Herpes Zoster Shingles Infection, Diagnosis of Herpes Zoster Shingles Infection, Treatment of Herpes Zoster Shingles Infection, Prevention of Herpes Zoster Shingles Infection, and 4 Nursing Care Plan Examples for Herpes Zoster Shingles Infection.

Herpes Zoster Shingles Infection, Diagnosis of Herpes Zoster Shingles Infection, Treatment of Herpes Zoster Shingles Infection, Prevention of Herpes Zoster Shingles Infection, and 4 Nursing Care Plan Examples for Herpes Zoster Shingles Infection.

This study guide is about herpes zoster shingles infection, diagnosis of herpes zoster shingles infection, treatment of herpes zoster shingles infection, prevention of herpes zoster shingles infection, and 4 nursing care plan examples for herpes zoster shingles Infection. Use it to create educational nursing care plans for zoster shingles.

Herpes Zoster Shingles Infection

What is herpes zoster shingles infection?

Herpes Zoster Shingles Infection, Diagnosis of Herpes Zoster Shingles Infection, Treatment of Herpes Zoster Shingles Infection, Prevention of Herpes Zoster Shingles Infection, and 4 Nursing Care Plan Examples for Herpes Zoster Shingles Infection.
Herpes Zoster Shingles Infection

Herpes zoster infection, commonly known as shingles, occurs after the reactivation of the primary infection, chickenpox, or varicella-zoster infection. A person who had chickenpox infection in the past will have the virus Varicella zoster lay dormant into the nerve tissues next to the brain and spinal cord. The virus stays there without causing any problems until it is reactivated by unknown causes later in life. Once activated, it results in a painful maculopapular rash called herpes zoster.

What are the signs and symptoms of herpes zoster shingles infection?

Unilateral rash – painful; contains both flat and raised skin lesions. The rash usually starts as a raised blotch. It will then transform into blisters and will dry out a few more days later. The rash does not usually appear on the midline of the body. If the rash appears on both sides of the body, then most likely it is not herpes zoster infection. Aside from the rash that typically appears in herpes zoster infection, the following may be noted:

  • Fever
  • Chills
  • Headache
  • Stabbing or shooting pain
  • Tingling of the skin
  • Photophobia
  • Body malaise

What causes herpes zoster shingles infection?

The primary cause of shingles is a previous varicella-zoster infection. It is a common childhood illness, but adults can develop it, too. After the virus runs its course of the disease, the virus then hides and stays latent in the nerve tissues. It is still unknown as to what reactivates it later in life. However, it is believed that the following risk factors can explain the reactivation:

  • Age 50 years and above
  • Stress
  • Other conditions that cause weak immune system like HIV
  • Serious physical injury
  • Long-term steroid use as it weakens the immune system

Though these risk factors appear to be true, there are still cases that happen without the presence of any of the risk factors stated above.

Diagnosis of Herpes Zoster Shingles Infection

How do you diagnose herpes zoster shingles infection?

Herpes Zoster Shingles Infection, Diagnosis of Herpes Zoster Shingles Infection, Treatment of Herpes Zoster Shingles Infection, Prevention of Herpes Zoster Shingles Infection, and 4 Nursing Care Plan Examples for Herpes Zoster Shingles Infection.
Diagnosis of Herpes Zoster Shingles Infection
  • Physical examination and history taking – the characteristic rash is usually enough to suspect herpes zoster infection. Support from history taking and physical assessment often confirms the diagnosis. History of previous chickenpox infection is noted; pain and other signs and symptoms associated with herpes zoster infection are observed
  • Other skin diseases will need to be ruled out if the rash and history is not conclusive to make a diagnosis.

What happens when herpes zoster shingles infection is left untreated?

Herpes zoster infection in itself does not cause life-threatening conditions. However, it can cause serious complications such as:

  1. Loss of eyesight. The rash associated with herpes zoster can appear on the face particularly, near the eyes. When this happens, it can cause problems in the eyes such as redness, swelling, glaucoma, and in severe cases, serious nerve damage causing blindness.
  2. Ramsay-Hunt Syndrome. Ramsay Hunt Syndrome is a condition where there is paralysis of the facial muscles caused by the herpes zoster virus. It is normally suspected when the rash appears on the face next to the ear.  Before the rash appears, symptoms including loss of balance, loss of hearing, nausea and vomiting, vertigo, and ear pain can be noted.

A person with herpes zoster infection is contagious until all the rash crust is over. It is then important to avoid pregnant women and people with weak immune systems.

Treatment of Herpes Zoster Shingles Infection

What are the available treatment options for a patient suffering from herpes zoster shingles infection?

Treatment of Herpes Zoster Shingles Infection
Skincare
  1. Antivirals. Antiviral medications are prescribed to be taken within 72 hours of diagnosis. They slow down the progress of the rash and prevent complications.
  2. Analgesia. The characteristic rash associated with herpes zoster infection is very painful. Over-the-counter painkillers are commonly given to relieve the discomfort caused by the pain.
  3. Capsaicin cream can also be prescribed for pain after the rash dries out. Postherpetic neuralgia is the burning pain experienced by the patient when the herpes zoster rash clears off.
  4. Antibiotics. If the rash leads to another skin breakdown which then gets infected, antibiotics are prescribed. However, if the bacterial infection is not detected, then it is not needed.
  5. Tricyclic antidepressants. Sometimes the physician prescribes these to help ease the pain after the rash clears away. They can also help with depression.
  6. Skincare. It is important to keep the affected area clean, dry, and exposed to air as much as possible.

