Shingles Assessments, Interventions, and Core Rationales

Shingles Assessments, Best Interventions, and Core Rationales

Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus (VZV)—the same virus that causes chickenpox. After recovering from chickenpox, the virus remains dormant in the dorsal nerve root ganglia of sensory cranial and spinal nerves. When the immune system weakens due to aging, stress, or illness, the virus can reactivate, leading to a painful rash that follows the path of the affected nerve. The condition is contagious to those who have never had chickenpox or the chickenpox vaccine, potentially causing them to develop chickenpox (not shingles).

Although shingles is caused by VZV, it is different from herpes simplex virus (HSV), which causes cold sores (HSV-1) and genital herpes (HSV-2).

Shingles is diagnosed through visual examination, a Tzanck smear, or viral culture.

As a nurse, when assessing a patient with shingles, one of the first things you will likely notice is vesicles along peripheral sensory nerves, which are typically clustered on one side of the body—often on the trunk, thorax, or face. This is a key characteristic of herpes zoster. Since the fluid inside these vesicles contains the varicella-zoster virus, it is crucial to maintain standard precautions and implement contact precautions until the vesicles have dried up. This helps prevent the virus from spreading to others, especially those who have never had chickenpox or are immunocompromised.

Now, the patient may also experience fever and malaise, which are signs of systemic involvement. This means we need to closely monitor for signs of infection, particularly skin and eye infections, as well as any indication of skin necrosis. Shingles can sometimes lead to secondary bacterial infections, so early detection is essential.

Another hallmark symptom of shingles is burning pain, which can be quite severe. The affected nerves become inflamed, making the skin extremely sensitive to touch and temperature changes. To help alleviate this, we can use an air mattress and a bed cradle to prevent unnecessary pressure on the skin. Additionally, keeping the environment cool is important because warmth and touch can worsen the pain.

Patients may also report paresthesia, which is a tingling or numb sensation in the affected area. Since shingles affects nerves, we need to assess neurovascular status and evaluate seventh cranial nerve function, especially if the rash is on the face. This is because Bell’s palsy, which causes facial paralysis, is a possible complication of herpes zoster.

Another common symptom is pruritus, or itching. While it may be tempting for the patient to scratch, this can break the skin, leading to bacterial infections and delayed healing. We must educate the patient on avoiding scratching and rubbing the affected area.

Additionally, they should wear lightweight, loose-fitting clothing to minimize irritation—materials like wool or synthetic fabrics can be harsh on the skin and worsen discomfort.

To further promote healing and comfort, astringent compresses may be prescribed to help with irritation and pain while also encouraging crust formation. Patients should also be taught the importance of keeping the skin clean to prevent secondary infections.

Lastly, prevention is key. The shingles vaccine is recommended for individuals 50 years and older to significantly reduce the risk of developing shingles and its associated long-term complications.

For shingles vesicles, the appropriate dressing depends on the stage of the rash and whether the lesions are open or crusted.

For Open Vesicles:

Moist (Non-Adherent) Dressings is used such as *Non-Adherent Gauze (e.g., Adaptic, Telfa) -prevents the dressing from sticking to the blisters and minimizes pain when changing it.

*Sterile Hydrocolloid or Hydrogel Dressings  - Help maintain a moist wound environment, promoting healing and preventing scabbing.

For crusted lesions it is better to use a Dry Sterile Gauze – Used once vesicles have dried and crusted over to protect the area from irritation.

For Medicated or Cooling Dressings

• An Astringent Compresses is used such as (Burow’s Solution or Domeboro Soaks) . This Help dry out vesicles, reduce inflammation, and relieve itching.

• A Cool, Moist Compresses will Soothe discomfort and prevent excessive dryness.

The primary medications for shingles (herpes zoster) include:

1.    Antiviral Medications (Start within 72 hours of rash onset)

• Acyclovir (Zovirax) – Given orally or IV in severe cases

• Valacyclovir (Valtrex) – More effective and requires fewer doses than acyclovir

These help reduce viral replication, speed up healing, lessen pain, and lower the risk of postherpetic neuralgia (PHN).

2. Pain Management

Since shingles causes nerve pain, various pain relievers may be prescribed:

• NSAIDs & Acetaminophen for mild to moderate pain

• Opioids For severe pain if necessary

3. Medications for Postherpetic Neuralgia (PHN)

If nerve pain persists after the rash heals

• Gabapentin (Neurontin) or Pregabalin (Lyrica) is given to Reduce nerve pain and tingling sensations

4. Corticosteroids (Use with Caution)

Prednisone is Sometimes given with antivirals to reduce inflammation, especially in severe cases like herpes zoster ophthalmicus

5. Antiviral Eye Drops (For Eye Involvement)

• Trifluridine and Corticosteroid eye drops are used.

6. For pruritus

*Calamine Lotion, Astringent Compresses, Oral Antihistamines

         Such as Diphenhydramine (Benadryl) are often prescribed to the patient

Possible complications include:

1. Postherpetic Neuralgia. A Persistent nerve pain that lasts for months or even years after the rash has healed. This is the most common complication, especially in older adults.

2. Secondary skin infections

3. Ophthalmic zoster occurs if shingles affects the eye.

4. Neurological complications such as bell’s palsy

5. Hearing Loss and Vertigo

6. And in rare cases a disseminated herpes zoster in immunocompromised individuals, wherein the virus can spread to multiple organs, such as the lungs, liver, and brain.