : CHILD HEALTH NURSING

TOPIC : COMMUNICALE DISEASES(Typhoid fever, Tuberculosis, Chickenpox)

DATE OF PRESENTATION :

PLACE : CLASSROOM

TIME : 1 HR

METHOD OF TEACHING : LECTURE CUM DISCUSSION, DEMONTRATION

SUPERVISOR

AV AIDS : CHARTS, FLASH CARDS

GROUP :
PREVIOUS KNOWLWDGE OF THE STUDENTS:
Students may have some knowledge about the different communicable diseases.

GENERAL OBJECTIVES:

Group point of view:

At the end of the teaching session the group will be able to

 Gain knowledge about the topic .
 Able to assess the conditions in the clinical area.

Student teacher point of view:

 Teach the group effectively.

 Realize the cognitive functions.
 Develop and improve professional efficiency.

SPECIFIC OBJECTIVES:

- Introduce the topic ‘Communicable disease’.

Typhoid fever
- Define typhoid fever
- Enlist the clinical manifestations.
- Enlist the complications.
- List the diagnostic evaluations.
- Explain the medical, surgical and nursing management.
Tuberculosis
- Define tuberculosis
 - Explain the pathophysiology of tuberculosis
- List the clinical features
- List the diagnostic evaluations.
- Explain the management of tuberculosis.
- Explain the nursing management.
Chickenpox
- Define chickenpox
- Explain the pathology of chickenpox
- Enlist the clinical manifestations.
- Enumerate the complications.
- Enlist the diagnosis of chickenpox.
- Explain the management of chickenpox.
- Explain the preventive measures for chickenpox.
Time Specific Content Teaching – Learning Evaluation
Objective Activity
1min To introduce the INTRODUCTION:
topic.
Communicable disease
are also known as
infectious disease. They
spread from one person
to another person may
catch it from a patient. A
disease is said to be non
communicable if it does
not spread from one
person to another.
Communicable disease
are caused by
pathogenic micro-
organisms which spread
through air, water, food
and contact.
In the chapter of communicable diseases the following diseases
are going to be taken up:

1. Typhoid fever
2. Tuberculosis
3. Chicken pox

Time Specific Content Teaching – Learning Evaluation

Objective Activity
 Typhoid fever

2min Define typhoid Definition: Student teacher defines What is typhoid fever?
fever.  Typhoid fever is an acute bacterial systemic infection caused typhoid fever.
by Salmonella typhi. The illness is characterized by prolonged
typical continuous fever for 3 to 4 weeks with cross station,
relative bradycardia and involvement of spleen and lymph
nodes.

The term enteric fever indicates both Typhoid and paratyphoid

fever. This condition may found as epidemics and endemics.
India, Typhoid fever occurs in endemics. It is found all over
the world where water supplies and sanitation are sub-standard.
The disease is uncommon in developed countries.

Epidemiology

The causative agent of typhoid fever is Typhi 90%.

S typhi has three main antigens O, H, Vi. It can readily kill by
drying pasteurization and common disinfectants.

Man is the only reservoir of infection in the form of cases and

carriers. This case maybe mild, mist or severe. A case for
carrier is infectious as long as bacilli are found in stools and
urine.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
 Carrier state is more common in under five children. Primary
sources of infection are stool and urine.

Secondary sources of infection are contaminated water, food,

fingers or hands and flies. 

Mode of transmission- It is mainly the feco-oral route or urine

oral routes. Infection takes place directly through soiled hands
contaminated with stool or urine of infected patients or carriers.
indirect transmission occurs by the ingestion of contaminated
water, food, milk or through flies.  

Incubation period is usually 10 to 14 days with a range of 3

days to 3 weeks depending upon the dose of bacilli ingested. It
is shortest in food borne and longest in waterborne.

 The incidence of typhoid fever is highest in 5 to 19 years of

age group. More cases are found among males but carriers are
more in females. The disease is found throughout the year but
more in summer and rainy season with increased number of
flies.

Pollution of drinking water supply, open field defecation and

urination, food hygiene and personal hygiene health ignorance,
literacy and poor socio-economic conditions are important
contributing factors.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
5min Enlist the Clinical Manifestations Student teacher enlists What are the clinical
clinical the clinical manifestations of
manifestations. The clinical presentations of typhoid fever in children main manifestation of typhoid typhoid fever?
found suddenly, through classically the onset of the disease is fever.
gradual.

