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Nursing Care Plan (NCP) for Herpes Zoster – Shingles

Nursing Care Plan (NCP) for Herpes Zoster – Shingles

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Study Tools For Nursing Care Plan (NCP) for Herpes Zoster – Shingles

Herpes Zoster (Shingles) (Picmonic)
Shingles Pathochart (Cheatsheet)

Outline

Lesson Objective for Herpes Zoster (Shingles) Nursing Care Plan

  • Understand the Pathophysiology:
    • Explain the pathophysiology of herpes zoster, including the reactivation of the varicella-zoster virus, its impact on nerve fibers, and the development of characteristic skin lesions.
  • Identify Etiological Factors:
    • Recognize and analyze the etiological factors that contribute to the development of herpes zoster, such as a history of chickenpox, immunocompromised status, and advancing age.
  • Establish Desired Outcome:
    • Define the desired outcomes of the nursing care plan, including pain management, prevention of complications, and promotion of healing to enhance the patient’s quality of life during and after the shingles episode.
  • Conduct Comprehensive Nursing Assessment:
    • Perform a thorough nursing assessment to identify the patient’s symptoms, pain level, psychological impact, and any potential complications. This assessment guides the development of an individualized care plan.
  • Develop and Implement Holistic Care Strategies:
    • Formulate and implement a comprehensive nursing care plan that encompasses pharmacological and non-pharmacological interventions for pain relief, skin care, emotional support, and patient education on managing and preventing recurrences.

Pathophysiology of Herpes Zoster (Shingles)

 

  • Varicella-Zoster Virus (VZV) Reactivation:
    • Herpes zoster is caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. After a primary infection (chickenpox), the virus remains dormant in sensory nerve ganglia.
  • Triggering Factors:
    • Reactivation often occurs when the immune system weakens due to factors such as aging, stress, immunosuppression, or other medical conditions, allowing the virus to travel along sensory nerves and reach the skin.
  • Neurological Involvement:
    • The virus primarily affects sensory nerves, leading to inflammation and irritation. This results in the characteristic pain, tingling, or burning sensations experienced by individuals with herpes zoster.
  • Dermatomal Distribution:
    • The virus follows a dermatomal distribution, affecting a specific segment of the skin supplied by a single sensory nerve. This is why shingles typically presents as a painful rash or blisters in a specific area on one side of the body.
  • Skin Lesions and Complications:
    • As the virus travels down the nerve fibers to the skin, it causes the development of vesicles and characteristic skin lesions. Complications may include postherpetic neuralgia, scarring, and, in severe cases, ocular involvement if the ophthalmic branch of the trigeminal nerve is affected.

Etiology of Herpes Zoster (Shingles)

 

  • Varicella-Zoster Virus (VZV) Primary Infection:
    • Herpes zoster is caused by the reactivation of the varicella-zoster virus, which initially infects individuals during primary exposure to chickenpox. After the primary infection, the virus remains latent in sensory ganglia.
  • Virus Reactivation:
    • Reactivation of the varicella-zoster virus occurs when the immune system is compromised, allowing the virus to escape from its dormant state and travel along sensory nerves to the skin.
  • Risk Factors for Reactivation:
    • Aging is a significant risk factor for herpes zoster as the immune system weakens with age. Other risk factors include stress, immunosuppression (e.g., due to HIV or immunosuppressive medications), and certain medical conditions.
  • Immunosuppression:
    • Conditions or treatments that suppress the immune system, such as chemotherapy, organ transplantation, or autoimmune diseases, increase the risk of varicella-zoster virus reactivation.
  • Close Contact with Varicella or Herpes Zoster Patients:
    • Close contact with individuals who have active varicella (chickenpox) or herpes zoster lesions can expose susceptible individuals to the virus and increase the risk of reactivation.

