What is Smallpox? Smallpox is a very contagious and potentially fatal viral disease caused by Variola virus and is usually associated with fever, malaise, headache and back pain followed by a characteristic rash.
Smallpox is a very contagious and potentially fatal viral disease caused by the variola virus and is usually associated with fever malaise headache and back pain followed by a characteristic rash thanks to vaccination smallpox is the first human infectious disease that was successfully eradicated worldwide in 1980 let’s start by discussing the physiology of the
Immune response it all begins in the bone marrow where undifferentiated hematopoietic stem cells begin to differentiate into different types of white blood cells some of these cells migrate to the thymus where they become mature t cells also known as t lymphocytes which defend us against intracellular viruses fungi and tumor cells additionally they are responsible
For long-term immunity now after a foreign antigen enters the body it runs into antigen presenting cells like macrophages and dendritic cells by whom it is engulfed and digested into fragments these antigen fragments are then presented on their surface and recognized by t helper cells which help activate b cells to produce antibodies against that antigen next
These antibodies bind to any affected cell that expresses the antigen on its surface eventually enabling natural killer or nk cells and cytotoxic t cells to easily recognize and destroy them furthermore these natural killer cells enhance the inflammatory response by producing cytokines that recruit neutrophils macrophages and mast cells okay the cause of smallpox
Is variolavirus which is a large dna virus that belongs to the orthopoxvirus genus and the poxvirus family important risk factors for contracting smallpox before it was eradicated included close contact with an infected client or contaminated surfaces infancy older age and immunodeficiency nowadays clients with occupational exposure such as laboratory researchers
That study variola virus healthcare workers first responders and military personnel can also be at risk it’s important to know that even though smallpox has been eradicated there is still a risk of the variola virus being used as a potential bioweapon moving on to pathology variola virus is an airborne virus meaning it spreads via small virus-containing droplets
That get flung in the air when an infected client coughs or sneezes if another client breathes in these droplets or they get in contact with infected surfaces and then touch their mouth they can become infected clients can also become infected if they get in contact with the fluid from an infected client’s skin lesions and then touch their own mouth in any case
Once the virus enters the body it invades epithelial cells in the nasopharynx and starts replicating in the cytoplasm creating new viral particles that leave the cell the virus then infects macrophages and dendritic cells which carry it to regional lymph nodes where the virus replicates once again from there the virus enters blood vessels causing what’s known as
Primary viremia and spreads to other lymph nodes as well as the spleen bone marrow and thymus after replicating inside lymphoid organs variola virus enters blood vessels once again causing secondary viremia making its way to other organs such as the liver kidneys skin and mucosal membranes now complications of smallpox include secondary bacterial infections of the
Skin bacterial pneumonia encephalitis osteomyelitis viral arthritis and orchitis as well as keratitis and coronal ulcerations which can lead to blindness rarely smallpox can cause bone marrow suppression and heart failure also as skin lesions heal they can form residual pock marks which are deep and discolored scars clinical manifestations of smallpox typically
Appear after an incubation period of 10 to 14 days and include high fever severe headache back pain malaise and sometimes abdominal pain vomiting and diarrhea two to four days later comes an enanthem which is a rash on the mucous membranes of the tongue and palate this is followed by the onset of an x anthem or a red macular rash that typically starts at the face
Distal extremities hands and soles of the feet and then spreads to the trunk and proximal extremities over the course of four to five days the lesions evolved from macules to papules to vesicles filled with clear fluid which can then turn into pus giving rise to pustules as these pustules pop open the pus dries out and crusts form an important characteristic of
The smallpox rash is that all lesions are at the same stages of development at a time diagnosis of smallpox typically begins with the client’s history and physical assessment followed by detection of smallpox specific igm antibodies a pcr test can be used to detect viral dna in the swabs of the oropharynx conjunctiva skin lesions urine samples or organ biopsies
Additionally biopsy of skin lesions can show guarnieri bodies in the nuclei or cytoplasm of infected cells which are aggregates of proteins produced by the virus as it replicates treatment of smallpox is mainly supportive and typically involves adequate fluid intake maintaining electrolyte balance skin care and monitoring for complications such as secondary
Infections rest as well as medications like acetaminophen are also important to reduce symptoms immediately after exposure to smallpox clients should receive post-exposure prophylaxis which may reduce the severity of the disease finally since smallpox was eradicated routine vaccination is no longer carried out except for those clients that are at increased risk
However the vaccine is available and should be given in the event of exposure as it could decrease the severity of the disease all right now let’s move on to the management of care for a client diagnosed with smallpox your priority goals of care are to prevent disease transmission and provide supportive care begin by applying personal protective equipment including
Gloves gowns and an n95 mask and provide your client with a surgical mask or a properly fitted n95 mask then place your client on airborne contact and standard precautions and transport them to an airborne infection isolation room as soon as possible if an airborne infection isolation room is not available place your client in a private room with the door closed
Also cover any areas where rash is present with a sheet or other covering to prevent any rash particles from becoming airborne also be sure to limit the number of people involved in caring for your client ensure that all caregivers have been vaccinated against smallpox and obtain dedicated equipment that would be kept in the client’s room for the duration of their
Hospitalization in addition notify your institution’s infection control department and ensure local and state public health departments have been notified of the case next assess your clients vital signs and their pain and anxiety level administer the prescribed antipyretics as needed encourage fluid intake promote nutrition provide comfort measures and take steps
To reduce your clients anxiety during their illness okay now let’s talk about client and family teaching for clients diagnosed with smallpox begin by explaining that smallpox is transmitted either by respiratory viral shedding such as when you sneeze or cough or through direct contact with the fluid in the sores let their client know that they are contagious when
The first lesions appear and remain contagious until the last scabs fall off and that the virus is highly transmissible and that they will be in isolation for the duration of the illness which usually lasts three to four weeks teach them how to properly wear their mask and explain why they will need to wear an n95 mask when they are being transported review basic
Infection control techniques including hand hygiene and cough etiquette finally tell your client that they will have lifelong protection from re-infection after they recover alright as a quick recap smallpox is a highly contagious and often fatal disease caused by the variola virus important risk factors for contracting smallpox before it was eradicated included
Close contact with an infected client or contaminated surfaces infancy older age and immunodeficiency nowadays clients with occupational exposure such as laboratory researchers that study variola virus healthcare workers first responders and military personnel can also be at risk clinical manifestations of smallpox typically appear 10 to 14 days after exposure
Initial symptoms include a high fever headache back pain malaise abdominal pain vomiting and diarrhea and after one to four days of these symptoms a rash appears which evolves to form macules to papules to vesicles after the vesicles pop open crusts begin to form a key characteristic of the smallpox rash is that all the lesions are in the same stage of development
At the same time now diagnosis is made based on the client’s history and physical assessment followed by a detection of smallpox-specific igm antibodies a pcr test to detect viral dna as well as biopsy of the skin lesions treatment usually involves supportive care as well as post-exposure prophylaxis to reduce the severity of the disease goals of nursing care
Include preventing disease transmission and providing supportive care client and family teaching is focused on learning about the disease and infection control measures helping current and future clinicians focus learn retain and thrive learn more you
Transcribed from video
Smallpox: Clinical Nursing Care By Osmosis
