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BIOGRAPHICAL DATA

Name: Baby AC Sex: Female

Birthdate: August 02, 2010 Age: 9 months old

Address: Dona Faustina II Machaca Camp Cul, Quezon City

Religion: Roman Catholic

Nationality: Filipino

Fathers Name: Mr. PC

Mothers name: Mrs. EC

Admission: May 07, 2011 (05:20 AM)

Admitting Diagnosis: Infected Varicella

Attending Physician: Dr. Rachelle A Grafil

HEALTH HISTORY

CURRENT HEALTH PROBLEMS

The condition of the patient started on May 03, 2011, when the mother noticed

vesiculomaculo rash starting from the head going to lower extrimities with

accompanying symptoms of fever and vomiting. They went to Barangay Health Center

and prescribed with Paracetamol and Immunosin. There was no relief of the symptoms

of the patient.

May 06, 2011, persistence of Bullous lesion prompted consult at East Avenue

Medical Center then referred to San Lazaro Hospital hence admitted.


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PAST HEALTH PROBLEMS

It was her 2nd hospitalization. Her 1st confinement was due to Sepsis Neonatorum

8 months ago. Her common illness includes cough, colds, and fever. Her mother usually

gave her a Paracetamol to relieve her fever. She received 1 dose of BCG, 1 dose Hepa

B, 3 doses of OPV, 3 doses of DPT except for measles. She had no known allergies to

drugs, foods, and agents.

OBSTETRICAL HISTORY

During Mrs. ECs pregnancy, she always go for check- ups in their Barangay

Health Center and was completed her Tetanus Toxoid Vaccine. Baby AC delivered in a

Normal Spontaneous Delivery without any known complications. Baby AC is a breastfed

baby until now but also eats soft foods such as crashed potato and cereals.

FAMILY RISK FACTORS

The family is residing at Bucaue, Bulacan. Mrs. EC verbalized that one of her

cousin had chicken pox. Their common illnesses are cough, colds, headache and fever.

They usually take OTC meds to relieve their illness such as Robitusin for cough and

colds, Alaxan for headache and Paracetamol for Fever. There is no known diseases

noted that runs in their family. There are no known allergies noted in their family.

MEDICATION

Paracetamol drops q4hours for fever

Zinc Oxide to apply in diaper rash

Cloxacillin 250mg/ 5mL QID


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PERSON ASSESSMENT

PSYCHOSOCIAL Lives at Bucaue, Bulacan with her mother and 2 sisters, ages 5

years old and 3 years old. Her mother and her father separated 5

months ago due to failure to provide the needs of their family. Her

grandmother was the one who provide their needs even her

hospital bills. Her mother is a house wife. She is a Roman Catholic.

She was baptized when she was 5 months old. Her mother usually

brought her to Barangay Health Center for health consultation.

Before hospitalization, she weighs 8.7kgsand now she weighs

7.4kgs. She is active and playful upon assessment.

ELIMINATION She consumed two diapers per day if there is no stool present. She

defecates once a day, sometimes the color is yellow and

sometimes green in color.

REST ANDACTIVITY

She has 16 hours of sleep. Her sleeping time is usually around 7pm

and usually wakes up around 11am. Sometimes she wakes up in

the midnight due to needs to be breastfed. She usually take a naps

around 1pm.


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SAFEENVIRONMENT

She has no known allergy in medications and foods. She has dry

skin, presence of crust and macules. The mucous membrane is

normal in color and there is no presence of dryness. Her present

temperature is 37C. On admission her temperature is 39.4C.

Medicated with paracetamol, oxacillin and zinc oxide. Medicated at

home with paracetamol for her fever. Upon admission her WBC is

17.19 due presence of infection.

OXYGEN There is no presence of murmur sound. No accessory muscles

being used. Her respiratory rate is 29 cpm. Her cardiac rate is 11O

bpm. No presence of edema. ( - ) homans sign. Upon admission

her Hb: 10.48, Hct: 37.79, and RBC of 402. Blunch test done;

capillary refill immediately back to its normal color.