The child usually present with a rapid rise of temperature,

extreme malaise, loss of appetite, headache vomiting, coated
tongue abdominal pain and distention. 
 
When it is severe the child may have a party cloudiness of
consciousness and delirium and diarrhoea is usually found than
constipation.

Abdomen feels heavy, spleen is palpable 1 or 2 cm below costal

margin and liver may be also palpable.

 Typhoid rash as muscular red rose spots appear on about 6th

day of illness. Rash may be visible on the trunk or may not be
visible on pigmented skin specially in Indian children.

Sometimes the child may present with clinical features of

bacillary dysentery, respiratory infection or meningitis along
with Typhoid fever.

 Neonatal typhoid may occur from vertical transmission.

Neonates usually present with vomiting, abdominal distension,
diarrhoea and fever with variable intensity about 72 hours after

Time Specific Content Teaching – Learning Evaluation

Objective Activity
 birth. Other features include convulsions jaundice, loss of
appetite, weight loss and enlargement of liver.

Enlist down the  Complications Student teacher enlists What are the
2min complications the complications of complications of
s of typhoid fever  a. Abdominal - intestinal perforation, GI bleeding, hepatitis, typhoid fever. typhoid fever?
cholecystitis, peritonitis, gastroenteritis, urinary tract infection liver
abscess, fatty liver, pancreatitis.

b.  Neurological- encephalopathy, meningitis, hemiplegia,

transfers meningitis, GB Syndrome, cranial nerve involvement,
psychiatric problems like depression.

c. Haematological- haemolytic anaemia, bone marrow

depression

d. Cardiovascular- toxic myocarditis, pericarditis, endocarditis,

venous thrombosis
e.  Respiratory- pneumonia, bronchitis, empyema,pulmonary
infarction.
 
f.  Others- parotitis bed source, otitis media, tonsillitis, alopecia
chronic osteomyelitis, supportive arthritis and superficial
abscess.  

Time Specific Content Teaching – Learning Evaluation

Objective Activity
2min Enlist the Diagnosis  Student teacher enlists What are the diagnostic
s diagnostic tests   the diagnostic tests tests for typhoid fever?
for typhoid Clinical manifestations are useful for diagnosis of typhoid typhoid fever.
fever. fever. the investigations to support the diagnosis:
- Routine blood examination shows normal or low WBC
count.   Eosinophils maybe low are completely absent.

- Blood culture in first week of illness shows S typhi in

about 75% of patients. Widal test is positive, 60% in 2nd
week and 80% in 3rd week.

- Bone marrow culture is highly sensitive 90% for diagnosis

of typhoid fever.

- Stool and urine cultures may show Typhi after 2 weeks of

illness and in suspected chronic carriers.  

- Rapid diagnostic procedures like counter immune-

electrophoresis, ELISA test are simplest modern specific
diagnostic measures.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
5min Explain the Management Student teacher explains list down the
s medical,   about the medical, management for
surgical and Medical Management surgical and nursing typhoid fever.
nursing management for typhoid
management for - Specific antimicrobial therapy for the treatment of typhoid fever
typhoid fever. fever in children is chloramphenicol 50 200 mg per kg per
day in 4 divided doses for 10 to 14 days.
 
- Other Drugs which can be used are ampicillin, amoxicillin,
cotrimoxazole etc.
The drug therapy with chloramphenicol is associated with high
relapse rate, drug resistance, bone marrow toxicity, high rate of
chronic carrier etc.

- The newer cephalosporins including

ceftriaxone, cefoperazone other drug of choice (50-100
mg/kg/ day) in single or two divided doses IV for 5 to 10
days.

- Corticosteroid is given to the children with severe toxic

state, prolonged illness, altered mental function and shock.
Dexamethasone 3 mg/kg first dose followed by 1 mg/ kg 6
early for another 8 dose is administered.

- Symptomatic management with antipyretics, hydrotherapy and

maintenance of fluid and electrolyte balance by IV fluid therapy
is essential.

