Nursing Care Plan (NCP) for Herpes Zoster – Shingles

Pathophysiology

Anyone who has had chickenpox may get herpes zoster (shingles). Shingles causes a painful rash that forms blisters along a single stripe. It can be located anywhere on the body, but only erupts on one side (unilateral). Shingles is not life-threatening, but is very painful and can be treated with early diagnosis. Complications that may arise from a shingles infection include vision loss, hearing or balance problems, or postherpetic neuralgia, a longstanding pain in the area of the outbreak after the disease has cleared. It may last months or years after having the disease. Shingles occurs most often in older adults.

Etiology

Herpes zoster is an infectious condition  of the same virus (varicella-zoster virus, VZV) that causes chickenpox.  After having chickenpox, the virus lies dormant in the nerve tissue until it is reactivated as shingles. The reason for reactivation is not completely clear, but some scientists believe that it may be related to a lowered immunity to infections. The disease is very contagious and can be passed to anyone who has not had chickenpox or the chickenpox vaccine through direct contact with the open sores of a shingles rash.

Desired Outcome

Promote optimal comfort and managed pain, prevention of complications, promote skin healing

Herpes Zoster – Shingles Nursing Care Plan

Nursing Interventions and Rationales

• Assess pain level
  • Note location and quality of pain
  • Duration
  • Non-verbal clues
  • Relieving factors

• Apply cool moist dressings to lesions while in vesicle stage. Discontinue once lesions begin to crust.

• Administer medications and apply topical steroids, antihistamines and analgesics as necessary

• Assess for signs / symptoms of bacterial infections on skin and obtain culture and sensitivity test as indicated

• Initiate contact precautions
  • Wear and encourage visitors to wear appropriate PPE
  • Limit visitors, especially those who may be at high risk (elderly, pregnant, infants, anyone who has not had chickenpox or chickenpox vaccine)
  • Cluster care and anticipate needs

• Assess for changes in vision and rash on forehead or nose

References

• https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/herpes-zoster#v1019800
• https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054
• https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054
• https://www.aafp.org/afp/2002/1101/p1723.html