Shingles/Herpes zoster virus

Question 1

Secondary to underlying disease

Answer 1

• syphilis
• kaposis sarcoma- herpes virus, immune suppressed, cancer, HIV, herpes that causes cancer
• rash from lupus

Question 2

Assessment

Answer 2

within 24 hr
size
color
temp
odor
moisture
turgor
texture
approximated

Question 3

Shingles- Herpes zoster virus

Answer 3

continuation of chicken pox- had to have had chicken pox once to get it

Question 4

Herpes zoster

Answer 4

virus lays dormant in nerve pathways
reactivation of dormant herpes zoster (varicella zoster)
cluster of vesicles follow peripheral sensory nerves:
- vesicles do not cross midline
- 2/3 of lesions will arise over thoracic area (neck-legs)
- remainder are in trigeminal nerve (face, eye, scalp)
- only unilateral in organized pattern

Question 5

Pre- eruptive

Answer 5

infectious, b/f lesion occurs, 48hr after exposure and infection, can last up to 10 days
- headache
- fever
- light sensitivity- tingling along area
- fatigue

Question 6

Acute eruptive

Answer 6

very infectious, lesions appear, lasts 10-15 days
- headache
- fatigue
- fever
- light sensitivity- tingling
- severe pain
- emergence of lesions- oozing and closing and reopening of lesions

at end of stage- wounds crusted over and sealed

Question 7

Post-herpetic neuralgia

Answer 7

• severe pain- chronic pain as a result of nerve damage- days to years
• tingling/burning
• numbness

Chronic pain management
- gabapentin (nerve pain)
- tylenol

Question 8

Treatment

Answer 8

• often none
• symptom management (cool compress, calamine lotion, baking soda)
• antivirals given w/in first 24-72 hr (acyclovir, valacyclovir, famciclovir)
• analgesics for long term management

Question 9

Necrosed lesion

Answer 9

wound debridement, maybe wound vac, need granulation tissue to heal

Question 10

Prevention

Answer 10

zostavax- banned not effective

shingrix:
- indicated for >60 y/o
- 90% effective in preventing shingles and post herpetic neuralgia
- 5-7 years of immunity after initial dose
- 2 doses 6 months apart
- no booster

Question 11

isolation precautions

Answer 11

Standard precautions + airborne and contact until lesions are dry and crusted

• gown, gloves, N-95, eye protection
• reverse airflow rooms
• hand washing