NUTRITION Still on breast feed, but sometimes her mother gives her soft foods

e.g. crashed biscuits. She is also a bottlefed baby, uses bearbrand

and consumed 1L of milk per day. She has good appetite. She

weighs 7.4, weight loss of 1.3 kgs. over past 4 days. IV: D5 IMB

500cc @ 21 gtts/hour. She is on diet according to age as ordered.


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DRUG STUDY

NAME OF DRUG/GENERICDRUG CLASIFICATION

ACTION

RATIONALE

SIDE EFFECT NURSING IMPLICATION

OXACILLIN (PINICILLIN)

BETA-LACTAMASEINHIBITOR

DOSAGE:90 mg/kg/day P.OQ 12 hours for 10 days

BACKTERICIDAL

INHIBITS THE ENZYME INCELL WALL SYNTHESIS

NAUSEA, VOMITING,

DIARRHEA, RASH,STOMATITIS,HERPENSENSITIVITYRANGING FROM RASH,UNRTICARIA

SUPER INFECTIONSIGN/SYNTOMS,BLACK,FURRY TONGUE,THRUSH, AND VIGINALDISCHARGE

MONITOR V/S

MONITOR WBC MONITOR I&O

CHECK FORBLEEDING OF HIGHDOSE OFPENICILLIN.

CULTURE &SENSITIVITY

REPORTS RENALFUNCTION TEST

PARACETAMOL(ACETAMINOPHEN)

PARA-AMINOPHENNOLDERIVATIVE

DOSAGE:80 mg P.OQ 4 to 6 hours P.R.N

PRODUCE ANALGESIABY BLOCKING PAIN

IMPULSES BY INHIBITINGSYNTHESIS OFPROSTAGLANDIN IN THECNS

HEMATOLOGIC:HEMOLYTIC ANEMIA,

LEUKOPENIA,NEUTROPENIA,PANCYTOPENIA

HEPATIC: JAUNDICE

METABOLIC:HYPOGLYCEMIA

SKIN: RASH & URTICARIA

MONITOR V/S

MONITOR I&O

MONITOR WBC,RBC CHECK FOR

GLUCOSE ANDHEMOGLOBIN


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CHICKEN POX

Chickenpox is a highly contagious illness caused by

primary infection with varicella zoster virus (VZV). It

usually starts with vesicular skin rash mainly on the

body and head rather than at the periphery and

becomes itchy, raw pockmarks, which mostly heal

without scarring.

Chickenpox is an airborne disease spread easily

through coughing or sneezing of ill individuals or

through direct contact with secretions from the rash. A

person with chickenpox is infectious from one to five

days before the rash appears. The contagious period continues for 4 to 5 days after the

appearance of the rash, or until all lesions have crusted over. Immunocompromised

patients are probably contagious during the entire period new lesions keep appearing.

Crusted lesions are not contagious. It takes from 10 to 21 days after contact with an

infected person for someone to develop chickenpox.

The onset of illness with chickenpox is often characterized by symptoms

including myalgia, nausea, fever, headache, sore throat, pain in both ears, complaints of

pressure in head or swollen face, and malaise in adolescents and adults. In children,

the first symptom is usually the development of a papular rash, followed by

development of malaise, fever (a body temperature of 38 C (100 F), but may be as

high as 42 C (108 F) in rare cases), and anorexia. Typically, the disease is more

severe in adults. Chickenpox is rarely fatal, although it is generally more severe in adult

males than in adult females or children. Non-immune pregnant women and those with a

suppressed immune system are at highest risk of serious complications. Chickenpox is

believed to be the cause of one third of stroke cases in children. The most common late