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Objective Activity
 - Blood transfusion may be needed in intestinal perforation
or haemorrhage.

- Nutritious diet to be provided.

 
- Early detection of complication and prompt management
promote better prognosis.

Surgical Management 
Surgical Management may be with required in intestinal
perforation and gallbladder infection in chronic carriers.

Nursing management 
-Supporting nursing care is important for better prognosis.

-Bed rest, skin care, good for dental hygiene and frequent
mouth care with antiseptic mouthwash, adequate fluid intake
for IV fluid therapy, administration of prescribed medicine
tepid sponge to treat fever and continuous monitoring of
patients conditions are important aspects of nursing measures.

 -Isolation of patient and care of bladder and bowel are

essential.
 
-Prevention of consumption or care during diarrhoea,
prevention of urinary retention observation for frank for occult
blood in stool and careful disposal of stool and urine are
important.
Time Specific Content Teaching – Learning Evaluation
Objective Activity
 -Diet should be planned with adequate calories protein, iron and
vitamins by liquid or semi -solid food.

 -Assessment and recording of vital signs and drug effects of

any features of complication should be emphasised.

-Parental involvement in child care and necessary instructions

to parents for continuing care at hospital and home are essential.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
1min Define Tuberculosis
tuberculosis.
Definition:
Tuberculosis is a chronic infectious disease caused by Student teacher defines What is tuberculosis?
Mycobacterium tuberculosis. Children are susceptible to both tuberculosis.
human(Mycobacterium tuberculosis) and bovine
(Mycobacterium bovis) organisms.

Epidemiology

a. Agent
All cases of pulmonary tuberculosis are caused by
human type Mycobacterium tuberculosis.
Few cases of extra pulmonary illness may be due to
bovine type.

b. Reservoir of infection
Infection spreads by TB patient, who discharges
tubercle bacilli in his sputum or nasopharyngeal
secretions, during bouts of coughing or sneezing etc.

c. Mode of infection
The usual mode of infection is inhalation of droplet of
infected secretions.
Infection through ingestion is infected material is rare.
Rarely infection spreads through skin, mucous
membrane or transplacental.

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Objective Activity
 d. Host factors
Age: No age is exempted from tuberculosis. Congenital
tuberculosis is rare. Frequency of infections with
tubercle bacilli increases as the child grows in age.

Sex: the adolescent children especially girls are more

prone to tuberculosis during puberty.

Malnutrition: Undernourished children are most

susceptible to develop tuberculosis
due to depressed immunological defences.

Intercurrent infections: A tuberculosis infection may

flare up after attack of measles
or whooping cough.

e. Environment:

- There is a little difference in the prevalence of disease in

rural or urban communities.
- Children living in overcrowded apartments/ houses with
inadequate ventilation or very little sunshine are at a higher
risk.
- Damp insanitary and unhygienic conditions are also
important predisposing factors.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
7mins Explain the Pathophysiology Student teacher explains What is the
pathophysiolog about the pathophysiol-
y of Tuberculosis bacillus present in the lungs of the infected person pathophysiology of gy of tuberculosis?
tuberculosis tuberculosis.
The bacilli is expelled out a microdroplets during coughing and
sneezing

These droplets are inhaled by the other persons

Inhaled tubercle bacilli gets lodged in the pulmonary alveoli

Cause inflammation with hyperaemia and congestion in lungs.

Initially, Polymorphonuclear leucocytes infiltrate the site of

lesion

Later on, other cells such as macrophages and histocytes

appears in the area of inflammation

Phagocytosis begins

Pulmonary alveoli gets filled with exudates comprising of fibrin

leucocytes, phagocytes and tubercle bacilli.

The central part of inflamed area is necrosed and looks like

cheesy or caseous material

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Objective Activity
 The inflamed area at a point of entry tubercle bacilli is the
primary focus or Ghon’s foci. The lymph node, draining the
primary focus is inflamed and enlarged after few months of
primary infection.

Bacilli may enter the lymphatics and the blood stream and are
carried to different parts of the body.

1.If resistance of the child lowers:

- Child develops infections infection of the lymph gland.
- Hematogenous spread may occur.
- Erosion of blood vessels by primary lesion can cause
widespread of tubercle bacilli leading to military TB,
Tuberculosis meningitis, Tubercular coxitis. Tuberculosis
dactylitis(fingers and bone), Tuberculosis spondylitis or Pott’s
disease.