Prevention of Herpes Zoster Shingles Infection

How can herpes zoster infection shingles be prevented?

Vaccines are available to prevent shingles. At present, there are two vaccines available in the market, Shingrix, and Zostavax. Shingrix is the preferred vaccine as it is 90% effective in preventing shingles. It is recommended to be given to healthy individuals aged 50 years and above. The Shingrix vaccine is given twice, with a 2-6 months interval in between the doses. It can be given even if the person has had shingles before.

4 Nursing Care Plan Examples for Herpes Zoster Shingles Infection

What are some of the available nursing care plans for Herpes Zoster Infection?

Nursing Care Plan 1

Nursing Diagnosis: Impaired Skin Integrity related to infection of the skin secondary to herpes zoster infection, as evidenced by a temperature of 39 degrees Celsius, chills, headache, stabbing or shooting pain, tingling of the skin, photophobia, and body malaise

Desired Outcome: The patient will re-establish healthy skin integrity by following a treatment regimen for herpes zoster infection.

Intervention Rationale
Assess the patient’s skin on his/her whole body. To determine the severity of herpes zoster infection and any affected areas that require special attention or wound care.
Isolate the patient in his/her room ideally during the first 48 hours since the appearance of blisters. Herpes zoster infection is an infectious/ communicable skin disease to people who have not had chickenpox before. It is also harmful to pregnant women as it can affect the unborn baby.
The affected area should be washed first in warm water, wet compresses may also be used. This is followed by the application of the prescribed antipruritic cream or ointment directly to the affected areas. Cleansing the skin and applying the topical antipruritic cream promotes relief of itchiness due to shingles.
Administer antiviral medication as prescribed. Ensure that the patient finishes the course of antibiotics prescribed by the physician. Herpes zoster infection is generally treated through the use of antiviral therapy. If the rash leads to other skin breakdowns which then get the skin infected, antibiotics are prescribed. Application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antiviral therapy for at least 7 days.
Educate the patient and caregiver about proper skincare through washing the rash with soap and water. Advise the patient and caregiver to prevent scratching the affected areas. It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The unilateral rash may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent the worsening of the infection.
Teach the patient/ caregiver the proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.

Nursing Care Plan 2

Nursing Diagnosis: Risk for Infection related to a contagious skin infection

Desired Outcome: The patient will prevent the spread of infection to the rest of the body, as well as cross-contamination to other people by following a treatment regimen for herpes zoster infection.

Intervention Rationale
Assess the patient’s skin on his/her whole body. To determine the severity of herpes zoster infection and any affected areas that require special attention or skincare.
Isolate the patient in his/her room ideally during the first 48 hours since the appearance of blisters. Herpes zoster infection is an infectious/ communicable skin disease to people who have not had chickenpox before. It is also harmful to pregnant women as it can affect the unborn baby.
Administer antiviral medication as prescribed. Ensure that the patient finishes the course of antibiotics prescribed by the physician. Herpes zoster infection is generally treated through the use of antiviral therapy. If the rash leads to other skin breakdowns which then gets the skin infected, antibiotics are prescribed. Application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.
Educate the patient and caregiver about proper wound hygiene through washing the rash with soap and water. It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The rash may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent the worsening and spread of the infection.
Trim the patient’s fingernails and ensure frequent hand hygiene. Advise the patient and caregiver to prevent scratching the affected areas. Long fingernails tend to harbor more bacteria. Scratching the infected skin areas will allow the bacteria to transfer into the fingernails and onto the fingerpads. When the patient touches other people or objects with infected hands, the infection will likely spread.
Teach the patient/ caregiver the proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.

Nursing Care Plan 3

Nursing Diagnosis

  • Acute Pain
  • Chronic Pain

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 the affected nerve

Desired Outcomes

  • The client will be comfortable as evidenced by the ability to rest.
  • The 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).

Nursing Care Plan 4

Nursing Diagnosis

  • Risk for Disturbed Body Image

May be related to

  • Preoccupation with a changed body part
  • Visible skin lesions

Possibly evidenced by

  • [not applicable]

Desired Outcomes

  • The client will verbalize feelings about lesions and continues daily activities.
  • The client will demonstrate positive body image, as evidenced by the ability to look at, talk about, and care for lesions.
Nursing Interventions Rationale
Assess the client’s perception of his or her changed appearance. Because the course of an outbreak may span several weeks, clients typically need to work or carry out their usual routine; they may require assistance coping with changes in appearance.
Note verbal references to skin lesions. Scarring may occur with repeated outbreaks or if lesions are infected. This may cause a preoccupation with appearance.
Discuss reasons for infectious isolation and procedures when indicated. Taking time to sit down and talk/listen to the client in the room decreases the feeling of isolation and loneliness.
Assist the client in articulating responses to questions from others regarding lesions and infectious risk. Clients may need some guidance in determining what to say to people who comment on the appearance of their skin. The rehearsal of set responses to anticipated questions may provide some reassurance.
Suggest the use of concealing clothing when lesions can be easily covered. This approach may help the client who is having problems adjusting to body-image changes.

Other possible nursing diagnoses:

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.

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