Herpes zoster, commonly known as shingles, is a viral infection that affects the nerve roots. It causes a painful rash that typically appears in a band or strip on one side of the body. Shingles can be very painful and uncomfortable, and if left untreated, it can lead to complications. Nursing diagnosis for herpes zoster (shingles) nursing care plans are essential for managing this condition. In this article, we will discuss effective strategies for managing this condition and preventing complications.
What is Herpes Zoster?
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):
Patients with herpes zoster or shingles often have deficient knowledge about their condition and the appropriate nursing care plans to manage it. This may be due to limited access to healthcare resources and a lack of education about the condition, leading to a poor understanding of their care needs.
- Deficient Knowledge
May be related to
- Complexity of treatment
- Emotional state affecting learning
- Herpes zoster outbreak
- New condition and procedures
Possibly evidenced by
- Inadequate follow-up of instructions
- Questioning members of healthcare team
- Verbalizing inaccurate information
- The client or caregiver will verbalize needed information regarding the disease, signs and symptoms, treatment, and possible complications of herpes zoster.
Nursing Assessment and Rationale
1. Determine the client’s and caregiver’s understanding of the disease condition, treatment, and complications.
It is important for the client and caregiver to understand that an occult disease may have weakened the client and allowed the expression of the herpes zoster.
2. Because of potential infectivity, determine whether the client’s caregiver or family has had chickenpox or varicella vaccine or is immunocompromised.
Even though varicella vaccine does not confer immunity to shingles, it is less common in varicella-vaccinated adults than those who have had chickenpox.
Nursing Interventions and Rationales
1. Provide necessary information to the client and caregiver, including written information:
Client may confuse terminology and confuse herpes zoster with genital herpes. Because the client may be reluctant to ask, clarify this point for the client. Clients must have a comprehensive understanding of their disease to actively participate in their own care.
- 1.1. Explanation of the need for isolation. Clients should isolate their clothing and linen, including towels.
- 1.2. Description of herpes zoster, including how the disease is spread. Fluids from lesions contain viruses, which are spread by direct contact.
- 1.3. Need to notify health care professionals of the signs of the central nervous system (CNS) inflammation (changes in the level of consciousness). Early assessment facilitates prompt treatment of complications.
2. Encourage herpes zoster vaccination (Zostavax).
This vaccination is recommended for individuals 60 years or older. It is not recommended for pregnant women or those with primary or acquired immunodeficiencies or any allergy to its components. A 50% decrease in future outbreaks and greater than 60% reduction in postherpetic neuralgia have been reported.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans affecting the integumentary system:
- Burn Injury | 11 Care Plans
- Dermatitis | 4 Care Plans
- Herpes Zoster (Shingles) | 4 Care Plans
- Pressure Ulcer (Bedsores) | 3 Care Plans