# A nurse is caring for a 45-year-old client diagnosed with herpes zoster (shingles) affecting the thoracic dermatome. Which nursing intervention should be the priority?

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> subject: Adult Health

## 문제

A nurse is caring for a 45-year-old client diagnosed with herpes zoster (shingles) affecting the thoracic dermatome. Which nursing intervention should be the priority?

## 보기

1. Implement contact precautions and ensure isolation procedures **✔ 정답**
2. Apply cool, moist compresses to the affected area every 2 hours
3. Administer prescribed analgesics on a scheduled basis rather than as needed
4. Educate the client about the importance of completing the full course of antiviral medication

**정답: 1**

## 해설

Contact precautions are the priority to prevent transmission of varicella-zoster virus to susceptible individuals, especially before lesions crust over. Other interventions are important but secondary to infection control.

## 심화 해설

Priority Nursing Intervention for Herpes Zoster (Shingles)

When caring for a client with herpes zoster affecting a thoracic dermatome, the nurse must prioritize interventions based on the most immediate risks to the client and others. Herpes zoster represents a reactivation of the varicella-zoster virus, and the fluid-filled vesicles contain active viral particles capable of transmitting the virus to susceptible individuals. The priority nursing intervention is to implement contact precautions and ensure isolation procedures.

The rationale for prioritizing infection control stems from the fundamental principle of client and public safety. A client with active, vesicular herpes zoster lesions is contagious. Contact precautions are essential to prevent transmission of the virus to healthcare workers, other patients, and visitors who may be non-immune to varicella (e.g., individuals who have not had chickenpox or the varicella vaccine). For immunocompromised individuals, this transmission can lead to severe, disseminated, and potentially life-threatening illness. The case report on managing herpes zoster in an immunotherapy-treated lung cancer patient highlights the critical risk of viral reactivation in vulnerable populations, underscoring the necessity of stringent protective measures as a foundational element of care [1]. Without immediate implementation of appropriate isolation, the risk of a nosocomial outbreak is significant.

While the other listed interventions are important components of holistic care, they do not supersede the immediate safety need of infection control. Applying cool, moist compresses and administering scheduled analgesics are comfort measures that address the client's pain. An evidence-based pain management protocol for postherpetic neuralgia emphasizes the importance of systematic pain relief to improve quality of life, but this becomes a focus after safety is established [2]. Similarly, educating the client about completing a full course of antiviral medication is crucial for limiting viral replication and reducing the risk of complications like postherpetic neuralgia, yet this teaching can be effectively initiated once isolation is in place. The nursing process dictates that safety and infection control, which address a potential risk for widespread harm, take precedence over pain management and education in this scenario.

References (research sources)

- [1]MPNFS Framework for Managing Herpes Zoster and Refractory Pain in an Immunotherapy-Treated Lung Cancer Patient: A Case Report.Case reportQiao S, Zhang X, Tian S, Wu Y, Li Y, Tong Y. (2026) · DOI: 10.2147/cmar.s579681

- [2]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

## 임상 시나리오

Shingles Infection Control PriorityImmediate Isolation for Active Thoracic Zoster
For a client with active, vesicular herpes zoster, the priority is implementing contact precautions and private room isolation. The fluid in the vesicles contains the varicella-zoster virus and is transmissible to non-immune individuals.

Standard contact precautions require gloves and a gown for any direct contact with the client or their environment. These must be maintained until all lesions are dried and crusted over.

CautionAirborne precautions are required for disseminated zoster or disease in an immunocompromised host. For localized thoracic zoster in an immunocompetent patient, contact precautions are sufficient to prevent a nosocomial outbreak.

## 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.
- **Contact Precautions** — Infection control measures including a private room, gloves, and gowns used to prevent the transmission of pathogens spread by direct or indirect contact with the patient or their environment.
- **Varicella-Zoster Virus** — The human alphaherpesvirus that causes varicella (chickenpox) as a primary infection and herpes zoster (shingles) upon reactivation from latency.
- **Vesicular Fluid** — The liquid contained within blisters; in herpes zoster, this fluid is highly contagious and contains the active virus until the lesions crust over.

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