Nursing Care Plans for Shingles – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Shingles plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Shingles or herpes zoster is a viral infection that causes a painful rash. Although shingles can occur anywhere on the body, they often appear as a single stripe of blisters that wrap around either the left or the right side of the torso.

Shingles is caused by the varicella-zoster virus, which also causes chickenpox. After having chickenpox, the virus lies inactive in nerve tissue near the spinal cord and brain. Years later, the virus may reactivate as shingles.

Shingles isn’t a life-threatening condition, but it can be very painful. Vaccines can help reduce the risk of shingles. Early treatment can help shorten a shingles infection and lessen the chance of complications. Postherpetic neuralgia is the most common complication, which causes shingles pain for a long time after the blisters have cleared.

Nursing Care Plans for Shingles – Symptoms of Shingles

The signs and symptoms of shingles usually affect only a small section of one side of the body. These signs and symptoms may include:

• Pain, burning, numbness, or tingling
• Sensitivity to touch
• A red rash that begins a few days after the pain
• Fluid-filled blisters that break open and crust over
• Itching

Some people also experience:

• Fever
• Headache
• Sensitivity to light
• Fatigue

Pain is usually the first symptom of shingles. For some, it can be intense. Depending on the location of the pain, it can sometimes be mistaken for a symptom of problems affecting the heart, lungs, or kidneys. Some people experience shingles pain without ever developing the rash.

Most commonly, the shingles rash develops as a stripe of blisters that wraps around either the left or right side of the torso. Sometimes the shingles rash occurs around one eye or on one side of the neck or face.

Nursing Care Plans for Shingles – Causes of Shingles

Shingles is caused by the varicella-zoster virus, which causes chickenpox. Anyone who’s had chickenpox may develop shingles. After recovering from chickenpox, the virus enters the nervous system and lies dormant for years.

Eventually, it may reactivate and travel along nerve pathways to the skin — producing shingles. But, not everyone who’s had chickenpox will develop shingles.

The reason for shingles is unclear. But it may be due to lowered immunity to infections as one grows older. Shingles is more common in older adults and in people who have weakened immune systems.

Varicella-zoster is part of a group of viruses called herpes viruses, which include the viruses that cause cold sores and genital herpes. Because of this, shingles is also known as herpes zoster. But the virus that causes chickenpox and shingles is not the same virus responsible for cold sores or genital herpes, a sexually transmitted infection.

Nursing Care Plans for Shingles – Risk Factors of Shingles

Anyone who has ever had chickenpox can develop shingles. Most adults in the United States had chickenpox when they were children, before the advent of the routine childhood vaccination that now protects against chickenpox.

Factors that may increase your risk of developing shingles include:

1. Being older than 50. Shingles is most common in people older than 50. The risk increases with age.
2. Having certain diseases. Diseases that weaken the immune system, such as HIV/AIDS and cancer, can increase the risk of shingles.
3. Undergoing cancer treatments. Radiation or chemotherapy can lower the resistance to diseases and may trigger shingles.
4. Taking certain medications. Drugs designed to prevent rejection of transplanted organs can increase shingles’ risk, as can prolonged use of steroids, such as prednisone.

Nursing Care Plans for Shingles – Diagnosis of Shingles

Physical examination and history taking – the characteristic rash is usually enough to suspect herpes zoster infection. Support from history taking and physical assessment often confirms the diagnosis. History of previous chickenpox infection is noted; pain and other signs and symptoms associated with herpes zoster infection are observed.

Other skin diseases will need to be ruled out if the rash and history are not conclusive to diagnose.

Nursing Care Plans for Shingles – Treatment of Shingles

Antivirals

Antiviral medications are prescribed to be taken within 72 hours of diagnosis. They slow down the progress of the rash and prevent complications. 

Analgesia

The characteristic rash associated with herpes zoster infection is very painful. Over-the-counter painkillers are commonly given to relieve the discomfort caused by the pain.

