Week 8: Nursing Diagnosis

Nursing Considerations-Nursing Diagnoses

Acute pain
Fatigue
Impaired skin integrity
Risk for infection

Nursing Considerations-Expected Outcomes

Patients will:

express feelings of comfort and relief from pain
report increased levels of energy
maintain warm, dry, and intact skin with healed or improved lesions or wounds
remain free from signs and symptoms of secondary infections.

Nursing Considerations-Nursing Interventions

Notify the local health department immediately if you suspect monkeypox in a patient.
Institute a combination of standard, contact, and droplet precautions in all health care settings. Maintain airborne precautions until monkeypox is confirmed and smallpox is ruled out. Continue contact precautions until lesions are crusted.

Nursing Considerations-Associated Nursing Procedures

Combination of standard, contact, and droplet precautions
Immunization guidelines
Oral drug administration
Reportable diseases
Temperature assessment

 Nursing Alert:

Washing hand thoroughly after contact with an infected patients or contaminated object.

Place a patient in a private room. Use negative pressure room if available.

When transporting patient, place a mask over his/her mouth & nose, and cover exposed skin lesions with a sheet or gown.

If the patient is to remain at home, he/she should maintain the same precaution. 

Website: http://www.drugs.com/cg/monkeypox.html

Week 7: Nursing Care

Nursing Considerations-Nursing Diagnoses

*Acute pain *Fatigue *Impaired skin integrity *Risk for infection

Nursing Considerations-Expected Outcomes

*Express feelings of comfort and relief from pain *Report increased levels of energy
*Maintain warm, dry, and intact skin with healed or improved lesions or wounds
*Remain free from signs and symptoms of secondary infections.

Nursing Considerations-Nursing Interventions

*Notify the local health department immediately if you suspect monkeypox in a patient.
*Institute a combination of standard, contact, and droplet precautions in all health care settings. *Maintain airborne precautions until monkeypox is confirmed and smallpox is ruled out. 

*Continue contact precautions until lesions are crusted.

Nursing Considerations-Associated Nursing Procedures

*Contact precautions *Immunization guidelines *Oral drug administration *Reportable diseases
*Temperature assessment

Patient Teaching-General

*Disorder, diagnosis, and treatment, including information that the infection is usually self-limiting and resolves in 2 to 4 weeks
*Need to wear a mask over his nose and mouth and to cover exposed lesions with a sheet or gown when he's in contact with others
*Proper hand-washing practices *Comfort measures *Care of lesions, including the use of contact precautions until lesions are crusted
*Measures to reduce the risk of infection such as importing of exotic animals as pets.

 Providing supportive care

Care for a patient with monkeypox is supportive. Place him in a negative-pressure room (preferably) or a private room and initiate contact, droplet, and airborne precautions. Use a face shield or goggles if splashing or spraying of body fluids might occur. Strictly follow infection control protocols for hand hygiene and disinfection or disposal of equipment.

If a patient with monkeypox is recovering at home, he should be isolated in his home; he should stay in a private room and minimize contact with others if he has respiratory symptoms or lesions that aren't easily covered. 

 Teach his caregivers to follow strict hand hygiene and other infection control measures, including the use of personal protective equipment as appropriate. To prevent infection hazards from fomites, provide this advice to patients and their families:

* Don't shake bedding, towels, or clothing, which may release airborne droplets.

* Launder bedding and clothing with warm water in the washing machine and dryer. Bleach may be added, but isn't required.

* Don't share dishes or eating utensils with the patient. Clean the patient's dishes and utensils as usual in a dishwasher or by hand with soap and warm water.

* Clean and disinfect contaminated surfaces with a standard household disinfectant.

* Place soiled dressings and disposable medical equipment in a plastic bag and place it in another container for disposal with the household trash.

Week 6: Treatment

Currently, there is no proven, safe treatment for monkeypox. Smallpox vaccine has been reported to reduce the risk of monkeypox among previously vaccinated persons in Africa. CDC is recommending that persons investigating monkeypox outbreaks and involved in caring for infected individuals or animals should receive a smallpox vaccination to protect against monkeypox. 

