01.04 Herpes Zoster – Shingles

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Reactivation of Herpes Zoster (Mnemonic)
Shingles Pathochart (Cheat Sheet)
Shingles on Neck (Image)
Shingles Dermatome (Image)
Shingles Progression (Image)
Shingles Dermatome on Chest (Image)
Herpes Zoster (Shingles) (Picmonic)

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This lesson is going to talk about the herpes zoster virus, better known as shingles. Now this is pretty straightforward, but it's something that affects a lot of our patients, so we want you to know the basics.

So Shingles is a viral infection caused by the herpes zoster virus. This virus is a sister to the varicella-zoster virus, which is chicken pox. So we most often see shingles in elderly patients who have either had chickenpox as a child or have received the chickenpox vaccine. it can happen in younger patients but we most often see it in people over the age of 60. It is especially likely to flare up if patient is somehow immunocompromised. Now this could mean something severe like cancer treatment or Aids, but most of the time it's something as simple as having an upper respiratory infection that weakens their immune system just enough for the virus to take hold. Just like chicken pox shingles is highly, highly contagious.

So what we'll see in a patient with shingles is a vesicular rash. What that means is that the rash is made up of these fluid filled vesicles. this rash is very painful and very itchy, and often comes with fatigue, malaise, and fever. However, what you really need to know is how to differentiate this from any other rash or illness. The way that we know this is shingles, is that it presents typically on one side of the body only, and it follows nerve Pathways. in the spinal cord injury lesson we talked about something called a dermatome. Dermatome is an area of the skin that is affected by a single spinal nerve. So, if this is the body, each nerve innervates one section of the skin. So, you can see here in this picture how the rash is linear and follows the dermatome for approximately the T3 to T4 spinal nerve. you could also see it in a line across the abdomen, or down the back of the arm. But either way, it typically is linear and unilateral, whereas chickenpox could be all over the body. That’s how we can tell that this is actually shingles

When we do see this type of rash with fatigue and fever, we want to immediately suspect shingles, and put the patient in isolation. This will always be contact isolation. However, if they have a rash in more than one location, for example down the back of their arm and across their abdomen, that is considered a more advanced stage of shingles, and it also requires Airborne isolation in addition to contact isolation. We want to assess their Vital Signs and their neurological status, because the herpes zoster virus could also affect the nervous system, and because the vesicles could potentially get infected. So we're going to check their temperature, heart rate, and blood pressure. For patients at home, we can encourage them to take an oatmeal bath to help relieve the itching, or we can provide some kind of anti-itch cream or ointment. we just want them to remember that this is very contagious and they should avoid having visitors while they have the rash. As far as medications we are going to give antivirals to fight the virus itself, NSAIDs to decrease inflammation and pain, and we want to encourage all of our elderly patients to receive the herpes zoster vaccination. This is especially important if they have any family members who’ve contracted shingles.

Our top priority nursing concepts for a patient with shingles are going to be infection control and comfort. We want to keep the skin clean and dry and free of infection, and we want to help relieve some of that pain and itching. Remember that the virus travels along nerves, so irritated nerves can be extremely painful. Make sure you check out the care plan attached to this lesson to see more detailed nursing interventions and rationales.

Like I said, shingles is pretty straightforward, but let's review. Herpes zoster is an extremely contagious virus that's common in elderly patients who had the chickenpox as a child or whoever received the chickenpox vaccine. It is a vesicular rash that is extremely painful and itchy and tends to follow linear nerve pathways called dermatomes. We want to put them in isolation, which would be contact and potentially also Airborne isolation if there rash is more diffuse. And we're going to give them antivirals, and NSAIDs for the pain.

So that's it for herpes zoster or shingles. don't miss out on all of the resources attached to this lesson to learn more. Now go out and be your best selves today. And, as always, happy nursing!
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