# A 68-year-old client with herpes zoster (shingles) on the left side of the chest is experiencing severe pain rated 8/10. The vesicular rash appeared 3 days ago and is confined to the T4-T6 dermatome. Which nursing intervention should be the priority?

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> subject: Adult Health

## 문제

A 68-year-old client with herpes zoster (shingles) on the left side of the chest is experiencing severe pain rated 8/10. The vesicular rash appeared 3 days ago and is confined to the T4-T6 dermatome. Which nursing intervention should be the priority?

## 보기

1. Apply cool, moist compresses to the affected area every 2 hours
2. Encourage the client to wear loose-fitting cotton clothing
3. Administer prescribed topical calamine lotion to dry the vesicles
4. Ensure timely administration of antiviral medication **✔ 정답**

**정답: 4**

## 해설

Timely antiviral administration within 72 hours of rash onset is the priority to reduce viral replication and prevent complications like postherpetic neuralgia. Other options are supportive but do not address the underlying viral pathophysiology.

## 심화 해설

Priority Nursing Intervention for Acute Herpes Zoster Pain

The correct answer is ensure timely administration of antiviral medication.

Rationale

The priority intervention is to address the underlying pathophysiology driving the acute pain and to prevent the most debilitating long-term complication. The client is in the acute phase of herpes zoster (shingles), with a vesicular rash that appeared only 3 days ago and is confined to the T4-T6 dermatome. At this stage, the severe pain rated 8/10 is caused by active viral replication and inflammation within the sensory ganglion and peripheral nerve. The varicella-zoster virus (VZV) is directly causing tissue damage and an intense inflammatory response, which is the primary source of the nociceptive and neuropathic pain [2].

The highest priority is to halt this process as quickly as possible. Timely administration of antiviral therapy (e.g., acyclovir, valacyclovir, famciclovir) is the only intervention among the options that directly suppresses viral replication. By reducing the viral load and limiting neural damage, antivirals not only accelerate the healing of the acute rash but, more critically, are the most effective strategy to reduce the risk of developing postherpetic neuralgia (PHN) [1, 2]. PHN is the most prevalent and feared complication of herpes zoster, characterized by severe, intractable pain that persists for months or years after the rash has healed, severely compromising a patient's quality of life [1]. The window for antiviral efficacy is narrow, typically within 72 hours of rash onset; at day 3, the client is at a critical juncture where initiating therapy immediately is paramount. Delaying this intervention can lead to irreversible nerve damage and a significantly higher probability of transitioning to PHN, a condition that is notoriously difficult to manage even with multimodal analgesic regimens, including agents like pregabalin [3, 4].

The other options are supportive comfort measures that address symptoms but not the disease's root cause. Applying cool, moist compresses, wearing loose-fitting cotton clothing, and applying calamine lotion are all appropriate nursing interventions for managing localized skin discomfort, pruritus, and irritation. However, they do not suppress the viral replication that is actively destroying nerve tissue and generating the severe 8/10 pain. In the clinical reasoning hierarchy of the NCLEX-RN, an intervention that treats the etiology to prevent a serious, long-term complication (PHN) takes precedence over symptomatic relief measures. The evidence-based management of herpes zoster pain begins with aggressive antiviral treatment in the acute phase to modify the disease trajectory and prevent the development of chronic neuropathic pain syndromes [1, 2].References (research sources)

- [1]Development of an evidence-based pain management protocol and its application in patients with postherpetic neuralgia.Research articleChen W, Cheng Y, Cai Y, Hong J. (2025) · DOI: 10.1097/md.0000000000046629

- [2]A survey on the clinical practice of herpes zoster and postherpetic neuralgia management by Korean medicine doctors: towards the development of Korean medicine clinical practice guidelines.GuidelineKim B, Kim K. (2026) · DOI: 10.1186/s12906-026-05248-y

## 임상 시나리오

Acute Herpes Zoster: Priority InterventionAntiviral therapy is the top priority to reduce pain and prevent PHN
For a client with acute herpes zoster and severe pain, the priority is to administer antiviral medication promptly. This directly suppresses varicella-zoster virus replication, which is the source of neural inflammation and pain.

Antivirals like acyclovir are most effective when started within 72 hours of rash onset. The key goal is to accelerate healing of the rash and, critically, reduce the risk of developing postherpetic neuralgia (PHN).

NoteComfort measures such as cool compresses, loose clothing, and calamine lotion are supportive but secondary. They do not alter the disease course or prevent long-term complications like PHN.

## 핵심 개념

- **Herpes Zoster** — A viral infection caused by the reactivation of the varicella-zoster virus, presenting as a painful, unilateral vesicular rash along a dermatome.
- **Postherpetic Neuralgia (PHN)** — The most common complication of herpes zoster, defined as persistent neuropathic pain lasting more than 90 days after rash onset.
- **Antiviral Therapy** — Medications such as acyclovir, valacyclovir, or famciclovir that inhibit viral DNA replication, most effective when initiated within 72 hours of rash onset.
- **Dermatome** — An area of skin supplied by a single spinal nerve root; herpes zoster rash is typically confined to one or two adjacent dermatomes.
- **Nociceptive Pain** — Pain arising from actual or threatened damage to non-neural tissue and due to the activation of nociceptors, often associated with inflammation.

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