NCLEX Review Guide: Herpes Zoster (Shingles)

Disease Process

• Herpes zoster is the reactivation of the varicella-zoster virus (VZV) that remains dormant in nerve ganglia after initial chickenpox infection. The virus travels along sensory nerve pathways, causing painful vesicular eruptions in a unilateral dermatomal distribution.
• Most commonly affects adults over 50 years old and immunocompromised individuals due to declining cell-mediated immunity.

Signs & Symptoms

• Prodromal phase: 1-3 days of burning, tingling, or stabbing pain along affected dermatome before rash appears.
• Active phase: Unilateral vesicular rash that follows nerve pathway, fever, malaise, and severe neuropathic pain.
• Vesicles progress from clear fluid to pustular, then crust over within 7-10 days.

Medications & Interventions

• Antiviral therapy must be started within 72 hours of rash onset for maximum effectiveness: acyclovir, valacyclovir, or famciclovir.
• Pain management includes gabapentin or pregabalin for neuropathic pain, topical lidocaine, and analgesics as needed.
• Keep lesions clean and dry, apply cool compresses, and avoid scratching to prevent secondary bacterial infection.

1. Assess pain level using 0-10 scale and document location
2. Administer antivirals as prescribed within 72-hour window
3. Apply standard precautions and contact precautions if lesions are open
4. Educate on proper wound care and avoiding immunocompromised individuals

Potential Complications

• Postherpetic neuralgia (PHN): Persistent nerve pain lasting >90 days after rash heals, most common in elderly patients.
• Herpes zoster ophthalmicus: Involves trigeminal nerve affecting the eye - requires immediate ophthalmologic consultation.
• Secondary bacterial infection of lesions, scarring, and rarely, disseminated zoster in immunocompromised patients.

Common Pitfalls