complication of chickenpox is shingles, caused by reactivation of the varicella

zoster virus decades after the initial episode of chickenpox.
http://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Varicella_zoster_virushttp://en.wikipedia.org/wiki/Vesicle_(dermatology)http://en.wikipedia.org/wiki/Rashhttp://en.wikipedia.org/wiki/Pockmarkshttp://en.wikipedia.org/wiki/Airborne_diseasehttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Malaisehttp://en.wikipedia.org/wiki/Papulehttp://en.wikipedia.org/wiki/Malaisehttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Herpes_zosterhttp://en.wikipedia.org/wiki/Herpes_zosterhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Malaisehttp://en.wikipedia.org/wiki/Papulehttp://en.wikipedia.org/wiki/Malaisehttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Airborne_diseasehttp://en.wikipedia.org/wiki/Pockmarkshttp://en.wikipedia.org/wiki/Rashhttp://en.wikipedia.org/wiki/Vesicle_(dermatology)http://en.wikipedia.org/wiki/Varicella_zoster_virushttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Infectious_disease


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DIAGNOSIS

The diagnosis of varicella is primarily clinical, with typical early "prodromal" symptoms,

and then the characteristic rash. Confirmation of the diagnosis can be sought through

either examination of the fluid within the vesicles of the rash, or by testing blood for

evidence of an acute immunologic response.

Vesicular fluid can be examined with a Tsanck smear, or better with examination

for direct fluorescent antibody. The fluid can also be "cultured", whereby attempts are

made to grow the virus from a fluid sample. Blood tests can be used to identify a

response to acute infection (IgM) or previous infection and subsequent immunity (IgG).

Prenatal diagnosis of fetal varicella infection can be performed using ultrasound, though

a delay of 5 weeks following primary maternal infection is advised. A PCR (DNA) test of

the mother's amniotic fluid can also be performed, though the risk of spontaneous

abortion due to the amniocentesis procedure is higher than the risk of the baby

developing foetal varicella syndrome.

EPIDEMIOLOGY

Primary varicella is an endemic disease. Cases of varicella are seen throughout the

year but more commonly in winter and early spring. Varicella is one of the classic

diseases of childhood, with the highest prevalence in the 410 year old age group.

Like rubella, it is uncommon in preschool children. Varicella is highly communicable,

with an infection rate of 90% in close contacts. Most people become infected before

adulthood but 10% of young adults remain susceptible.

Historically, varicella has been a disease predominantly affecting young school-aged

children. In adults the pock marks are darker and the scars more prominent than inchildren.
http://en.wikipedia.org/wiki/Prodromehttp://en.wikipedia.org/wiki/Rashhttp://en.wikipedia.org/wiki/Tzanck_testhttp://en.wikipedia.org/wiki/Direct_fluorescent_antibodyhttp://en.wikipedia.org/wiki/Ultrasoundhttp://en.wikipedia.org/wiki/Polymerase_chain_reactionhttp://en.wikipedia.org/wiki/Amniotic_fluidhttp://en.wikipedia.org/wiki/Spontaneous_abortionhttp://en.wikipedia.org/wiki/Spontaneous_abortionhttp://en.wikipedia.org/wiki/Amniocentesishttp://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Rubellahttp://en.wikipedia.org/wiki/Rubellahttp://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Amniocentesishttp://en.wikipedia.org/wiki/Spontaneous_abortionhttp://en.wikipedia.org/wiki/Spontaneous_abortionhttp://en.wikipedia.org/wiki/Amniotic_fluidhttp://en.wikipedia.org/wiki/Polymerase_chain_reactionhttp://en.wikipedia.org/wiki/Ultrasoundhttp://en.wikipedia.org/wiki/Direct_fluorescent_antibodyhttp://en.wikipedia.org/wiki/Tzanck_testhttp://en.wikipedia.org/wiki/Rashhttp://en.wikipedia.org/wiki/Prodrome


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PATHOPHYSIOLOGY

Exposure to VZV in a healthy child initiates the

production of host immunoglobulin

G (IgG),immunoglobulin M (IgM), and immunoglobulin

A (IgA) antibodies; IgG antibodies persist for life and

confer immunity. Cell-mediated immune responses are

also important in limiting the scope and the duration of

primary varicella infection. After primary infection, VZV

is hypothesized to spread

frommucosal and epidermal lesions to local sensory

nerves. VZV then remains latent in the dorsal ganglion cells of the sensory nerves.