2.If the child resistance is good

- Healing of primary lesion
- Calcification may occur

Later on when immunity is lowered this latent lesion again

becomes active.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
5min List down the Clinical features: Student teacher enlists What can be the
clinical feature down the clinical feature clinical manifestation
of tuberculosis. Incubation Period: It varies between 4 to 12 weeks. of tuberculosis. of tuberculosis?
Onset: it is insidious but may be sudden, in case of tubercular
meningitis or milliary tuberculosis.

Early symptoms:

- Fever
- Malaise
- Weight loss
- Cough
- Aching pain and tightness of chest
- Night sweats mainly on forehead
- Child looks pale, peevish, dull and fretful
- Anorexia
- Haemoptysis(rare)

Late symptoms:

- Respiratory rate changes

- Poor expansion of lung on affected side
- Diminished breath sounds and crackles
- Dullness in percussion
- Fever persists
- Pallor, anaemia, weakness and weight loss.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
5min List down the Diagnostic Evaluation: Student teacher lists What diagnostic tests
diagnostic down the diagnostic are followed for
evaluation of 1. History of contact: evaluation for tuberculosis?
tuberculosis There may be a history of infected case in neighbourhood. Such tuberculosis
history is available less than 1/3rd of patients.

2. Mantoux Test

0.1ml of suitable dilution of tuberculin protein purified

derivative (PPD)

Given intradermally on anterior aspect of forearm (standard

dose is 5 IU)
A wheel of 5 mm should be raised

Results are read after 48-72 hours

Results:

An induration of 5mm or more is interpreted as positive in

individuals with closed recent contact with infectious cases.

Induration of more than 10mm is positive in high risk groups

like those with high environmental risk of exposure, associated
medical diseases like lymphoma, malnutrition, renal failure,
diabetes mellitus and children <3 years of age.

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Objective Activity
 An induration of more than 15mm may point to tuberculosis,
infection.

3. Chest X-ray

It may show primary focus and pulmonary lesion.

4. BCG test.

An induration of more than 5-6mm after 3 days of BCG

vaccine is considered a positive reaction.

5. Lab Investigations.

- ESR is elevated during acute phase of disease.

- Demonstration of Acid-Fast Bacilli in sputum or

laryngeal swab culture for mycobacterium.

- Histopathology:
Gland, liver and other tissues may be examined for
histological evidence of TB by FNAC.

- Rapid diagnostic modalities: this includes ELISA to

detect mycobacterium antigen and IgG, IgM and IgA
antibodies, BACTEC for specific identification of
mycobacterium tuberculosis (<5 days) and PCR to
identify and detect bacilli in sputum, CSF tissue biopsy
and gastric aspirate.
Time Specific Content Teaching – Learning Evaluation
Objective Activity
5min Explain the Management: Student teacher explain What is the
management of the management of management for
tuberculosis The principles of treatment are: tuberculosis tuberculosis?

1.Early diagnosis
2.Prompt, adequate vigorous and prolonged treatment.
3.More than one anti- tubercular drug should be used for
prevention of development resistance in tubercle bacilli to
drugs.
4.nutritionally balanced diet to improve the child’s health.
5. Prevention and treatment of intercurrent infections.
6.Living conditions should be improved by better sanitation and
hygienic measures.

Drugs

a. Anti-tuberculosis therapy (ATT)

The anti-tubercular drugs are divided into 3 major
categories:

1. First line drugs: majority of patients can be

successfully treated with these drugs. They are effective
with minimum toxicity and include:
- Isoniazid (INH)
- Rifampicin (R)
- Ethambutol (H)
- Streptomycin (SM)
- Pyrazinamide (Z)

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Objective Activity
 2.Second line drugs: these are used in multi drug
resistant cases or in cases where first line drugs can not
be used . these include :
- Cycloserine
- Ethionamide
- PAS
- Capreomycin
- Kanamycin

.Other drugs
These are reserved for drugs resistant cases. These
include:
- Rifamycin
- Amikacin
- Ampicillin
- Imipenem