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Antibiotics

 If the rash leads to other skin breakdowns, which then gets infected, antibiotics are prescribed. However, if the bacterial infection is not detected, then it is not needed.

Tricyclic antidepressants

Sometimes the physician prescribes these to help ease the pain after the rash clears away. They can also help with depression.

Skincare

It is essential to keep the affected area clean, dry, and exposed to air as much as possible.

Nursing Care Plans for Shingles – Complications of Shingles

Complications from shingles can include:

Postherpetic neuralgia

For some people, shingles pain continues long after the blisters have cleared. This condition is known as postherpetic neuralgia, and it occurs when damaged nerve fibers send confused and exaggerated messages of pain from the skin to the brain.

Vision loss

Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections that may result in vision loss.

Neurological problems

Depending on which nerves are affected, shingles can cause an inflammation of the brain (encephalitis), facial paralysis, or hearing or balance problems.

Skin infections

If shingles blisters aren’t properly treated, bacterial skin infections may develop.

Nursing Care Plans for Shingles – Prevention of Shingles

A shingles vaccine may help prevent shingles.

People who are eligible to get it should get the Shingrix vaccine in the U.S.

In the United States, Shingrix was approved by the Food and Drug Administration (FDA) in 2017. Studies suggest that Shingrix offers protection against shingles for more than five years. Shingrix is a nonliving vaccine made of a virus component. It is given in two doses, with 2-6 months between doses.

Shingrix is approved and recommended for people age 50 and older, including those who’ve previously received the Zostavax vaccine or had shingles.

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The Zostavax vaccine is no longer sold in the U.S., but other countries may still use it.

Both shingles vaccine’s most common side effects are redness, pain, tenderness, swelling and itching at the injection site, and headaches.

The shingles vaccine doesn’t guarantee that one won’t get shingles. But this vaccine will likely reduce the course and severity of the disease and reduce the risk of postherpetic neuralgia.

The shingles vaccine is used only as a prevention strategy. It’s not intended to treat people who currently have the disease.

Nursing Care Plans for Shingles / Herpes Zoster Based on Diagnosis

Nursing Care Plans for Shingles – Nursing Care Plan 1: Diagnosis -Acute/Chronic Pain

May be related to nerve pain (most commonly cervical, lumbar, sacral, thoracic, or ophthalmic division of trigeminal nerve)

Possibly evidenced by:

• Alteration in muscle tone
• Facial mask of pain
• Reports of burning, dull, or sharp pain
• Reports of pain localized to the affected nerve

Desired Outcomes

• A patient will be comfortable, as evidenced by the ability to rest.
• A patient will report satisfactory pain control at levels less than 3 to 4 on a scale of 0 to 10.

Nursing Interventions	Rationale
Assess the patient’s description of pain or discomfort: severity, location, quality, duration, precipitating or relieving factors.	The patient may describe the pain as a tingling sensation, a burning pain, or extreme hyperesthesia in one area of the skin. These sensations usually precede the development of skin lesions by several days. Postherpetic neuralgia is a chronic pain syndrome that may continue after the skin lesions have healed. The patient may have constant pain or intermittent episodes of pain.
Assess for nonverbal signs of pain or discomfort.	Each individual has his or her own pain threshold and ways to express pain or discomfort. Some individuals may deny the experience of pain when it is present. Attention to associated signs may help the nurse evaluate the pain.
Educate the patient about the following measures:
Wear loose, nonrestrictive clothing made of cotton.	Constrictive, nonbreathing garments may rub lesions and aggravate skin irritation. Cotton clothing allows evaporation of moisture.
Apply cool, moist dressings to pruritic lesions several times a day with or without Burrow’s solution. Discontinue once the lesions have dried.	This provides relief and reduces the risk for secondary infection.
Avoid temperature extremes in both the air and bathwater.	Tepid water causes the least itching and burning.
Avoid rubbing or scratching the skin or lesion.	Scratching stimulates the skin, which in turn increases itchiness. It can also increase the possibility of secondary infection.
Use topical steroids (anti-inflammatory effect), anti-histamines (anti-itching effect, particularly useful at bedtime), and analgesics.	A variety of medications may be required to provide relief.
Administer medications as indicated.	Oral opioid analgesics (codeine, hydrocodone) are typically prescribed during the acute phase. Analgesics, antidepressants, and antiepileptic may be used in the management of postherpetic neuralgia. Topical preparations of postherpetic neuralgia include capsaicin cream (Zostrix) and lidocaine-prilocaine cream (EMLA).