Reactivation of VZV results in the clinically distinct syndrome of herpes

zoster (i.e., shingles), and sometimes Ramsay Hunt syndrome type II.

INFECTION IN PREGNANCY AND NEONATES

For pregnant women, antibodies produced as a result of immunization or previous

infection is transferred via the placenta to the fetus. Women who are immune to

chickenpox cannot become infected and do not need to be concerned about it for

themselves or their infant during pregnancy.

Varicella infection in pregnant women could lead to viral transmission via the placenta

and infection of the fetus. If infection occurs during the first 28 weeks of gestation, this

can lead to fetal varicella syndrome (also known as congenital varicella syndrome).

Effects on the fetus can range in severity from underdeveloped toes and fingers to

severe anal and bladder malformation. Possible problems include:

Damage to brain: encephalitis, microcephaly, hydrocephaly, aplasia of brain

Damage to the eye: optic stalk, optic cup, and

lens vesicles, microphthalmia, cataracts,chorioretinitis, optic atrophy

Other neurological disorder: damage to cervical and lumbosacral spinal cord,

motor/sensory deficits, absent deep tendon reflexes, anisocoria/Horner's syndrome
http://en.wikipedia.org/wiki/Immunoglobulin_Ghttp://en.wikipedia.org/wiki/Immunoglobulin_Ghttp://en.wikipedia.org/wiki/Immunoglobulin_Mhttp://en.wikipedia.org/wiki/Immunoglobulin_Ahttp://en.wikipedia.org/wiki/Immunoglobulin_Ahttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/Cell-mediated_immunityhttp://en.wikipedia.org/wiki/Mucosahttp://en.wikipedia.org/wiki/Epidermis_(skin)http://en.wikipedia.org/wiki/Sensory_nervehttp://en.wikipedia.org/wiki/Sensory_nervehttp://en.wikipedia.org/wiki/Dorsal_root_ganglionhttp://en.wikipedia.org/wiki/Herpes_zosterhttp://en.wikipedia.org/wiki/Herpes_zosterhttp://en.wikipedia.org/wiki/Ramsay_Hunt_syndrome_type_IIhttp://en.wikipedia.org/wiki/Ramsay_Hunt_syndrome_type_IIhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/Placentahttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Transmission_(medicine)http://en.wikipedia.org/wiki/Gestationhttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Microcephalyhttp://en.wikipedia.org/wiki/Hydrocephalyhttp://en.wikipedia.org/wiki/Aplasiahttp://en.wikipedia.org/wiki/Optic_stalkhttp://en.wikipedia.org/wiki/Optic_cup_(ophthalmology)http://en.wikipedia.org/wiki/Vesicle_(dermatology)http://en.wikipedia.org/wiki/Microphthalmiahttp://en.wikipedia.org/wiki/Cataractshttp://en.wikipedia.org/wiki/Chorioretinitishttp://en.wikipedia.org/wiki/Optic_atrophyhttp://en.wikipedia.org/wiki/Spinal_cordhttp://en.wikipedia.org/wiki/Tendon_reflexhttp://en.wikipedia.org/wiki/Anisocoriahttp://en.wikipedia.org/wiki/Horner%27s_syndromehttp://en.wikipedia.org/wiki/File:Checkenpox_Adult_back.jpghttp://en.wikipedia.org/wiki/Horner%27s_syndromehttp://en.wikipedia.org/wiki/Anisocoriahttp://en.wikipedia.org/wiki/Tendon_reflexhttp://en.wikipedia.org/wiki/Spinal_cordhttp://en.wikipedia.org/wiki/Optic_atrophyhttp://en.wikipedia.org/wiki/Chorioretinitishttp://en.wikipedia.org/wiki/Cataractshttp://en.wikipedia.org/wiki/Microphthalmiahttp://en.wikipedia.org/wiki/Vesicle_(dermatology)http://en.wikipedia.org/wiki/Optic_cup_(ophthalmology)http://en.wikipedia.org/wiki/Optic_stalkhttp://en.wikipedia.org/wiki/Aplasiahttp://en.wikipedia.org/wiki/Hydrocephalyhttp://en.wikipedia.org/wiki/Microcephalyhttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Gestationhttp://en.wikipedia.org/wiki/Transmission_(medicine)http://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Placentahttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/Ramsay_Hunt_syndrome_type_IIhttp://en.wikipedia.org/wiki/Herpes_zosterhttp://en.wikipedia.org/wiki/Herpes_zosterhttp://en.wikipedia.org/wiki/Dorsal_root_ganglionhttp://en.wikipedia.org/wiki/Sensory_nervehttp://en.wikipedia.org/wiki/Sensory_nervehttp://en.wikipedia.org/wiki/Epidermis_(skin)http://en.wikipedia.org/wiki/Mucosahttp://en.wikipedia.org/wiki/Cell-mediated_immunityhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/Immunoglobulin_Ahttp://en.wikipedia.org/wiki/Immunoglobulin_Ahttp://en.wikipedia.org/wiki/Immunoglobulin_Mhttp://en.wikipedia.org/wiki/Immunoglobulin_Ghttp://en.wikipedia.org/wiki/Immunoglobulin_G