Anti-Tuberculosis Regimen

Newly diagnosed patients of pulmonary TB and extra

pulmonary TB are treated with short term chemotherapy
regimen. It has two phases:

a. Intensive phase : The goal of this phase is to

eliminate bacterial load and prevent emergence of
drug resistant strains. At least three bactericidal
drugs are used in this phase.
INH-R-SM or
INH-H-R
Time Specific Content Teaching – Learning Evaluation
Objective Activity
 b. Continuation phase: Two bactericidal drugs are
used to continue and complete the therapy.

i. In tuberculin positive patients INH and

Rifampicin are given for nine months in
either daily or weekly schedule.

ii. In non progressive pulmonary TB, Pleural

effusion and cervical adenitis
6 months regimen ------ INH + R+PZA x 2
months
H and R daily x 4 months

9 months regimen ---H and R daily x 9 months

or
H and R daily x 1month
Followed by H and R twice weekly x 8 months.

iii. Progressive pulmonary tuberculosis, skeletal,

disseminated, meningeal and miliary TB.
H+R+Z+SM x 2months followed by
H+R daily x 10 months.

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Objective Activity
 B. Steroids

It is useful to add corticosteroids for their anti-inflammatory

effect during first week of ATT in case of Tubercular
meningitis, pericarditis or Peritonitis (prednisolone 1-2
mg/kg/day).

Prevention:
1. Isoniazid Prophylaxis: For all children having
household contacts, who are less than 5 years of age,
should be given 5-10mg/kg Isoniazed as prophylaxis.
2. Tracing the source of infection: Efforts should be made
to trace the source of infection in family and extra
familial contacts of every child with TB.
3. Health education : The community should be educated
about mode of infection of TB, early sign and
symptoms, prevention and treatment.
- Hygienic living with good environmental sanitation
should be propagated .
- Living apartments should be well ventilated ; dampness
should be avoided with provision of sunlight entering
the house.
4. BCG vaccination: (Bacillus Calmette Guerin) BCG
vaccination is extremely useful in reducing the
incidence of TB.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
5min list down the Nursing Management Student teacher lists What is the nursing
nursing down the nursing management for
management for i. Children and adolescents with infectious management of tuberculosis?
tuberculosis. pulmonary TB should be isolated, until effective tuberculosis.
chemotherapy is started.
ii. Proper nutritious diet: high protein, calcium and
vitamin C diet should be given to children.
iii. Adequate rest must be provided to the child.
iv. Avoidance of infection
v. Regular immunization.
vi. Efforts should be made to trace the source of
infection.
vii. Periodic weighing and health assessment.
viii. Parents are explained the need of long and
regular use of drugs. They are told about the side
effects of the drugs.
ix. Proper coughing and sneezing technique by
covering the mouth and nose to prevent droplet
infection should be encouraged.
x. BCG vaccination should be carried out for all
children at birth or within 3months of age.

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Objective Activity
 Chickenpox (Varicella)

2min Define Definition: Student teacher defines What is the definition

s chickenpox. chickenpox. of chickenpox?
Chicken pox is an acute and highly communicable disease
caused by varicella-zoster (V-Z) virus. It is characterized by
sudden onset of low-grade fever, mild constitutional symptoms
and vesicular rash appearing on the first day of illness.

It is found as both epidemic and endemic form throughout the

world.

Epidemiology

The causative agent of chickenpox is virus V-Z, a DNA virus

and also called as “human alpha herpes virus- 3”.
The source of infection is usually a case of chickenpox.
Man is the only reservoir. The virus found in oropharyngeal
secretions, lesions of skin and mucosa.
The virus can also be found in the vesicular fluid during the
first 3 days of illness. The scabs are not ineffective.

The period of infectivity is mainly 1-2 days before 4-5 days

after the appearance of the rash.
The disease is a highly communicable and secondary attack rate
of chickenpox is very high.

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Time Specific Content Teaching – Learning Evaluation
Objective Activity
 Mode of transmission - is by droplet infection and by droplet
infection and by droplet nuclei. Majority patients are infected
by direct face to face personal contact.

Portal of entry is the respiratory tract. Infections usually do not

spread through fomites, because the virus is extremely liable.