Desired Outcome for Herpes Zoster (Shingles)

 

  • Pain Relief:
    • Alleviate acute pain associated with the shingles rash, which can be severe and persistent. The goal is to enhance the individual’s comfort and quality of life.
  • Prevention of Complications:
    • Minimize the risk of complications, such as postherpetic neuralgia (PHN), bacterial skin infections, and ocular involvement. Timely and appropriate management contributes to reducing potential complications.
  • Shorten Duration of Illness:
    • Promote the resolution of the acute phase of herpes zoster, aiming to minimize the duration of the illness. Early antiviral treatment can contribute to achieving this outcome.
  • Prevent Secondary Transmission:
    • Reduce the risk of secondary transmission of the varicella-zoster virus to susceptible individuals, especially those who have not been previously exposed or immunized. This involves appropriate precautions to prevent the spread of the virus.
  • Improve Quality of Life:
    • Enhance the overall quality of life for individuals affected by herpes zoster by addressing not only the physical symptoms but also the emotional and psychosocial impact of the illness.

Herpes Zoster – Shingles Nursing Care Plan

 

Subjective Data:

  • Pain, burning
  • Numbness, tingling
  • Itching
  • Headache
  • Sensitivity to light
  • Fatigue

Objective Data:

  • Rash that develops in clusters of vesicles
  • Rash follows dermatome (nerve pathway)

Nursing Assessment for Herpes Zoster (Shingles)

 

  • History of Present Illness:
    • Obtain a detailed account of the onset and progression of symptoms, including the appearance of the rash, associated pain, and any factors that may have triggered the outbreak.
  • Pain Assessment:
    • Assess the severity, location, and character of pain, as well as any factors that worsen or alleviate the pain. Utilize a pain scale for accurate measurement.
  • Skin Examination:
    • Inspect the affected areas for the characteristic rash, which often presents as a unilateral, painful, and vesicular eruption along a dermatomal distribution. Document the extent and appearance of lesions.
  • Neurological Assessment:
    • Evaluate sensory function in the affected dermatomes, looking for signs of hyperesthesia or hypoesthesia. Assess motor function if applicable, as motor nerves can be affected.
  • Vital Signs:
    • Monitor vital signs regularly, especially in older adults or individuals with underlying health conditions, to identify signs of systemic involvement or complications.
  • Ocular Assessment:
    • If lesions are present on the face, assess for ocular involvement. Herpes zoster ophthalmicus can lead to serious complications, including vision impairment.
  • Psychosocial Assessment:
    • Evaluate the impact of the illness on the individual’s mental and emotional well-being. Shingles can be emotionally distressing, especially if complications such as postherpetic neuralgia occur.
  • Immunization History:
    • Inquire about the individual’s immunization history, specifically regarding varicella-zoster virus vaccination. This information helps determine the likelihood of recurrent episodes.

Implementation for Herpes Zoster (Shingles)

 

  • Pain Management:
    • Administer prescribed analgesics to alleviate pain, considering the use of medications such as antiviral agents, nonsteroidal anti-inflammatory drugs (NSAIDs), and, in some cases, opioids.
  • Topical Treatments:
    • Apply prescribed antiviral or analgesic topical agents to the affected areas to help reduce discomfort and promote healing. Follow proper hygiene measures during application.
  • Isolation and Infection Control:
    • Implement isolation precautions to prevent the spread of the varicella-zoster virus, especially if the individual is in a healthcare setting. Educate the patient on personal hygiene practices to minimize transmission.
  • Wound Care:
    • Provide meticulous care for open lesions, including keeping the affected areas clean and dry. Instruct the patient on proper wound care techniques to prevent secondary infections.
  • Education and Support:
    • Educate the patient about the nature of the illness, including its course, potential complications, and the importance of completing the prescribed antiviral medication. Offer emotional support and address any concerns or questions.

Nursing Interventions and Rationales

 

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

 

Severe nerve (burning) pain is the primary complaint with preceding sensations of tingling or itching.

