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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
• $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!
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
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.
"aricellazoster virus may be a lifethreatening condition to the patient who is
immunosuppressed! who is receiving cytotoxic chemotherapy! or who is a bone marrow
• ,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.
• #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.
• 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.
• 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
• "isceral dissemination678pneumonitis! esophagitis! enterocolitis! myocarditis!
• #cute or Chronic 9ain related to inflammation of cutaneous nerve endings
• &mpaired .kin &ntegrity related to rupture of vesicles
• #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.
• #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
• #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
• # 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