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Damage to body: hypoplasia of upper/lower extremities, anal and

bladder sphincter dysfunction

Skin disorders: (cicatricial) skin lesions, hypopigmentation

Infection late in gestation or immediately following birth is referred to as "neonatal

varicella".Maternal infection is associated with premature delivery. The risk of the baby

developing the disease is greatest following exposure to infection in the period 7 days

prior to delivery and up to 7 days following the birth. The baby may also be exposed to

the virus via infectious siblings or other contacts, but this is of less concern if the mother

is immune. Newborns that develop symptoms are at a high risk of pneumonia and other

serious complications of the disease.

SHINGLES

After a chickenpox infection, the virus remains dormant in the body's nerve tissues.

The immune system keeps the virus at bay, but later in life, usually as an adult, it can be

reactivated and cause a different form of the viral infection called shingles.

PREVENTION

HYGIENE MEASURES

The spread of chicken pox can be prevented by isolating affected individuals. Contagion

is by exposure to respiratory droplets, or direct contact with lesions, within a period

lasting from three days prior to the onset of the rash, to four days after the onset of the

rash. The chicken pox virus (VZV) is susceptible to disinfectants, notably chlorine

bleach (i.e., sodium hypochlorite). Also, like all enveloped viruses, VZV is sensitive to

desiccation, heat and detergents. Therefore these viruses are relatively easy to kill.

VACCINE

Main article:Varicella vaccine

A varicella vaccine was first developed by Michiaki Takahashi in 1974 derived from the

Oka strain. It has been available in the U.S. since 1995 to inoculate against the disease.

Some countries require the varicella vaccination or an exemption before entering

elementary school. Protection from one dose is not lifelong and a second dose is

necessary five years after the initial immunization, which is currently part of the routine
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immunization schedule in the US. The chickenpox vaccine is not part of the routine

childhood vaccination schedule in the UK. In the UK, the vaccine is currently only

offered to people who are particularly vulnerable to chickenpox.

TREATMENT

Varicella treatment mainly consists of easing the symptoms as there is no actual cure of

the condition. Some treatments are however available for relieving the symptoms while

the immune system clears the virus from the body. As a protective measure, patients

are usually required to stay at home while they are infectious to avoid spreading the

disease to others. Also, sufferers are frequently asked to cut their nails short or to

wear gloves to prevent scratching and to minimize the risk of secondary infections.

