Viral infections

Dermatology Nursing, Feb, 2008 by Marcia J. Hill

* Viral infections include warts, molluscum contagiosum, condylomata acuminata, herpes simplex virus, and herpes zoster.

* Warts, benign epidermal growths, are caused by the human papillomavirus.

* They are most common in children and young adults, but can occur at any age. They are generally seen on the hands, periungual area, and plantar surfaces.

* Common warts (verruca vulgaris) are elevated, well circumscribed, and vary in size from pinhead to 10 mm.

* Spontaneous resolution is common.

* Treatment includes salicylic acid, liquid nitrogen, light electrocautery, dissection for large or resistant lesions, and intralesional bleomycin sulfate when other treatments fail.

* Plane warts (verruca plana, flat warts, juvenile warts) are slightly raised and irregular, smooth, or slightly hyperkeratotic.

* Multiple lesions generally appear with irregular distribution on the dorsa of the hands and face.

* Treatment includes tretinoin cream, liquid nitrogen, light touch electrocautery, 5-fluorouracil cream, and Aldara[R] gel.

* Nursing considerations are described in Table 1.

* Molluscum contagiosum is a benign tumor seen in skin and mucous membranes.

* It is caused by an unassigned pox virus and may spread through sexual or casual contact.

* A cheesy white material may be expressed upon manipulation; this material contains virus.

* Seen around the eyes and mouth in children. When seen in genital/anal areas of children, sexual abuse should be suspected.

* Seen on the face, think, and extremities in adults.

* Treatment includes curettage, cryosurgery, tretinoin, salicyclic acid, cantharidin, laser therapy, and Aldara gel.

* Nursing considerations are described in Table 1.

* Condylomata acuminata (anogenital/venereal warts) are highly contagious, sexually transmitted, and often seen in conjunction with other sexually transmitted diseases.

* They are caused by human papillomavirus.

* Genitalia and anorectal area, urethral, bladder, and oral mucosa may be affected.

* Lesions are discrete single or multiple papillary growths.

* White or gray in color, lesions may coalesce and form large cauliflower-like masses.

* Treatment includes trichloracetic acid, podophyllin, electrocautery, surgical excision, 5-fluorouracil, cryosurgery, laser therapy, and Aldara gel.

* Recurrence and reinfection are possible; therefore, long-term followup is recommended.

* Nursing considerations are described in Table 1.

* Herpes simplex virus includes cold sores, fever blisters, genital herpes, and herpetic whitlow caused by a specific virus and having both primary and secondary presentations.

* Types include herpes simplex virus type I (HSV-I), which is generally associated with oral lesions, and HSV-II, generally associated with genital infections. Virus remains in the nerve root ganglion and returns to the skin and produces a recurrence when exacerbated.

* Symptoms occur 3 to 7 days after contact.

* Tenderness, pain, mild parasthesias, and burning may be experienced prior to appearance of clinical lesions.

* Symptomatic treatment includes cool, moist compresses, and astringent compresses.

* Drug therapy includes acyclovir, valcyclovir, and famciclovir.

* Nursing considerations are described in Table 1.

* Herpes Zoster (shingles) is an acute vesicobullous eruption seen in a dermatomal distribution with sharp demarcation at the midline.

* It is caused by reactivation of varicella virus acquired during an episode of, or exposure to, chicken pox.

* Virus lies dormant in nerve root ganglion until reactivated.

* Occurs in 10% to 20% of all persons; can occur in all ages with incidence increasing with age.

* Factors that reactivate the virus include age, immunosuppressive drugs, lymphoma, fatigue, emotional upset, and radiation.

* Pre-emption symptoms (pain, pruritus or burning, flu-like symptoms, etc.) precede the eruption by 4 to 5 days.

* Eruption begins with erythematous, swollen plaques of various sizes and spreads to involve dermatome.

* Treatment includes acyclovir, valcyclovir, and famciclovir; vidarabine for severe infections; systemic corticosteroids to reduce postherpetic neuralgia; analgesics; cool compresses, astringent compresses; zinc oxide shake solutions.

* Nursing considerations are described in Table 1.

Marcia J. Hill, MSN, RN, is Dermatology Regional Clinical Coordinator, Genentech, Inc., Columbus, TX, and Editor, Dermatology Nursing.

Table 1. Nursing Considerations for Patients
with Cutaneous Infections

Nursing Diagnoses             Outcomes

Impaired skin integrity       Skin integrity has been
related to inflammatory       improved or maintained.
process.

High risk for impaired        Skin integrity is preserved.
skin integrity related to
exudates.

High risk for infection       No evidence of infection
related to inadequate         spread.
primary or secondary
defenses.

Body image disturbance        Patient exhibits
related to presence of        improved/positive body
lesions.                      1 image.

Pain related to infection.    Pain is relieved; need for
                              analgesics is decreased.

Impaired mobility related     Mobility is increased.
to pain and edema.

Nursing Diagnoses             Interventions

Impaired skin integrity       Assess lesions, remove crusts or
related to inflammatory       necrotic material before applying
process.                      medication; elevate and immobilize
                              affected extremity as indicated
                              (cellulitis/erysipelas).

High risk for impaired        Instruct patient and significant
skin integrity related to     others regarding good handwashing
exudates.                     technique; contain and eliminate
                              exudates with appropriate dressings.

High risk for infection       Instruct patient and significant
related to inadequate         other regarding importance of using
primary or secondary          good handwashing technique and
defenses.                     appropriate disposal of dressings to
                              avoid spread of infection; observe
                              for signs of spreading infection;
                              maintain good nutritional status.

Body image disturbance        Assess patient's perception of body
related to presence of        image; allow verbalization; give
lesions.                      positive feedback.

Pain related to infection.    Assess level of discomfort; intervene
                              appropriately to relieve any
                              discomfort (medications, elevation
                              and immobilization, compresses).

Impaired mobility related     Assess restriction in mobility
to pain and edema.            and cause; elevate to help relieve
                              edema.