Nursing Care Plan for Herpes Zoster – Shingles

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Pathophysiology

Anyone who has had chickenpox may get herpes zoster (shingles). Shingles causes a painful rash that forms blisters along a single stripe. It can be located anywhere on the body, but only erupts on one side (unilateral). Shingles is not life-threatening, but is very painful and can be treated with early diagnosis. Complications that may arise from a shingles infection include vision loss, hearing or balance problems, or postherpetic neuralgia, a longstanding pain in the area of the outbreak after the disease has cleared. It may last months or years after having the disease. Shingles occurs most often in older adults.

Etiology

Herpes zoster is an infectious condition  of the same virus (varicella-zoster virus, VZV) that causes chickenpox.  After having chickenpox, the virus lies dormant in the nerve tissue until it is reactivated as shingles. The reason for reactivation is not completely clear, but some scientists believe that it may be related to a lowered immunity to infections. The disease is very contagious and can be passed to anyone who has not had chickenpox or the chickenpox vaccine through direct contact with the open sores of a shingles rash.

Desired Outcome

Promote optimal comfort and managed pain, prevention of complications, promote skin healing

Herpes Zoster – Shingles Nursing Care Plan

Subjective Data:

  • Pain, burning
  • Numbness, tingling
  • Itching
  • Headache
  • Sensitivity to light
  • Fatigue

Objective Data:

  • Rash that develops in clusters of vesicles
  • Rash follows dermatome (nerve pathway)

Nursing Interventions and Rationales

  • Assess pain level
    • Note location and quality of pain
    • Duration
    • Non-verbal clues
    • Relieving factors

 

Severe nerve (burning) pain is the primary complaint with preceding sensations of tingling or itching.

 

  • Apply cool moist dressings to lesions while in vesicle stage. Discontinue once lesions begin to crust.

 

Cool moist dressings can help relieve pain and itching and provide some protection against secondary infection or spread of disease to others

 

  • Administer medications and apply topical steroids, antihistamines and analgesics as necessary

 

  • Antivirals (acyclovir, valacyclovir)  are given to decrease the severity and duration of symptoms
  • Oral analgesics (opioids) are given to treat severe pain of acute phase;
  • Antidepressants and antiepileptic medications may be given to treat postherpetic neuralgia;
  • Topical steroids provide an anti-inflammatory effect;
  • Antihistamines help with itching, especially at bedtime;
  • Topical analgesics provide pain relief

 

  • Assess for signs / symptoms of bacterial infections on skin and obtain culture and sensitivity test as indicated

 

This test provides an indication for appropriate antibiotics if necessary for infection

 

  • Initiate contact precautions
    • Wear and encourage visitors to wear appropriate PPE
    • Limit visitors, especially those who may be at high risk (elderly, pregnant, infants, anyone who has not had chickenpox or chickenpox vaccine)
    • Cluster care and anticipate needs

 

The disease is spread through direct contact with open lesions; limiting contact with visitors and staff help reduce the risk of spreading the disease.

 

  • Assess for changes in vision and rash on forehead or nose

 

Shingles that affects the cranial or optic nerve can cause serious loss of vision. Treatment with oral antivirals is essential and must be started as soon as possible.

 


References

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