The condition resolves by itself within a couple of weeks but meanwhile patients must

pay attention to their personal hygiene. The rash caused by varicella zoster virus may

however last for up to one month, although the infectious stage does not take longer

than a week or two. Also, staying in a cold surrounding can help in easing the itching

as heat and sweat makes it worse.

Although there have been no formal clinical studies evaluating the effectiveness of

topical application of calamine lotion, a topical barrier preparation containing zinc

oxide and one of the most commonly used interventions, it has an excellent safety

profile. It is important to maintain good hygiene and daily cleaning of skin with warm

water to avoid secondary bacterial infection. Scratching may also increase the risk of

secondary infection.

To relieve the symptoms of chicken pox, people commonly use anti-itching creams and

lotions. These lotions are not to be used on the face or close to the eyes.

An oatmeal bath also might help ease discomfort.

CHILDREN

If oral acyclovir is started within 24 hours of rash onset it decreases symptoms by one

day but has no effect on complication rates. Use of acyclovir therefore is not currently

recommended for immunocompetent individuals (i.e., otherwise healthy persons without

known immunodeficiency or on immunosuppressive medication). Children younger than

12 years old and older than one month are not meant to receive antiviral medication if

they are not suffering from another medical condition which would put them at risk of

developing complications.
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Treatment of chicken pox in children is aimed at symptoms whilst the immune system

deals with the virus. With children younger than 12 years cutting nails and keeping them

clean is an important part of treatment as they are more likely to deep scratch their

blisters.

Aspirin is highly contraindicated in children younger than 16 years as it has been related

with a potentially fatal condition known as Reye's syndrome.

ADULTS

Infection in otherwise healthy adults tends to be more severe and active; treatment with

antiviral drugs (e.g. acyclovir) is generally advised, as long as it is started within 2448

hours from rash onset. Remedies to ease the symptoms of chicken pox in adults are

basically the same as those used on children. Moreover, adults are often prescribed

antiviral medication as it is effective in reducing the severity of the condition and the

likelihood of developing complications. Antiviral medicines are not however aimed to kill

the virus, but to stop it from multiplying. Adults are also advised to increase water intake

to reduce dehydration and to relieve headaches. Painkillers such as paracetamol and

ibuprofen are also recommended as they are effective in relieving itching and other

symptoms such as fever or pains. Antihistamines may be used in cases when thesymptoms cause the inability to sleep, as they are efficient for easing the itching and

they are acting as a sedative. As with children, antiviral medication is considered more

useful for those adults who are more prone to develop complications. These

includepregnant women or people who have a poor immune system. Sorivudine, a

nucleoside analogue has been found in few case reports effective in the treatment of

primary varicella in healthy adults. Larger scale clinical trials are needed to demonstrate

the efficacy of this medication.

PROGNOSIS

The duration of the visible blistering caused by varicella zoster virus varies in children

usually from 4 to 7 days, and the appearance of new blisters begins to subside after the

5th day. Chickenpox infection is milder in young children, and symptomatic treatment,

with sodium bicarbonate baths or antihistamine medication may ease itching.

Paracetamol (acetaminophen) is widely used to reduce fever. Aspirin, or productscontaining aspirin, should not be given to children with chickenpox as it can

cause Reye's syndrome.
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In adults, the disease is more severe, though the incidence is much less common.

Infection in adults is associated with greater morbidity and mortality due to pneumonia,

hepatitis, and encephalitis. In particular, up to 10% of pregnant women with chickenpox

develop pneumonia, the severity of which increases with onset later in gestation. In

England and Wales, 75% of deaths due to chickenpox are in adults. nflammation of the

brain, or encephalitis, can occur in immunocompromised individuals, although the risk is

higher withherpes zoster. Necrotizing fasciitis is also a rare complication.

Secondary bacterial infection of skin lesions, manifesting as impetigo, cellulitis,

and erysipelas, is the most common complication in healthy children. Disseminated

primary varicella infection usually seen in the immunocompromised may have high

morbidity. Ninety percent of cases of varicella pneumonia occur in the adult population.