The virus can transmit through placental barrier and can infect
the fetus. So infection during pregnancy presents risk for fetus
and neonates and may cause limb atrophy, skin scaring,
microcephaly, neurological and ocular anomalies.

Incubation period is usually 14 t0 16 days with a range from

7-12 days.

Pathology
2min Explain the Student teacher explains What is the pathology
pathology of Pathological changes are limited to skin and respiratory tract. about chickenpox. of chickenpox?
chickenpox The skin leisions found as macules which quickly develop into
papules and vesicles with scab and crust formation.

The vesicles are formed in prickle cell of skin. Degeneration of

cells in the vesicles result in multinucleated giant cells
containing intranuclear inclusions.

The inclusion bodies and foci of necrosis may be present in

oesophagus pancreas, liver, adrenal gland and genitourinary
tract.

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Objective Activity
 Varicella may cause disseminated intertitial pneumonia,
encephalitis, perivascular demyelination. The V-Z virus may
remain latent and may cause herpes-zooster in the later life. The
virus has a potential for oncogenicity.

5min Enlist the Clinical manifestations. Student teacher enlists What are the clinical
s clinical the clinical manifestations of
manifestations The clinical presentation of chickenpox may vary from a mild manifestation of chickenpox?
of chickenpox. illness with only a few scattered leisions to a severe febrile chickenpox.
illness with widespread skin leisions.

The clinical course of chickenpox can be divided into two

stages:

The pre-eruptive or prodromal phase :presents with the sudden

onset of mild to moderate fever, back pain, shivering and
malaise for a short period of (about 24 hours). This may be
overlooked in some cases.

The eruptive stage: it manifests with rash which can be the first
sign. It appears usually on the day, the fever starts. The
eruptions pass through the stages, i.e. macule, papule, vesicle,
pustule and crusts or scabs.

The distribution of rash is symmetrical and first appears on the

trunk and scalp; then on face, arms and legs. The rash begins as
multiple small red bumps (papules) that look like pimples or
insect bites.

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Objective Activity
 These lesions are small and have an erythematous
(erythematous macules) base with a diameter of 5–10 mm.

After another 12 to 24 hours the spots typically become itchy,

fluid- filled bumps called vesicles, which continue to appear in
crops for the next 2 to 5 days. The rash is very itchy, and cool
baths or calamine lotion may help to manage the itching.

After the chickenpox red spot appears, it usually takes about 1

or 2 days for the spot to go through all its stages. This includes:
blistering, bursting, drying and crusting over.
New red spots will appear every day for up to 5-7 days.
It usually takes about 10 days after the first symptoms before
all blisters have crusted over.
This is when the person with chickenpox can return to day care,
school, or work.

Some children have very few lesions, while others have as

many as 2000. Younger children tend to have fewer vesicles
than older individuals. Disease severity varies from person to
person, but older patients tend to have more severe diseases.
Secondary and tertiary cases within families are associated with
a relatively large number of vesicles.

In the immune-competent patient, chickenpox is usually a

benign illness associated with tiredness, weakness and with
body temperatures of 37.8°–39.4°C (100°–103°F) of 3–5 days’
duration.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
2min Enumerate the Complications Student teacher Enumerate the
s complications enumerates the complications of
of chickenpox. The most common extracutaneous site of involvement in complication of chickenpox?
children is the CNS. The syndrome of acute cerebellar ataxia chickenpox.
and meningeal inflammation generally appears ~21 days after
onset of the rash and rarely develops in the pre eruptive phase.
The cerebrospinal fluid (CSF) contains lymphocytes and
elevated levels of protein. CNS complications

CNS involvement is a benign complication of VZV infection in

children and generally does not require hospitalization. Aseptic
meningitis, encephalitis, transverse myelitis, and Guillain-Barré
syndrome can also occur.

Pneumonia due to VZV usually has its onset 3–5 days into the
illness and is associated with tachypnoea, cough, dyspnoea, and
fever.

Cyanosis, pleuritic chest pain, and haemoptysis are common.

Roentgenographic evidence of disease consists of nodular
infiltrates and interstitial pneumonitis. Resolution of
pneumonitis parallels improvement of the skin rash; however,
patients may have persistent fever and compromised pulmonary
function for weeks. Varicella pneumonia.