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Nursing Care Plans for Shingles – Nursing Care Plan 2: Diagnosis -Impaired Skin Integrity related to infection of the skin secondary to herpes zoster infection

Evidenced by:

• A temperature of 39 degrees Celsius
• Chills
• Headache
• Stabbing or shooting pain
• Tingling of the skin
• Photophobia
• Body malaise

Desired Outcome

The patient will re-establish healthy skin integrity by following a treatment regimen for herpes zoster infection.

Intervention	Rationale
Assess the patient’s skin on his/her whole body.	To determine the severity of herpes zoster infection and any affected areas that require special attention or wound care.
Isolate the patient in his/her room ideally during the first 48 hours since the appearance of blisters.	Herpes zoster infection is an infectious/ communicable skin disease to people who have not had chickenpox before. It is also harmful to pregnant women as it can affect the unborn baby.
The affected area should be washed first in warm water, and wet compresses may also be used. This is followed by the application of the prescribed antipruritic cream or ointment directly to the affected areas.	Cleansing the skin and applying the topical antipruritic cream promotes relief of itchiness due to shingles.
Administer antiviral medication as prescribed. Ensure that the patient finishes the course of antibiotics prescribed by the physician.	Herpes zoster infection is generally treated through the use of antiviral therapy. If the rash leads to another skin breakdown which then gets infected, antibiotics are prescribed. Application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antiviral therapy for at least 7 days.
Educate the patient and caregiver about proper skincare through washing the rash with soap and water. Advise the patient and caregiver to prevent scratching the affected areas.	It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The unilateral rash may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent the worsening of the infection.
Teaching the patient/ caregiver the proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.	Proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.

Nursing Care Plans for Shingles – Nursing Care Plan 3: Diagnosis – Risk for Disturbed Body Image

May be related to:

• Preoccupation with changed body part
• Visible skin lesions

Desired Outcomes

• A patient will verbalize feelings about lesions and continues daily activities.
• A patient will demonstrate positive body image, as evidenced by the ability to look at, talk about, and care for lesions.

Nursing Interventions	Rationale
Assess the patient’s perception of his or her changed appearance.	Because the course of an outbreak may span several weeks, patients typically need to work or carry out their usual routine; they may require assistance coping with changes in appearance.
Note verbal references to skin lesions.	Scarring may occur with repeated outbreaks or if lesions are infected. This may cause a preoccupation with appearance.
Discuss reasons for infectious isolation and procedures when indicated.	Taking time to sit down and talk/listen to the patient in the room decreases the feeling of isolation and loneliness.
Assist the patient in articulating responses to questions from others regarding lesions and infectious risk.	Patients may need some guidance in determining what to say to people who comment on the appearance of their skin. The rehearsal of set responses to anticipated questions may provide some reassurance.
Suggest the use of concealing clothing when lesions can be easily covered.	This approach may help the patient who is having problems adjusting to body-image changes.

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Nursing Care Plans for Shingles – Nursing Care Plan 4: Diagnosis – Risk for Infection related to a contagious skin infection

Desired Outcome

A patient will prevent the spread of infection to the rest of the body, as well as cross-contamination to other people by following a treatment regimen for herpes zoster infection.