Rarer complications of disseminated chickenpox also include myocarditis, hepatitis,

andglomerulonephritis.

Hemorrhagic complications are more common in the immunocompromised or

immunosuppressed populations, although healthy children and adults have been

affected. Five major clinical syndromes have been described: febrile purpura, malignantchickenpox with purpura, postinfectious purpura, purpura fulminans, and anaphylactoid

purpura. These syndromes have variable courses, with febrile purpura being the most

benign of the syndromes and having an uncomplicated outcome. In contrast, malignant

chickenpox with purpura is a grave clinical condition that has a mortality rate of greater

than 70%. The etiology of these hemorrhagic chickenpox syndromes is not known.
http://en.wikipedia.org/wiki/Pneumoniahttp://en.wikipedia.org/wiki/Hepatitishttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Herpes_zosterhttp://en.wikipedia.org/wiki/Necrotizing_fasciitishttp://en.wikipedia.org/wiki/Impetigohttp://en.wikipedia.org/wiki/Cellulitishttp://en.wikipedia.org/wiki/Erysipelashttp://en.wikipedia.org/wiki/Myocarditishttp://en.wikipedia.org/wiki/Hepatitishttp://en.wikipedia.org/wiki/Glomerulonephritishttp://en.wikipedia.org/wiki/Anaphylactoid_purpurahttp://en.wikipedia.org/wiki/Anaphylactoid_purpurahttp://en.wikipedia.org/wiki/Anaphylactoid_purpurahttp://en.wikipedia.org/wiki/Anaphylactoid_purpurahttp://en.wikipedia.org/wiki/Glomerulonephritishttp://en.wikipedia.org/wiki/Hepatitishttp://en.wikipedia.org/wiki/Myocarditishttp://en.wikipedia.org/wiki/Erysipelashttp://en.wikipedia.org/wiki/Cellulitishttp://en.wikipedia.org/wiki/Impetigohttp://en.wikipedia.org/wiki/Necrotizing_fasciitishttp://en.wikipedia.org/wiki/Herpes_zosterhttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Hepatitishttp://en.wikipedia.org/wiki/Pneumonia


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ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM


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The nose consists of the visible external nose and the internal nasal cavity. The

nasal septum divides the nasal cavity into right and left sides. Air enters two

openings, the external nares (nostrils; singular, naris), and passes into the

vestibule and through passages called meatuses. The bony walls of the

meatuses, called concha, are formed by facial bones (the inferior nasal concha

and the ethmoid bone). From the meatuses, air then funnels into two (left and

right) internal nares. Hair, mucus, blood capillaries, and cilia that line the nasal

cavity filter, moisten, warm, and eliminate debris from the passing air.

The pharynx (throat) consists of the following three regions, listed in order

through which incoming air passes:

The nasopharynx receives the incoming air from the two internal nares.

The two auditory (Eustachian) tubes that equalize air pressure in the

middle ear also enter here. The pharyngeal tonsil (adenoid) lies at the back

of the nasopharynx.

The oropharyrnx receives air from the nasopharynx and food from the oral

cavity. The palatine and lingual tonsils are located here.

The laryngopharynx passes food to the esophagus and air to the larynx.

The larynx receives air from the laryngopharynx. It consists of the following nine

pieces of cartilage that are joined by membranes and ligaments.

The epiglottis, the first piece of cartilage of the larynx, is a flexible flap thatcovers the glottis, the upper region of the larynx, during swallowing to

prevent the entrance of food.

The thyroid cartilage protects the front of the larynx. A forward projection of

this cartilage appears as the Adam's apple.


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The paired arytenoids cartilages in the rear are horizontally attached to the

thyroid cartilage in the front by folds of mucous membranes. The upper

vestibular folds (false vocal cords) contain muscle fibers that bring the folds

together and allow the breath to be held during periods of muscular

pressure on the thoracic cavity (straining while defecating or lifting a heavy

object, for example). The lower vocal folds (true vocal cords) contain

elastic ligaments that vibrate when skeletal muscles move them into the

path of outgoing air. Various sounds, including speech, are produced in

this manner.

