4 Herpes Zoster (Shingles) Nursing Care Plans

August 22, 2017

Herpes zoster, also called shingles, is an infectious condition caused by varicella zoster virus (VZV), the same virus that causes varicella zoster (chickenpox). After a case of chickenpox run its course, the virus lies dormant in the ganglia of the spinal nerve tracts. Then the virus reactivates and travels along the peripheral nerves to the skin, where the viruses multiply and produce painful vesicular eruptions. It is most common in older adults and people who have weak immune systems.

Although VZV typically affects the trunk of the body, the virus may also be noted on the buttocks or face. If an ophthalmic nerve is involved, the client may potentially experience keratitis, ulceration and possibly blindness. Secondary infection resulting from scratching the lesions is common.

An individual with an outbreak of VZV is infectious for the first 2 to 3 days after the eruption. The incubation period ranges from 7 to 21 days. The total course of the disease is 10 days to 5 weeks from onset to full recovery. Some individuals may develop painful postherpetic neuralgia long after the lesions heal.

Shingles is characterized initially by a burning, tingling, numbness or itchiness of the skin in the affected area. VZV infection can lead to central nervous system (CNS) involvement; pneumonia develops in about 15% of cases. Approximately 20% of people who have had chickenpox will develop herpes zoster.

Nursing Care Plans

Major nursing goals for a client with shingles may include increased understanding of the disease condition and treatment regimen, relief of discomfort from the lesions, emphasis on strict contact isolation, development of self-acceptance, and absence of complications.

Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for patients with herpes zoster (shingles):

Acute/Chronic Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

Chronic Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain); sudden or slow onset of any intensity from mild to severe, constant or recurring without an anticipated or predictable end and a duration of greater than 6 months.

May be related to

Nerve pain (most commonly cervical, lumbar, sacral, thoracic, or ophthalmic division of trigeminal nerve)

Possibly evidenced by

Alteration in muscle tone
Facial mask of pain
Reports of burning, dull, or sharp pain
Reports of pain localized to affected nerve

Desired Outcomes

Client will be comfortable as evidenced by the ability to rest.
Client will report satisfactory pain control at levels less than 3 to 4 on a scale of 0 to 10.

Nursing Interventions	Rationale
Assess the client’s description of pain or discomfort: severity, location, quality, duration, precipitating or relieving factors.	The client may describe the pain as a tingling sensation, a burning pain, or extreme hyperesthesia in one area of the skin. These sensations usually precede the development of skin lesions by several days. Postherpetic neuralgia is a chronic pain syndrome that may continue after the skin lesions have healed. The client may have constant pain or intermittent episodes of pain.
Assess for nonverbal signs of pain or discomfort.	Each individual has his or her own pain threshold and ways to express pain or discomfort. Some individuals may deny the experience of pain when it is present. Attention to associated signs may help the nurse evaluate the pain.
Educate the client about the following measures:
Wear loose, nonrestrictive clothing made of cotton.	Constrictive, nonbreathing garments may rub lesions and aggravate skin irritation. Cotton clothing allows evaporation of moisture.
Apply cool, moist dressings to pruritic lesions with or without Burrow’s solution several times a day. Discontinue once the lesions have dried.	This provides relief and reduces the risk for secondary infection.
Avoid temperature extremes, in both the air and bathwater.	Tepid water causes the least itching and burning.
Avoid rubbing or scratching the skin or lesion.	Scratching stimulates the skin, which in turn increases itchiness. It can also increase the possibility of secondary infection.
Use topical steroids (anti-inflammatory effect), anti-histamines (anti-itching effect, particularly useful at bedtime), and analgesics.	A variety of medications may be required to provide relief.
Administer medications as indicated.	Oral opioid analgesics (codeine, hydrocodone) are typically prescribed during the acute phase. Analgesics, antidepressants, and antiepileptic may be used in the management of postherpetic neuralgia. Topical preparations of postherpetic neuralgia include capsaicin cream (Zostrix) and lidocaine-prilocaine cream (EMLA).