Intervention	Rationale
Assess the patient’s skin on his/her whole body.	To determine the severity of herpes zoster infection and any affected areas that require special attention or skincare.
Isolate the patient in his/her room ideally during the first 48 hours since the appearance of blisters.	Herpes zoster infection is an infectious/ communicable skin disease to people who have not had chickenpox before. It is also harmful to pregnant women as it can affect the unborn baby.
Administer antiviral medication as prescribed. Ensure that the patient finishes the course of antibiotics prescribed by the physician.	Herpes zoster infection is generally treated through the use of antiviral therapy. If the rash leads to other skin breakdowns, which then gets infected, antibiotics are prescribed. Application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.
Educate the patient and caregiver about proper wound hygiene through washing the rash with soap and water.	It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The rash may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent the worsening and spread of the infection.
Trim the patient’s fingernails and ensure frequent hand hygiene. Advise the patient and caregiver to prevent scratching the affected areas.	Long fingernails tend to harbor more bacteria. Scratching the infected skin areas will allow the bacteria to transfer into the fingernails and onto the fingerpads. When the patient touches other people or objects with infected hands, the infection will likely spread.
Teaching the patient/ caregiver the proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.	Proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.

Nursing Care Plans for Shingles – Nursing Care Plan 5: Diagnosis – Deficient Knowledge

May be related to:

• Complexity of treatment
• Emotional state affecting learning
• Herpes zoster outbreak
• New conditions and procedures

Possibly evidenced by:

• Inadequate follow-up of instructions
• Questioning members of the health care team
• Verbalizing inaccurate information

Desired Outcomes

The patient or caregiver will verbalize needed information regarding the disease, signs and symptoms, treatment, and possible complications of herpes zoster.

Nursing Interventions	Rationale
Determine the patient’s and caregiver’s understanding of the disease condition, treatment, and complications.	The patient and caregiver need to understand that an occult disease may have weakened the patient and allowed the expression of the herpes zoster.
Because of potential infectivity, determine whether the patient’s caregiver or family has had chickenpox or varicella vaccine or is immunocompromised.	Even though the varicella vaccine does not confer immunity to shingles, it is less common in varicella-vaccinated adults than in those who have had chickenpox.
Provide necessary information to the patient and caregiver, including written information:	A patient may confuse terminology and confuse herpes zoster with genital herpes. Because the patient may be reluctant to ask, clarify this point for the patient. Patients must have a comprehensive understanding of their disease to participate in their own care actively.
Explanation of the need for isolation.	Patients should isolate their clothing and linen, including towels.
Description of herpes zoster, including how the disease is spread.	Fluids from lesions contain viruses, which are spread by direct contact.
Need to notify health care professionals of the signs of central nervous system (CNS) inflammation (changes in the level of consciousness).	The early assessment facilitates prompt treatment of complications.
Encourage herpes zoster vaccination (Zostavax).	This vaccination is recommended for individuals 60 years or older. It is not recommended for pregnant women or those with primary or acquired immunodeficiencies or any allergy to its components. A 50% decrease in future outbreaks and greater than 60% reduction in postherpetic neuralgia have been reported.

Related FAQs

1. What is the nursing management of shingles?

The management of shingles includes the use of analgesics and antivirals. Antivirals reduce the duration of viral shedding, reduce the severity and duration of acute pain, and reduce the risk of post-herpetic neuralgia.

2. How do you care for someone with shingles?

It is usually treated with an antiviral medication plus a steroid. Treatment of shingles usually includes a combination of antiviral and pain-relieving medications. The areas affected by the rash should be kept clean and dry.

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3. What are the 4 main parts of a nursing care plan?

Components. A nursing care plan (NCP) usually includes nursing diagnoses, client problems, expected outcomes, and nursing interventions and rationales. These components are elaborated below: Client health assessment, medical results, and diagnostic reports

4. What interventions are required for patients with chickenpox or shingles?

Work restriction and isolation precautions

All patients with varicella or disseminated zoster should be placed on airborne and contact precautions until all lesions are crusted. For immunocompetent patients with dermatomal herpes zoster, standard precautions and complete covering of the skin lesions are recommended.

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