The cricoid cartilage, the paired cuneiform cartilages, and the paired

corniculate cartilages are the remaining cartilages supporting the larynx.

The trachea (windpipe) is a flexible tube, 10 to 12 cm (4 inches) long and 2.5 cm

(1 inch) in diameter, whose wall consists of four layers, as shown in Figure2 :

The mucosa is the inner layer of the trachea. It contains mucusproducing

goblet cells and pseudostratified ciliated epithelium. The movement of the

cilia sweep debris away from the lungs toward the pharynx.

The submucosa is a layer of areolar connective tissue that surrounds the

mucosa.

Hyaline cartilage forms 16 to 20 C-shaped rings that wrap around the

submucosa. The rigid rings prevent the trachea from collapsing during

inspiration.

The adventitia is the outermost layer of the trachea. It consists of areolar

connective tissue.

The primary bronchi are two tubes that branch from the trachea to the left and

right lungs.

Inside the lungs, each primary bronchus divides repeatedly into branches of

smaller diameters, forming secondary (lobar) bronchi, tertiary (segmental)

bronchi, and numerous orders of bronchioles (1 mm or less in diameter),

including terminal bronchioles (0.5 mm in diameter) and microscopic respiratory

bronchioles. The wall of the primary bronchi are constructed like the trachea, but

as the branches of the tree get smaller, the cartilaginous rings and the mucosa

are replaced by smooth muscle.
http://www.cliffsnotes.com/study_guide/Structure-of-the-Respiratory-System.topicArticleId-22032,articleId-21997.html#pack3734c17-fig-0002http://www.cliffsnotes.com/study_guide/Structure-of-the-Respiratory-System.topicArticleId-22032,articleId-21997.html#pack3734c17-fig-0002


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Alveolar ducts are the final branches of the bronchial tree. Each alveolar duct has

enlarged, bubblelike swellings along its length. Each swelling is called an

alveolus, and a cluster of adjoining alveolar is called an alveolar sac. Some

adjacent alveoli are connected by alveolar pores.

The respiratory membrane consists of the alveolar and capillary walls. Gas

exchange occurs across this membrane. Characteristics of this membrane follow:

Type I cells are thin, squamous epithelial cells that constitute the primary

cell type of the alveolar wall. Oxygen diffusion occurs across these cells.

Type II cells are cuboidal epithelial cells that are interspersed among the

type I cells. Type II cells secrete pulmonary surfactant (a phospholipidbound to a protein) that reduces the surface tension of the moisture that

covers the alveolar walls. A reduction in surface tension permits oxygen to

diffuse more easily into the moisture. A lower surface tension also prevents

the moisture on opposite walls of an alveolus or alveolar duct from

cohering and causing the minute airway to collapse.

Alveolar macrophage (dust cells) wander among the other cells of the

alveolar wall removing debris and microorganisms.

A thin epithelial basement membrane forms the outer layer of the alveolar

wall.

A dense network of capillaries surrounds each alveolus. The capillary walls

consist of endothelial cells surrounded by a thin basement membrane. The

basement membranes of the alveolus and the capillary are often so close

that they fuse.


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PATHOPHYSIOLOGY OF CHICKEN POX

PREDISPOSING FACTOR PRECIPITATING FACTOR

>childhood >herpes virus varicellae>occur at any age>socio economic status>environment>occupation

Invasion of virus or microorganism in the upper respiratory tract

Viral proliferation occurs in regional lymph nodes

Primary viremia (post infection 4-6 days)

Second round of viral replication occurs in the bodys internal organ (liver & spleen)

Secondary Viremia (14-16 days post infection)

Diffuse viral invasion of capillary endothelial cell and the epidermis

Intracellular edema intercellular edema

Macule

Papule

Vesicle

Crust

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