Persons who have had close or intimate contact with individuals or animals confirmed to have monkeypox should also be vaccinated. These persons can be vaccinated up to 14 days after exposure. CDC is not recommending preexposure vaccination for unexposed veterinarians, veterinary staff, or animal control officers, unless such persons are involved in field investigations.

Vaccination with vaccinia virus (i.e. the smallpox vaccine) results in a significant amount of protection against infection with monkey pox. Still, the vaccine is currently not used in monkeypox-endemic areas due to the concerns about severe adverse events in an immunocompromised population. Furthermore, the eradication of monkeypox is not feasible because of the existence of an animal reservoir.

The Centers for Disease Control and Prevention recommends pre-exposure vaccination for individuals investigating animal or human monkeypox cases, people with the direct contact with animals that could carry the pathogen, health care workers taking care of the patients with monkeypox and laboratory workers who handle specimens that may contain this virus.

Close contact with patients during the disease outbreak represents the most significant risk factor for monkeypox virus infection. As specific treatment and vaccine are lacking, raising awareness about the risk factors and proper education about preventive measures are the only efficient ways to reduce the burden of this disease.

References: 
Monkeypox. (2011, February 1). Retrieved March 30, 2015, from http://www.who.int/mediacentre/factsheets/fs161/en/
 Updated Interim Infection Control and Exposure Management Guidance in the Health-Care and Community Setting for Patients with Possible Monkeypox Virus Infection. (2008, September 5). Retrieved March 31, 2015, from http://www.cdc.gov/ncidod/monkeypox/infectioncontrol.htm 

Week 5: Signs and Symptoms

What are the signs and symptoms of monkeypox?
In humans, the signs and symptoms of monkeypox are like those of smallpox, but usually they are milder. Another difference is that monkeypox causes the lymph nodes to swell.

About 12 days after people are infected with the virus, they will get a fever, headache, muscle aches, and backache; their lymph nodes will swell; and they will feel tired. One to 3 days (or longer) after the fever starts, they will get a rash. This rash develops into raised bumps filled with fluid and often starts on the face and spreads, but it can start on other parts of the body too. The bumps go through several stages before they get crusty, scab over, and fall off. The illness usually lasts for 2 to 4 weeks.

The incubation period (interval from infection to onset of symptoms) of monkeypox varies from 6 to 16 days.

The infection can be divided into two periods:

·         the invasion period (0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle ache) and an intense asthenia (lack of energy);

·         the skin eruption period where the various stages of the eruption appear on the face (in 95% of cases), on the palms of the hands and soles of the feet (75%) and on the body nearly simultaneously. Evolution of the rash from maculopapules (lesions with a flat bases) to vesicles (small fluid-filled blisters), pustules, followed by crusts occurs in approximately 10 days. Three weeks might be necessary before the complete elimination of the crusts. 

 

The number of the lesions varies from a few to several thousand, affecting oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (eyelid) (20%), as well as the cornea (eyeball).

Some patients develop severe lymphadenopathy (swollen lymph nodes) before the appearance of the rash. The presence of lymphadenopathy can help identify the disease as monkeypox since it is not characteristic of either smallpox or chickenpox.

The symptoms of monkeypox usually last from 14 to 21 days.

The case fatality has varied widely between epidemics but, has been less than 10% in documented cases. Most fatalities occur in young children. In addition, children may be more susceptible to monkeypox due to the termination of regular smallpox vaccinations following the worldwide eradication of the disease in 1980.

References:
Monkeypox. (2011, February 1). Retrieved March 30, 2015, from http://www.who.int/mediacentre/factsheets/fs161/en/
 Updated Interim Infection Control and Exposure Management Guidance in the Health-Care and Community Setting for Patients with Possible Monkeypox Virus Infection. (2008, September 5). Retrieved March 31, 2015, from http://www.cdc.gov/ncidod/monkeypox/infectioncontrol.htm