Herpes Zoster Shingles

Herpes Zoster Shingles Nursing Care Plans and Diagnosis Interventions

Herpes Zoster Shingles NCLEX Review Care Plans

Nursing Study Guide on Herpes Zoster Shingles Infection

Herpes zoster infection, commonly known as shingles, occurs after the reactivation of the primary infection, chicken pox, or varicella zoster infection.

A person who had chicken pox infection in the past will have the virus Varicella zoster lay dormant into the nerve tissues next to the brain and spinal cord.

The virus stays there without causing any problems until it is reactivated by unknown causes later in life.

Once activated, it results to a painful maculopapular rash called herpes zoster.

Signs and Symptoms of Herpes Zoster Shingles Infection

Unilateral rash – painful; contains both flat and raised skin lesions. The rash usually starts as a raised blotch. It will then transform into blisters and will dry out a few more days later.

The rash does not usually appear on the midline of the body. If the rash appears on both sides of the body, then most likely it is not herpes zoster infection.

Aside from the rash that typically appears in herpes zoster infection, the following may be noted:

  • Fever
  • Chills
  • Headache
  • Stabbing or shooting pain
  • Tingling of the skin
  • Photophobia
  • Body malaise

Causes of Herpes Zoster Shingles Infection

The primary cause of shingles is a previous varicella-zoster infection. It is a common childhood illness, but adults can develop it, too.

After the virus runs its course of the disease, the virus then hides and stay latent in the nerve tissues.

It is still unknown as to what reactivates it later in life. However, it is believed that the following risk factors can explain the reactivation:

  • Age 50 years and above
  • Stress
  • Other conditions that cause weak immune system like HIV
  • Serious physical injury
  • Long-term steroid use as it weakens the immune system

Though these risk factors appear to be true, there are still cases that happen without the presence of any of the risk factors stated above.

Diagnosis of Herpes Zoster Shingles Infection

  • Physical examination and history taking – the characteristic rash is usually enough to suspect herpes zoster infection. Support from history taking and physical assessment often confirms the diagnosis. History of previous chicken pox infection is noted; pain and other signs and symptoms associated with herpes zoster infection are observed
  • Other skin diseases will need to be ruled out if the rash and history is not conclusive to make a diagnosis.

Complications of Herpes Zoster Shingles Infection

Herpes zoster infection in itself does not cause life threatening conditions. However, it can cause serious complications such as:

  1. Loss of eyesight. The rash associated with herpes zoster can appear on the face particularly, near the eyes. When this happens, it can cause problems in the eyes such as redness, swelling, glaucoma, and in severe cases, serious nerve damage causing blindness.
  2. Ramsay-Hunt Syndrome. Ramsay hunt syndrome is a condition where there is paralysis of the facial muscles caused by the herpes zoster virus. It is normally suspected when the rash appears on the face next to the ear.  Before the rash appears, symptoms including loss of balance, loss of hearing, nausea and vomiting, vertigo, and ear pain can be noted.

A person with herpes zoster infection is contagious until all the rash crust over. It is then important to avoid pregnant women and people with weak immune system.

Treatment of Herpes Zoster Shingles Infection

  1. Antivirals. Antiviral medications are prescribed to be taken within 72 hours of diagnosis. They slow down the progress of the rash and prevent complications.  
  2. Analgesia. The characteristic rash associated in herpes zoster infection is very painful. Over-the-counter painkillers are commonly given to relieve the discomfort caused by the pain.
  3. Capsaicin cream can also be prescribed for pain after the rash dries out. Post herpetic neuralgia is the burning pain experienced by the patient when the herpes zoster rash clears off.
  4. Antibiotics. If the rash leads to other skin breakdown which then gets infected, antibiotics is prescribed. However, if bacterial infection is not detected, then it is not needed.
  5. Tricyclic antidepressants. Sometimes the physician prescribes these to help ease the pain after the rash clears away. They can also help with depression.
  6. Skin care. It is important to keep the affected area clean, dry, and exposed to air as much as possible.

Prevention of Herpes Zoster Shingles Infection

Vaccines are available to prevent shingles. At present, there are two vaccines available in the market, Shingrix and Zostavax.

Shingrix is the preferred vaccine as it is 90% effective in preventing shingles.

It is recommended to be given to healthy individuals aged 50 year and above.

The Shingrix vaccine is given twice, with 2-6 months interval in between the doses.

It can be given even if the person has had shingles before.

Nursing Care Plans for Herpes Zoster Infection

Nursing Care Plan 1

Nursing Diagnosis: Impaired Skin Integrity related to infection of the skin secondary to herpes zoster infection, as evidenced by temperature of 39 degrees Celsius, chills, headache, stabbing or shooting pain, tingling of the skin, photophobia, and body malaise

Desired Outcome: The patient will re-establish healthy skin integrity by following treatment regimen for herpes zoster infection.

InterventionRationale
Assess the patient’s skin on his/her whole body.To determine the severity of herpes zoster infection and any affected areas that require special attention or wound care.
Isolate the patient in his/her room ideally during the first 48 hours since the appearance of blisters.Herpes zoster infection is an infectious/ communicable skin disease to people who have not had chickenpox before. It is also harmful for pregnant women as it can affect the unborn baby.
The affected area should be washed first in warm water, wet compresses may also be used. This is followed by the application of the prescribed antipruritic cream or ointment directly to the affected areas.Cleansing the skin and applying the topical antipruritic cream promotes relief of itchiness due to shingles.
Administer antiviral medication as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician.Herpes zoster infection is generally treated through the use of antiviral therapy. If the rash leads to other skin breakdown which then gets infected, antibiotics is prescribed. Application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antiviral therapy for at least 7 days.
Educate the patient and caregiver about proper skin care through washing the rash with soap and water. Advise the patient and caregiver to prevent scratching the affected areas.It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The unilateral rash may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent worsening of the infection.
Teach the patient/ caregiver the proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.Proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.

Nursing Care Plan 2

Nursing Diagnosis: Risk for Infection related to contagious skin infection

Desired Outcome: The patient will prevent spread of infection to the rest of the body, as well as cross-contamination to other people by following treatment regimen for herpes zoster infection.

InterventionRationale
Assess the patient’s skin on his/her whole body.To determine the severity of herpes zoster infection and any affected areas that require special attention or skin care.
Isolate the patient in his/her room ideally during the first 48 hours since the appearance of blisters.Herpes zoster infection is an infectious/ communicable skin disease to people who have not had chickenpox before. It is also harmful for pregnant women as it can affect the unborn baby.
Administer antiviral medication as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician.Herpes zoster infection is generally treated through the use of antiviral therapy. If the rash leads to other skin breakdown which then gets infected, antibiotics is prescribed. Application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.
Educate the patient and caregiver about proper wound hygiene through washing the rash with soap and water.It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The rash may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent worsening and spread of the infection.
Trim the patient’s fingernails and ensure frequent hand hygiene. Advise the patient and caregiver to prevent scratching the affected areas.Long fingernails tend to harbor more bacteria. Scratching the infected skin areas will allow the bacteria to transfer into the fingernails and onto the fingerpads. When the patient touches other people or objects with infected hands, the infection will likely spread.
Teach the patient/ caregiver the proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.Proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.

Other possible nursing diagnoses:

  • Disturbed Body Image
  • Anxiety
  • Knowledge Deficit

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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