Topic: Viral Exanthems- Herpes Zoster

I. Definition/Description
 Caused by Varicella-Zoster Virus (same virus the causes Chicken Pox)
 Tends to occur in older children or young adults, although it can occur in any age
II. Assessment
a. Signs and symptoms
 First invasion- have symptoms of Chicken Pox
 Second invasion- Herpes Zoster symptoms appear due to reactivation of a latent virus
o Pruritus and Cutaneous Vesicular Lesions on erythematosus bases that follows
the distribution of the lumbar and thoracic nerves and cause deep nagging Pain.
b. Lab tests
c. Pathognomonic sign
d. Other assessment
III. Therapeutic Management
a. Nursing Interventions
b. Pharmacologic Interventions
 Analgesia for pain
 Acyclovir- inhibits viral DNA synthesis may be effective in limiting the diseases
 Varicella Zoster Immune Globulin (VZIG)- may minimize symptoms
c. Health Teachings
IV. Other Management

Topic: Viral Exanthems- Small Pox (Variola)

I. Definition/Description
 Caused by Smallpox Virus
 Extinct in the world since 1995
 Mortality rate is as high as 50%
 Incubation period is within 7 to 17 days
 Period of communicability is from onset of rash until all crusts have been shed
 Mode of transmission is through direct or indirect contact
 Lasting natural immunity after contracting the disease
 Active Artificial Immunity is no longer recommended
 Passive Artificial Immunity through Vaccinia Immune Globulin (VIG)
II. Assessment
a. Signs and symptoms
 3-to -4-day prodromal period of chills, fever, headache, and vomiting
 Appears extremely ill and exhausted
 On day 3 or 4, rash and high fever appear
 Lesions, most prominent on the distal extremities and face (begins as macules) progress
to papules, vesicles and pustules, eventually crusting over a 10-to -14- day period
b. Lab tests
c. Pathognomonic sign
Of how it is being differentiated from Chicken Pox
  Appearance of the pustular stage (not seen with Chickenpox)
 Lesions of smallpox arise as one crop of lesions and all progress at the same rate
(Chickenpox occurs in stages)
 The crust of Chickenpox are not contagious; the crust of Smallpox are.
d. Other assessment
III. Therapeutic Management
a. Nursing Interventions
 May need oxygen or other measures to support respiratory function
b. Pharmacologic Interventions
 Vaccinia Immune Globulin (VIG)- suppress symptoms
 Antibiotic- prevent secondary infections of lesions
 Cardiac Glycoside- support cardiac function
c. Health Teachings
IV. Other Management

Topic: Viral Exanthems- Erythema Infectiosum (Fifth Disease)

I. Definition/Description
 Causative agent is Parvovirus B19
 Occurs most often in children 2 to 12 years of age
 Incubation period is within 6 to 14 days
 Period of communicability is uncertain
 Mode of transmission is through droplets
II. Assessment
a. Signs and symptoms
 First phase of infection includes fever, headache, and malaise
 A week later rash appears first on the face and characterized as intensely red
 The lesions are maculopapular and coalesce on the cheeks to form a “slapped face”
appearance
 Facial lesions fade in 1 to 120 days
 A day after facial lesions appear, a rash appears on the extensor surfaces of the
extremities
 One day later, the rash appears on the flexor surfaces and the trunk
 These lesions (in extremities and trunk) last for 1 week or more. They fade from the
center outward giving the lesions a lacelike appearance.
 After the rash faded, it may reappear if precipitated by skin irritations such as trauma,
sunlight, hot, or cold.
 Note: Some children develop a persistent arthritis
b. Lab tests
c. Pathognomonic sign
d. Other assessment
III. Therapeutic Management
a. Nursing Interventions
 The disease is teratogenic in a fetus so children with this disorder should avoid contact
with pregnant women.
 b. Pharmacologic Interventions
 Treatment is typically supportive, with antipyretics and analgesics
 Keep in mind that some children need an antihistamine such as diphenhydramine
(Benadryl) to reduce itching. Ask your primary care provider about using it.
c. Health Teachings
 Dress your child in light cotton clothing so overheating and perspiration do not occur.
Perspiration can make itching worse.
 Avoid wool clothing, because it can irritate skin and increase itching.
 Offer adequate fluid to maintain good hydration, because dry skin increases discomfort.
 Keep your child’s fingernails short, to avoid injury to the skin from scratching.
 Teach your child to press on an itchy area rather than scratching to relieve discomfort;
cold cloths applied to an area can also be helpful
 Adding a few teaspoonfuls of baking soda to bath water can be soothing. Use lukewarm
rather than hot water.
 Children can return to school as soon as the rash appears because they are no longer
infectious after this point.
IV. Other Management

