Herpes zoster, better known as shingles, is an infectious disease that causes a painful blistery rash. It is caused by the varicella zoster virus (VZV), which is the same agent that causes chickenpox. According to the Mayo Clinic, the shingles rash generally erupts on the middle of the back and warps around to the breastbone, and most commonly affects the elderly or those with compromised immune systems.
Causes
Re-activation of the VZV is the cause of shingles, and according to "Nursing Care Plans: Nursing Diagnosis and Intervention," approximately 20 percent of people who have had the chickenpox virus will develop herpes zoster. The Mayo Clinic says the virus lies dormant in nerve tissue located near the spinal cord and brain after a person has had the chickenpox.
Currently, an estimated one million cases in the United States of shingles develops each year, according to the Centers for Disease Control & Prevention (CDC). While the actual shingles disease is not spread person to person, VZV, the agent that causes the disease, can be passed to a person who has never had chickenpox through direct contact with the blistery rash, per the CDC.
Signs and Symptoms
In conjunction with the blisters, there may be irritation of the skin, itching at the rash site, fever, malaise (general sense of non well being), burning at the affected area, pain, and neuralgia (nerve pain). The pain intensity level is likely to increase with age. Moreover, most people can distinguish a shingles rash from the level of pain associated with it, according to "Understanding Medical Surgical Nursing."
Diagnosis
The University of Virginia Health System says a physical examination, medical history review are the method of primary diagnosis, but additional tests may be ordered. The additional tests of viral detection cultures and or blood tests, such as antibody testing, may be used to diagnosis shingles, according to Lab Tests Online.
Complications
Pneumonia and secondary infections may develop in 15 percent of shingles cases caused by scratching is commo,n according to the "Nursing Care Plans: Nursing Diagnosis and Intervention" text. Pain can last for weeks to months after the rash heals. Additional complications include eye problems, facial paralysis, hearing loss, vertigo, ringing in the ears and deadening of the skin if the rash does not heal properly.
Prevention/Solution
The best known prevention is to avoid the person with the disease during contagious stage. The infected person is contagious seven to 21 days before the rash appears, and will remain so until the blisters dry or scab. The CDC also recommends shingles vaccination for the elderly.
Treatments
Treated outpatient, unless a serious complication such as pneumonia occurs, the focus is on controlling the spread and decreasing a person's discomfort. Antiviral medications given intravenously, orally, and topically (ointments and or creams) for secondary infection, and are most effective if used within the first 72 hours of the disease's onset. Pain is also treated with oral medications, and if caught early enough, with epidural steroid injection for inflammation of the spinal nerves. Itching is treated with antihistamines, and antibiotics given if a bacterial infection is present.
References
- The Mayo Clinic: Shingles
- Centers for Disease Control & Prevention: Shingles
- University of Virginia Health System: Dermatology
- "Understanding Medical Surgical Nursing"; by Linda S. Williams, Paula Hopper;2003
- "Nursing Care Plans: Nursing Diagnosis an Intervention, 5th Edition"; by Meg Gulanick, Judith Myers, Audry Klopp. Deidra Gradishan, Susan Galanes, Michele Knoll Puzas; 2003