 

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

 

Cool moist dressings can help relieve pain and itching and provide some protection against secondary infection or spread of disease to others

 

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

 

  • Antivirals (acyclovir, valacyclovir)  are given to decrease the severity and duration of symptoms
  • Oral analgesics (opioids) are given to treat severe pain of acute phase;
  • Antidepressants and antiepileptic medications may be given to treat postherpetic neuralgia;
  • Topical steroids provide an anti-inflammatory effect;
  • Antihistamines help with itching, especially at bedtime;
  • Topical analgesics provide pain relief

 

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

 

This test provides an indication for appropriate antibiotics if necessary for infection

 

  • 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

 

The disease is spread through direct contact with open lesions; limiting contact with visitors and staff help reduce the risk of spreading the disease.

 

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

 

Shingles that affects the cranial or optic nerve can cause serious loss of vision. Treatment with oral antivirals is essential and must be started as soon as possible.

 

Evaluation for Herpes Zoster (Shingles)

 

  • Pain Assessment:
    • Regularly assess the intensity and nature of pain using appropriate pain scales. Evaluate the effectiveness of prescribed analgesics in managing pain and make adjustments as needed.
  • Healing Progress:
    • Monitor the healing process of lesions and affected areas. Assess for signs of resolution, reduction in redness, and the absence of new vesicles to determine the effectiveness of the treatment plan.
  • Infection Control:
    • Evaluate the success of infection control measures by assessing whether there are any new cases of varicella-zoster virus transmission, especially in healthcare settings or among close contacts of the affected individual.
  • Patient Education:
    • Assess the patient’s understanding of the disease, its potential complications, and the importance of completing the prescribed antiviral medication. Address any misconceptions or concerns and reinforce key educational points.
  • Psychosocial Well-being:
    • Evaluate the patient’s emotional well-being and coping mechanisms throughout the course of the illness. Assess for signs of anxiety or depression and provide additional support or referrals to mental health services if necessary.

References

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Nursing Care Plans

Concepts Covered:

