HERPES ZOSTER

Herpes zoster (shingles) is an inflammatory condition in which reactivation of the

chickenpox virus produces a vesicular eruption along the distribution of the nerves from
one or more dorsal root ganglia. The prevalence increases with age.
Pathophysiology and Etiology
Caused by a varicellazoster virus! which is a member of a group of
deoxyribonucleic acid viruses.
"irus is identical to the causative agent of varicella (chickenpox). #fter the
primary infection! the varicellazoster virus may persist in a dormant state in the
dorsal nerve root ganglia. The virus may emerge from this site in later years!
either spontaneously or in association with immunosuppression! to cause herpes
zoster.
Clinical Manifestations

$ruption may be accompanied or preceded by fever! malaise! headache! and pain%

pain may be burning! lancinating! stabbing! or aching.
&nflammation is usually unilateral! involving the cranial! cervical! thoracic!
lumbar! or sacral nerves in a bandlike configuration.
"esicles appear in ' to ( days.
o Characteristic patches of grouped vesicles appear on erythematous!
edematous skin.
o $arly vesicles contain serum% they later rupture and form crusts% scarring
usually does not occur unless the vesicles are deep and they involve the
dermis.
o &f ophthalmic branch of the facial nerve is involved! patient may have a
painful eye. (This can be a medical emergency.)
o &n healthy host! lesions resolve in ) to ' weeks.
# susceptible person can ac*uire chickenpox if he or she comes in contact with
the infective vesicular fluid of a zoster patient. # person with a history of
chickenpox or has received the immunization is immune and thus is not at risk
from infection after exposure to zoster patients.
+,-.&+/ #0$-T
"aricellazoster virus may be a lifethreatening condition to the patient who is
immunosuppressed! who is receiving cytotoxic chemotherapy! or who is a bone marrow
transplant recipient.
1iagnostic $valuation
,sually diagnosed by clinical presentation.
Culture of varicellazoster virus from lesions or detection by fluorescent antibody
techni*ues! including viral detection that uses monoclonal antibodies (2icroTrak)
or by electron microscopy! to confirm diagnosis.
Management
#ntiviral drugs! such as acyclovir (3ovirax)! famciclovir (4amvir)! and
valacyclovir ("altrex)! interfere with viral replication% may be used in all cases!
but especially for treatment of immunosuppressed or debilitated patients. 2ust be
started within 5) hours of onset.
Corticosteroids early in illness678given for severe herpes zoster if symptomatic
measures fail% given for antiinflammatory effect and for relief of pain.
Controversial.
9ain management% aspirin! acetaminophen! +.#&1s! opioids678useful during the
acute stage! but not generally effective for postherpetic neuralgia. &f treated early
((: to 5) hours)! may decrease risk of postherpetic neuralgia.
Complications
Chronic pain syndrome (postherpetic neuralgia)! characterized by constant aching
and burning pain or by intermittent lancinating pain or hyperesthesia of affected
skin after it has healed.
;phthalmic complications with involvement of ophthalmic branch of trigeminal
nerve with keratitis! uveitis! corneal ulceration! and possibly blindness.
4acial and auditory nerve involvement! resulting in hearing deficits! vertigo! and
facial weakness.
"isceral dissemination678pneumonitis! esophagitis! enterocolitis! myocarditis!
pancreatitis.
Nursing Diagnoses
#cute or Chronic 9ain related to inflammation of cutaneous nerve endings
&mpaired .kin &ntegrity related to rupture of vesicles
Nursing nter!entions
Controlling 9ain
#ssess patient<s level of discomfort and medicate as prescribed% monitor for
adverse effects of pain medications.
Teach patient to apply wet dressings for soothing effect.
$ncourage distraction techni*ues such as music therapy.
Teach relaxation techni*ues! such as deep breathing! progressive muscle
relaxation! and imagery! to help control pain.
&mproving .kin &ntegrity
#pply wet dressings to cool and dry inflamed areas by means of evaporation.
#dminister antiviral medication in dosage prescribed (usually high dose)% warn
the patient of adverse effects such as nausea.
9.==>?
#pply antibacterial ointments (after acute stage) as prescribed! to soften and
separate adherent crusts and prevent secondary infection.
9atient $ducation and Health 2aintenance
Teach patient to use proper handwashing techni*ue! to avoid spreading herpes
zoster virus.
#dvise patient not to open the blisters! to avoid secondary infection and scarring.
-eassure that shingles is a viral infection of the nerves% nervousness does not
cause shingles.
# caregiver may be re*uired to assist with dressings and meals. &n older persons!
the pain is more pronounced and incapacitating. 1ysesthesia and skin
hypersensitivity are distressing.
E!aluation" E#pected Outcomes
"erbalizes decreased pain
-eepithelialization of skin without scarring