Primary Nursing Diagnosis

Pain (acute or chronic) related to nerve root inflammation and skin lesions

OUTCOMES. Comfort level; Pain control behavior; Pain level; Symptom severity

INTERVENTIONS. Analgesic administration; Anxiety reduction; Environmental management: Comfort; Pain management; Medication management

U PLANNING AND IMPLEMENTATION Collaborative

The goals of therapy are to dry the lesions, relieve pain, and prevent secondary complications. These goals are met primarily through pharmacologic therapy. A wet-to-dry compress application of a Burow's solution (aluminum acetate) three to four times a day will help dry the lesions.

Pharmacologic Highlights

General Comments: Antihistamines may help with itching. Pain relief may vary—from the use of mild analgesics (such as aspirin or acetaminophen) to mild opiates (such as codeine) if the pain is excruciating. Nighttime sedation also may be helpful. Topical lidocaine sprays can be used to provide analgesia. The use of systemic corticosteriods appears to decrease the severity of PHN pain. Early corticosteroid therapy for 7 to 10 days can both shorten the duration of pain and prevent its chronic reoccurrence.

Medication or Drug Class

Dosage

Description

Rationale

Valacyclovir (Valtrex); acyclovir (Zovirax); famciclovir

Capsaicin (zostrix)

Varies with drug

Topical cream applied directly to area of discomfort tid-qid

Antiviral

Topical analgesic

Treats herpes zoster; most effective If given in the first 48 hr of onset of rash

Treats neuralgia after shingles; avoid contact with broken skin

Other Drugs: Corticosteroids, analgesics

Independent

Normally, the only patients treated in the hospital for a herpes zoster infection are those with a primary disease that leads to immunosuppression and can place them at risk for shingles. The

424 Hodgkin's Disease most important nursing intervention focuses on prevention of complications. Monitor for signs and symptoms of infection. Since involvement of the ophthalmic branch of the trigeminal nerve may result in conjunctivitis and possible blindness, be alert for lesions in the eye, and refer the patient to an ophthalmologist. Patients with involvement of sacral dermatomes may have changes in patterns of urinary elimination from acute urinary retention. Monitor intake and output to identify this complication.

Pain may be reduced by splinting the affected area with a snug wrap of nonadherent dressings and covering with an elastic bandage. Manage malaise and elevated temperature with bedrest and a quiet environment. Encourage diversionary activities and teach relaxation techniques to help the patient manage pain without medication. If oral lesions are painful, encourage use of a soft toothbrush and swishing and rinsing every 2 hours with a mouthwash based on a normal saline solution. A soft diet may be necessary during periods of painful oral lesions.

Discuss communicability of the disease. Although herpes zoster is not itself infectious, the patient can transmit chickenpox to those who have not had it or to those people who are immunocompromised.

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