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Study Plan Lessons

Nursing Care Plans Course Introduction
Purpose of Nursing Care Plans
How to Write a Nursing Care Plan
Using Nursing Care Plans in Clinicals
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Abdominal Pain
Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Activity Intolerance
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Acute Pain
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Alzheimer’s Disease
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Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Attention Deficit Hyperactivity Disorder (ADHD)
Nursing Care Plan (NCP) for Bell’s Palsy
Nursing Care Plan (NCP) for Benign Prostatic Hyperplasia (BPH)
Nursing Care Plan (NCP) for Bladder Cancer
Nursing Care Plan (NCP) for Blunt Chest Trauma
Nursing Care Plan (NCP) for Bone Cancer (Osteosarcoma, Chondrosarcoma, and Ewing Sarcoma)
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan (NCP) for Brain Tumors
Nursing Care Plan (NCP) for Breast Cancer
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Bronchoscopy (Procedure)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Cardiomyopathy
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Nursing Care Plan (NCP) for Cervical Cancer
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Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
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Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis
Nursing Care Plan (NCP) for Emphysema
Nursing Care Plan (NCP) for Encephalopathy
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Nursing Care Plan (NCP) for Hemophilia
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Nursing Care Plan (NCP) for Herpes Zoster – Shingles
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Hyperemesis Gravidarum
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
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Nursing Care Plan (NCP) for Impetigo
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Nursing Care Plan (NCP) for Influenza
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Nursing Care Plan (NCP) for Kidney Cancer
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Nursing Care Plan (NCP) for Lyme Disease
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Nursing Care Plan (NCP) for Marfan Syndrome
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Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Meconium Aspiration
Nursing Care Plan (NCP) for Meniere’s Disease
Nursing Care Plan (NCP) for Meningitis
Nursing Care Plan (NCP) for Migraines
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Multiple Sclerosis (MS)
Nursing Care Plan (NCP) for Mumps
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Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Nephrotic Syndrome
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Newborns
Nursing Care Plan (NCP) for Nutrition Imbalance
Nursing Care Plan (NCP) for Omphalocele
Nursing Care Plan (NCP) for Osteoarthritis (OA), Degenerative Joint Disease
Nursing Care Plan (NCP) for Osteoporosis
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Ovarian Cancer
Nursing Care Plan (NCP) for Pancreatitis
Nursing Care Plan (NCP) for Paranoid Disorders
Nursing Care Plan (NCP) for Parkinson’s Disease
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Personality Disorders
Nursing Care Plan (NCP) for Pertussis / Whooping Cough
Nursing Care Plan (NCP) for Phenylketonuria (PKU)
Nursing Care Plan (NCP) for Placenta Previa
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Pneumothorax/Hemothorax
Nursing Care Plan (NCP) for Polycystic Ovarian Syndrome (PCOS)
Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
Nursing Care Plan (NCP) for Postpartum Hemorrhage (PPH)
Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)
Nursing Care Plan (NCP) for Pressure Ulcer / Decubitus Ulcer (Pressure Injury)
Nursing Care Plan (NCP) for Preterm Labor / Premature Labor
Nursing Care Plan (NCP) for Process of Labor
Nursing Care Plan (NCP) for Prostate Cancer
Nursing Care Plan (NCP) for Psoriasis
Nursing Care Plan (NCP) for Pulmonary Embolism
Nursing Care Plan (NCP) for Renal Calculi
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care Plan (NCP) for Restrictive Lung Diseases
Nursing Care Plan (NCP) for Reye’s Syndrome
Nursing Care Plan (NCP) for Rhabdomyolysis
Nursing Care Plan (NCP) for Rheumatic Fever
Nursing Care Plan (NCP) for Rheumatoid Arthritis (RA)
Nursing Care Plan (NCP) for Risk for Fall
Nursing Care Plan (NCP) for Rubeola – Measles
Nursing Care Plan (NCP) for Schizophrenia
Nursing Care Plan (NCP) for Scoliosis
Nursing Care Plan (NCP) for Seizures
Nursing Care Plan (NCP) for Sepsis
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma
Nursing Care Plan (NCP) for Skull Fractures
Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Stomach Cancer (Gastric Cancer)
Nursing Care Plan (NCP) for Stroke (CVA)
Nursing Care Plan (NCP) for Suicidal Behavior Disorder
Nursing Care Plan (NCP) for Syncope (Fainting)
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Testicular Cancer
Nursing Care Plan (NCP) for Thoracentesis (Procedure)
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)
Nursing Care Plan (NCP) for Thyroid Cancer
Nursing Care Plan (NCP) for Tonsillitis
Nursing Care Plan (NCP) for Transient Tachypnea of Newborn
Nursing Care Plan (NCP) for Tuberculosis
Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)
Nursing Care Plan (NCP) for Varicella / Chickenpox
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan (NCP) for West Nile Virus
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)
Nursing Care Plan for (NCP) Trigeminal Neuralgia
Nursing Care Plan for Amputation
Nursing Care Plan for Chlamydia (STI)
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan for Compartment Syndrome
Nursing Care Plan for Coronary Artery Disease (CAD)
Nursing Care Plan for Distributive Shock
Nursing Care Plan for Endometriosis
Nursing Care Plan for Fibromyalgia
Nursing Care Plan for Fractures
Nursing Care Plan for Gastritis
Nursing Care Plan for Gonorrhea (STI)
Nursing Care Plan for Hemorrhoids
Nursing Care Plan for Herpes Simplex (HSV, STI)
Nursing Care Plan for Hiatal Hernia
Nursing Care Plan for Liver Cancer
Nursing Care Plan for Macular Degeneration
Nursing Care Plan for Myocarditis
Nursing Care Plan for Nasal Disorders
Nursing Care Plan for Newborn Reflexes
Nursing Care Plan for Osteomyelitis
Nursing Care Plan for Pelvic Inflammatory Disease (PID)
Nursing Care Plan for Pulmonary Edema
Nursing Care Plan for Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care Plan for Scleroderma
Nursing Care Plan for Syphilis (STI)
Nursing Care Plan for Testicular Torsion