Herpes zoster, also known as shingles, is caused by reactivation of the varicella zoster virus which causes chickenpox. It presents as a painful vesicular rash localized to specific dermatomes, and occurs more frequently in older adults. While antiviral medications can help shorten its duration, postherpetic neuralgia is a common complication of persistent pain long after rash healing. Nurses play an important role in managing zoster patients' pain and preventing complications through proper assessment, medication administration, and patient education.

1. HERPES ZOSTER.
VARICELLA ZOSTER, SHINGLES.
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.

2. MEANING:
 Its an inflammatory condition in which reactivation of the chicken pox
virus produces a vesicular eruption along the distribution of the nerves
from one or more dorsal root ganglia (dermatome).
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.

3. INCIDENCE.
 The prevalence increases with age.
 A varicella zoster vaccine (VZV) is available for people older than age 60
to prevent reactivation.
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.

4. ETIOLOGY:
 Varicella-zoster virus. ( member of a group of deoxyribonucleic acid
[DNA] virus.)
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.

5. PATHOPHYSIOLOGY
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6. CLINICAL MANIFESTATION:
 Eruption may be accompanied or preceded by fever, malaise, headache,
and pain; pain may be burning, lancinating, stabbing or aching.
 Inflammation may be unilateral, involving the cranial, cervical, thoracic,
lumbar, or sacral dermatome in a bandlike configuration.
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.
CONTD ON NEXT SLIDE

7. CLINICAL MANIFESTATION: CONTD
 Vesicles appear in 3 to 4 days.
 Characteristic patches of grouped vesicles appear on erythematous,
edematous skin.
 Early vesicles contain serum; they later rupture and form crusts; scarring
usually does not occur unless the vesicles are deep and they involve the
dermis.
 If ophthalmic branch of the facial nerve is involved, patient may have a
painful eye. (This can be a medical emergency.)
 Vesicles on the tip of the nose suggest eye involvement.
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.
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next slide

8. CLINICAL MANIFESTATION: CONTD
 A susceptible person can acquire chickenpox if there is contact with the
infective vesicular fluid of a zoster patient.
 A person with history of chickenpox or who has received immunization
is immune and thus is not at risk from infection after exposure to zoster
patients.
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.

9. DIAGONSIS:
 Usually diagnosed by clinical presentation.
 Culture of varicella-zoster from lesion or detection by fluorescent
antibody techniques, including viral detection that uses monoclonal
antibodies ( Micro T rak ) or by electron microscopy, to confirm
diagnosis.
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.

10. MANAGEMENT:
 Antiviral drugs.
 Acyclovir ( Zovirax).
 Famciclovir ( Famvir).
 Valacyclovir ( Valtrex).
 Coticosteroids.
 It is a controversial treatment; but to be given in sever herpes zoster.
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.
Contd on next slide

11. MANAGEMENT: CONTD
 Pain management.
 Aspirin.
 Acetaminophen.
 NSAIDs.
 Opioids.
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.

12. COMPLICATION:
 Chronic pain syndrome ( postherptic neuralagia), characterized by
constant itching and burning pain or by intermittent lancinating pain.
 Hyperesthesia of affected skin after it is healed.
 Ophthalmic complication: keratitis, uveitis, corneal ulceration, and
possible blindness.
 Facial and auditory nerve involvement; hearing defects, vertigo, and
facial weakness ( Ramsay Hunt Syndrome.)
 Visceral dissemination: pneumonitis, esophagitis, enterocolitis,
myocarditis, pancreatitis.
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.

13. NURSES ROLE.
 Assess patient level of discomfort and medicate as prescribed; monitor for
adverse effect of pain medication.
 Teach patient to apply wet dressing and soothing effect.
 Encourage distraction techniques such as music therapy.
 Teach relaxation techniques such as deep breathing exercises.
 Administer antiviral medication in dosage prescribed ( usually high dose);
warn the patient of adverse effect such as nausea.
 Teach patients proper hand washing technique to avoid spreading of
herpes zoster virus.
 Advise patient not to open the blisters to avoid secondary infection and
scarring.
COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.

14. COLLEGE OF NURSING, WANLESS HOSPITAL, MMC, MIRAJ.