Topic: Nonpolio Enteroviruses- Numbered Enterovirus and Echovirus Infections

I. Definition/Description
 There are three main types of enteroviruses: echoviruses (33 subdivisions),
coxsackievirus A (24 subdivisions) and coxsackievirus B (6 types), and polioviruses (3
subdivisions).
 Echoviruses are responsible for several childhood diseases, including aseptic meningitis,
diarrhea, acute respiratory illness, and maculopapular rashes
 The infections are benign and self-limiting
II. Assessment
a. Signs and symptoms
b. Lab tests
c. Pathognomonic sign
d. Other assessment
III. Therapeutic Management
a. Nursing Interventions
 Treatment involves supportive measures. If a child is hospitalized, follow contact
precautions for the duration of the illness, in addition to standard infection precautions.
b. Pharmacologic Interventions
c. Health Teachings
IV. Other Management

Topic: Nonpolio Enteroviruses- Coxsackievirus Infections

I. Definition/Description
 One of the most frequently found diseases of children caused by coxsackievirus A is
herpangina.
II. Assessment
 a. Signs and symptoms
 Abrupt elevation of temperature up to 104 or 105 F (40.0 or 40.6 C) for 1 to 4 days
 Anorexia, difficulty swallowing, sore throat, and vomiting may be present.
 May have headache or abdominal pain.
 Small lesions, generally discrete grayish vesicles, pinpoint in size, appear on the tonsillar
fauces, soft palate, and uvula.
 Lesions may be present elsewhere in the mouth or throat as well.
 The lesions gradually change to shallow ulcers surrounded by a red areola. They
disappear within a few days after the temperature returns to normal.
 Note: There are generally no complications
b. Lab tests
c. Pathognomonic sign
d. Other assessment
III. Therapeutic Management
a. Nursing Interventions
 If a child is hospitalized, follow contact precautions for the duration of the illness, in
addition to standard infection precautions.
b. Pharmacologic Interventions
 Antipyretic- for fever
c. Health Teachings
 Children need to be maintained in soft or liquid foods while their mouths and throats
are sore.
IV. Other Management

Topic: Poliovirus Infections: Poliomyelitis (Infantile Paralysis)

I. Definition/Description
 Polio is Greek for “gray,” the color of the spinal cord after it atrophies from the effect of
the poliomyelitis virus.
 Causative agent is Poliovirus
 Incubation period within 7 to 14 days
 Period of communicability is greatly shortly before and after onset of symptoms, when
virus is present in the throat and feces (1 to 6 weeks)
 Contracting the disease causes active immunity against the one strain of virus causing
the illness.
 Active artificial immunity through Inactivated Polio Virus vaccine (IPV); No passive
artificial immunity
 Survivors tend to develop progressive muscle atrophy (post poliomyelitis muscular
atrophy syndrome) or severe arthritis in late adulthood, further reducing their ability to
be self-sufficient
II. Assessment
a. Signs and symptoms
 The poliovirus enters the child’s gastrointestinal tract, where it multiplies and produces
symptoms such as fever, headache, nausea, vomiting, or abdominal pain.
 Moderate pain of the neck, back, and legs soon develops.
  The cerebrospinal fluid shows increased protein and lymphocytes.
 These initial symptoms are followed by intense pain and tremors of the extremities and
then paralysis, occurring either immediately or over a period of 1 to 7 days as the virus
invades the central nervous system.
 Laryngeal paralysis makes swallowing or talking difficult, and respiratory paralysis can
halt respiration
b. Lab tests
c. Pathognomonic sign
 Kernig’s sign- a test for meningeal irritation, is positive.
 Children demonstrate a tripod sign—when sitting on the floor or on an examining table,
they cannot sit without placing both the arms and hands behind them to brace
themselves. Their deep tendon reflexes are hyperactive at first and then diminish as the
central nervous system is fully invaded.
d. Other assessment
III. Therapeutic Management
a. Nursing Interventions
 Treatment for poliomyelitis is bedrest with analgesia and moist hot packs to relieve
pain.
 If the respiratory muscles are involved, long-term ventilation is necessary.
b. Pharmacologic Interventions
c. Health Teachings
IV. Other Management

Topic: VI of the Integumentary System (Herpes Virus Infections)- Acute Herpetic Gingivostomatitis

