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):
Risk for Infection
Patients with herpes zoster or shingles are at risk for infection due to the open sores and blisters that can develop as part of the condition. The virus can be spread through direct contact with the blisters or through contact with the fluid that leaks from them, which can lead to secondary bacterial infections.
- Risk for Infection
May be related to
- Crusted-over lesions
- Itching and scratching
- Skin lesions (papules, vesicles, pustules)
Possibly evidenced by
- [not applicable]
- The client will remain free of secondary infection, as evidenced by intact skin without redness or lesions.
- The client will have minimal risk for disease transmission through the use of universal precautions.
Nursing Assessment and Rationale
1. 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 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.
2. 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 and introduces bacteria.
3. 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.
4. 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.
5. 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.
6. 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.
Nursing Interventions and Rationales
1. Teach contact isolation.
VZV is spread by contact with fluid from lesions containing viruses.
2. Instruct the client to avoid contact with pregnant women and immunocompromised individuals.
Active lesions can be infectious, and immunosuppressed individuals are more susceptible.
3. 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 a person who has not previously had the disease.
4. Suggest the use of gauze to separate the lesions in skin folds.
This reduces irritation, itching, and cross-contamination.
5. Discourage the scratching of lesions. Encourage the client to trim fingernails.
These measures prevent the inadvertent opening of lesions, cross-contamination, and bacterial infection.
6. Instruct the client on 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.
7. 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 in severe cases.
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