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):
Deficient Knowledge
Nursing Diagnosis
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 health care team
- Verbalizing inaccurate information
Desired Outcomes
- Client or caregiver will verbalize needed information regarding the disease, signs and symptoms, treatment, and possible complications of herpes zoster.
| Nursing Interventions | Rationale |
|---|---|
| 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. |
| 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. |
| 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. |
|
Clients should isolate their clothing and linen, including towels. |
|
Fluids from lesions contain viruses, which are spread by direct contact. |
|
Early assessment facilitates prompt treatment of complications. |
| 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. |
See Also
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