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.
Risk for Infection
May be related to
- Crusted-over lesions
- Itching and scratching
- Skin lesions (papules, vesicles, pustules)
Possibly evidenced by
- [not applicable]
- Client will remain free of secondary infection, as evidenced by intact skin without redness or lesions.
- Client will have minimal risk for disease transmission through the use of universal precautions.
|Assess for the presence and location of skin lesions.||Lesions are fluid-filled, becoming yellow and finally crusting over, on one side of the trunk or buttock. Lesions follow the path of dermatomes and occur in a band like strips. Lesions may occur also on the face, arms, and legs if nerves for these areas are involved. As lesions rupture and crust, they take on the appearance of the lesions associated with chickenpox.|
|Assess for pruritus or irritations from the lesions, and the amount of scratching. Assess for the signs of localized infection: redness and drainage from the lesions.||Secondary infection can occur because scratching opens pustules introduces bacteria.|
|Assess for lesions around the eye or ear.||Particular attention needs to be given to assessing lesions near the eyes and ears because the virus may cause serious damage to the eyes and ears. This can cause blindness or hearing difficulties. To detect lesions on the cornea, the physician or nurse practitioner will stain the cornea in the office with fluorescein stain and view the typical lesions under a Wood’s lamp.|
|Assess the client’s and family’s immunization status and past history of chickenpox.||Clients with shingles are contagious to others who have not had chickenpox. Those who have had varicella vaccine are considered immune but should have varicella titers to confirm immunity.|
|Obtain a culture and sensitivity test of the suspected infected lesions, as indicated.||A culture and sensitivity test provides an indication for appropriate antibiotic therapy.|
|Obtain additional cultures and blood work as indicated.||Viral cultures, Tzanck smear, or viral smear may be required for diagnosis. Serological diagnoses also may be obtained.|
|Teach contact isolation.||VZV is spread by contact with fluid from lesions containing viruses.|
|Instruct the client to avoid contact with pregnant women and immunocompromised individuals.||Active lesions can be infectious, and immunosuppressed individuals are more susceptible.|
|Use universal precautions in caring for the client to prevent transmission of disease to self or other clients.||VZV can be transmitted to others and cause chickenpox in the person who has not previously had the disease.|
|Suggest the use of gauze to separate the lesions in skin folds.||This reduces irritation, itching, and cross-contamination.|
|Discourage the scratching of lesions. Encourage the client to trim fingernails.||These measures prevent the inadvertent opening of lesions, cross-contamination, and bacterial infection.|
|Instruct the client in the use of antiviral medications, as prescribed.||Antiviral agents are most effective during the first 72 hours of an outbreak when viruses are proliferating. Drugs of choice are acyclovir, famciclovir, or valacyclovir.|
|Instruct the client in the use of systemic steroids, if ordered, for anti-inflammatory effect.||The use of steroids is controversial; they are most commonly used for severe cases.|
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