I. Definition/Description
 Acute herpetic gingivostomatitis is the most common form of herpes simplex invasion in
young children.
 It occurs in children aged 1 to 4 years
II. Assessment
a. Signs and symptoms
 Children have a high fever (104° to 105° F [40.0° to 40.6° C]), are restless, and have
anorexia and a sore mouth.
 Their gumline is swollen and reddened and bleeds easily. White plaques or shallow
ulcers with red areolae appear on the buccal mucosa, tongue, and palate and perhaps
on the tonsillar fauces.
 The anterior cervical lymph nodes are enlarged and tender.
 The disease runs its course in 5 to 7 days.
 Children with gingivostomatitis appear very ill. The disease can become very serious,
especially in infants, if their mouths become so sore that they cannot swallow readily
and they become malnourished and dehydrated.
b. Lab tests
c. Pathognomonic sign
d. Other assessment
III. Therapeutic Management
 a. Nursing Interventions
 Use contact precautions with hospitalized children.
b. Pharmacologic Interventions
 Antipyretic- to reduce fever
 Oral acyclovir helps with healing.
c. Health Teachings
 Need soft, acid-free foods that they can eat with minimal irritation or abrasion.
 Popsicles are soothing against inflamed mucous membranes.
IV. Other Management

Topic: VI of the Integumentary System (Herpes Virus Infections)- Herpes Simplex (Herpes Labialis)

I. Definition/Description
 Herpes simplex infection, popularly known as a cold sore or fever blister, represents the
recurrent form of a type 1 herpesvirus invasion that has remained dormant in the
ganglia of the trigeminal or fifth cranial nerve.
II. Assessment
a. Signs and symptoms
 Herpes simplex typically appears as clusters of painful, grouped vesicles surrounded by
an erythematous base on the lips or skin surrounding the mouth.
 After 2 or 3 days, vesicles crust, then gradually dry.
b. Lab tests
c. Pathognomonic sign
d. Other assessment
III. Therapeutic Management
a. Nursing Interventions
b. Pharmacologic Interventions
 Topical or oral acyclovir reduces pain and increases healing
c. Health Teachings
 Keeping lesions dry helps them to fade sooner, but keeping them lubricated with an
ointment reduces pain.
IV. Other Management
 Children feel conspicuous about the appearance of herpes simplex lesions. They may
need counseling to assure them that the lesions are not as obvious to others as they
seem to them.

Topic: VI of the Integumentary System (Herpes Virus Infections)- Acute Herpetic Vulvovaginitis
(Genital Herpes)

I. Definition/Description
 Genital herpes is caused by the herpesvirus type 2, which remains dormant in the
ganglia of the sacral nerves
II. Assessment
a. Signs and symptoms
b. Lab tests
c. Pathognomonic sign
 d. Other assessment
III. Therapeutic Management
a. Nursing Interventions
b. Pharmacologic Interventions
c. Health Teachings
IV. Other Management
 The occurrence of this in a young child suggests child sexual abuse- counseling.

Topic: VI of the Integumentary System (Herpes Virus Infections)- Warts (Verrucae)

I. Definition/Description
 Warts, one of the most common dermatologic diseases in children, are caused by the
papillomavirus.
 Warts are flesh-colored, dirty-appearing papules. They generally occur on the dorsal
surface of the hands, although they may occur anywhere. Plantar warts appear on the
soles of the feet and are painful when children walk.
 They may be differentiated from calluses in that they obliterate skin lines as they grow,
whereas calluses do not.
 The virus has an incubation period of 1 to 6 months.
 The mode of transmission is unknown, but it is probably by direct contact.
 Warts on the hands or the face are generally removed if they are cosmetically
unattractive to children. Plantar warts may have to be removed because of the
discomfort they cause.
II. Assessment
a. Signs and symptoms
b. Lab tests
c. Pathognomonic sign
d. Other assessment
III. Therapeutic Management
a. Nursing Interventions
b. Pharmacologic Interventions
 Use over-the-counter wart-removing preparations, such as Compound W, to dissolve
them.
 Application of 40% salicylic acid may be prescribed to remove plantar warts.
 Carbon dioxide snow, liquid nitrogen, electrodesiccation, and curettage are also
effective for removal, but these methods are painful and rarely necessary.
c. Health Teachings
 Children need reassurance that people do not catch warts from frogs or toads and even
if left without any treatment, warts will eventually fade by themselves after about 24
months.
IV. Other Management
 Anogenital warts need special consideration as they can be a mark of sexual abuse