nurseinfo nursing notes for bsc, msc, p.c. or p.b. bsc and gnm nursing
HERPES ZOSTER (SHINGLES) – Causes and Risk Factors, Clinical Manifestations, Treatment

HERPES ZOSTER (SHINGLES) – Causes and Risk Factors, Clinical Manifestations, Treatment 

HERPES ZOSTER (SHINGLES) – Causes and Risk Factors, Clinical Manifestations, Treatment

Herpes zoster, or shingles, is an acute inflammatory and infectious disorder that produces a painful vesicular eruption on bright red edematous plaques along the distribution of nerves from one or more posterior ganglia. This eruption follows the course of the cutaneous sensory nerve and is almost always unilateral.

 

CAUSES AND RISK FACTORS


  • Herpes zoster is caused by the varicella zoster virus
  • Most common in the elderly people
  • Patient with acquired immunodeficiency syndrome (aids)
  • Patient on immunosuppressant agents
  • Patient with a malignancy
  • Patient injury to the spine or a cranial nerve
  • Radiotherapy and chemotherapy
  • After major organ transplant


 

PATHOPHYSIOLOGY

Herpes virus reactivate varicella virus (latent infection present in sensory dorsal ganglia near brain and spinal cord) -------------

When latent infection reactivated – virus travel by way of peripheral nerves to skin ----------------

Virus multiplies and creates blisters

 

CLINICAL MANIFESTATIONS

In addition to vesicles and plaques, there may be irritation, itching, tenderness, fever, malaise, headache and pain; pain may be burning, stabbing/aching depending on the location of lesions, visceral involvement. Lesions may be very painful; the likelihood of pain increases with age.

Severe pain and burning occur for up to 48 hours before and during eruption. Residual pain may continue for weeks to months after lesions have disappeared are called post-therapeutic neuralgia, and itching are the main problems with herpes zoster.

The early vesicles, which contain serum, later may become purulent, rupture, and form crusts. The inflammation is usually unilateral, involving the thoracic, cervical or cranial nerves in a band like configuration. Lesions continue to erupt for 3-5 days. Then crust and dry. Recovery occurs in 2-3 weeks.

 

TREATMENT


  1. Treatment is aimed at controlling the outbreak, reducing pain and discomfort and preventing complications.
  2. Antiviral drugs, such as acyclovir (zovirax), famiclovir (famvir), and valacyclovir (valtrex), interfere with viral replication.
  3. Pain management; aspirin, acetaminophen, NSAIDs, opioids are useful during the acute stage, but not generally effective for post-therapeutic neuralgia.
  4. Topical steroids should not be applied if a secondary infection is present because they suppress the immune system
  5. Trimcinolone (aristocort, kenacort, kenalog) injected subcutaneously under painful areas is effective as an anti-inflammatory agent.
  6. Antihistamines are administered to control itching. Antibiotics are prescribed for secondary bacterial infections.


 

NURSING DIAGNOSIS FOR SKIN INFECTIONS


  1. Acute pain may be related to presence of localized inflammation and open lesions
  2. Risk for (secondary) infection: risk factors may include broken/traumatized tissue, altered immune response, and untreated infection/treatment failure
  3. Risk for ineffective sexuality pattern: risk factors may include lack of knowledge, values conflict, and/or fear of transmitting the disease


 

NURSING INTERVENTIONS


  1. Monitor location, duration and intensity of pain. Monitor for adverse effects of pain medications.
  2. Assess patient’s level of discomfort and medicate as prescribed
  3. Teach patient to apply wet dressings for soothing effect
  4. Encourage distraction techniques such as music therapy
  5. Teach relaxation techniques, such as deep breathing, progressive muscle relaxation, and imagery, to help control pain
  6. Administer antiviral medication in dosage prescribed (usually high dose)
  7. Apply antibacterial ointments (after acute stage) as prescribed, to soften and separate adherent crusts and prevent secondary infection
  8. Administer anti pruritic medication. Apply wet compresses and calamine lotion
  9. Teach patient to use proper hand-washing technique, to avoid spreading herpes zoster virus
  10. Advise patient not to open the blisters, to avoid secondary infection and scarring
  11. Advice the patient to observe signs of systematic infection i.e. fever, malaise, headache, increased redness, formation and drainage of pustules.
  12. Maintain strict isolation. Wear gown and gloves if contact has to be established with patient
  13. Keep patient’s room cool and avoid heavy clothes and bedding