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Objective Activity
 Other complications of chickenpox include:
Myocarditis
Nephritis
Arthritis
acute glomerulonephritis
hepatitis. Hepatic involvement, is usually asymptomatic, is
common in chickenpox and is generally characterized by
elevated levels of liver enzymes.
5min Enlist the Diagnosis Student teacher enlists What is the diagnostic
diagnosis of the diagnosis of test for chickenpox?
chickenpox. The diagnosis of chickenpox is not difficult. The characteristic chickenpox.
rash and a history of recent exposure should lead to a prompt
diagnosis.

- Serology is the most common method of laboratory

diagnosis. The detection of VZV –specific IgM is
considered diagnostic of acute infection.
- Chickenpox also can be diagnosed by detection of VZV
DNA by reverse-transcriptase polymerase chain
reaction (RT-PCR) from clinical specimens Isolation of
VZV in culture also is possible but it is very expensive.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
5min Explain the Management: Student teacher explains What can be the
s management of about the management of management of
chickenpox Medical management of chickenpox in the immunologically chickenpox, chickenpox?
normal host is directed toward the prevention of avoidable
complications.

A good hygiene includes daily bathing and soaks. Secondary

bacterial infection of the skin can be avoided by scrupulous
skin care, particularly with close cropping of fingernails.
Pruritus can be decreased with topical dressings or the
administration of antipruritic drugs.

Water baths and wet compresses are better than drying lotions
for the relief of itching.
Administration of aspirin to children with chickenpox should be
avoided because of the association of aspirin derivatives with
the development of Reye’s syndrome. Instead antipyretics
should be given.

Antibiotics may require in secondary skin infection.

Steroids are contraindicated. Acyclovir (800 mg by mouth five

times daily), or valacyclovir (1 g three times daily), or
Famciclovir (250 mg three times daily). Treatment duration for
5–7 days is recommended. Antiviral drugs for adolescents and
adults with chickenpox Antiviral therapy can be helpful if
started within 24-48 hr of symptoms.
Acyclovir (20 mg/kg every 6 h) Antiviral drugs For children
<12 years of age acyclovir is recommended.
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Objective Activity
 Nursing management:

- An isolation room should be provided to the paediatric

client when on admission as it is a highly contagious air
borne disease and may not kept with other children.

- Supportive nursing management should be provided

with the application of calamine lotion or potassium
permanganate lotion and sponge bath with an aseptic
lotion

- Nails are to be cut shot.

- Oral hygiene to be maintained by special mouth care

with nonirritatting mouthwash and saline gargle.

- Soft toothbrush should be used to prevent mucosal

injury.

- Maintenance of general cleanliness is very essential to

prevent secondary infections.

- Rest, restriction of movement and isolation after the

appearance of rash are important measures to prevent
spread of infection.

Time Specific Content Teaching – Learning Evaluation

Objective Activity
2min Explain the Preventive measures. Student teacher explains What preventive
s preventive about the preventive measures can be taken
measures of A live attenuated chicken pox vaccine is available for active measures of chickenpox. for chickenpox?
chickenpox. immunity which is more effective than 80 percent of exposed
individuals.
The vaccine must be within 3 days of exposure to a case of
chickenpox.

Passive immunity can be provided by Varicella-Zoster

Immunoglobulin (VZIg) which is equally effective and
indicated in children with leukaemia, steroid therapy, suspected
pregnant womwn and neonates whose mothers develop
chickenpox 2 days before and after delivery.

Prognosis

Chickenpox is usually a self-limiting disease with good

prognosis. In case of serious complications like encephalitis
especially in immunocompromised children the prognosis may
be worse.

Summary

Therefore, at the end I would like to summarise the topic

communicable disease, in which tuberculosis, typhoid fever and
chicken pox were taken. We have discussed on the definition,
etiological factors, pathophysiology, risk factors, symptoms,
diagnostic test and management, nursing management and
complications.
Conclusion

I hope that all have understood the topic on communicable

disease.

Bibliography:

Sharma Rimple, “Essential of Pediatric Nursing”, Jaypee

Publishers
First edition. Pp

Dutta Parul, “Pediatric Nursing”, Jaypee Publishers

Third edition. Pp