Free Essay

Case Study-Herpes Zoster

In: Science

Submitted By malousteffie
Words 993
Pages 4
Case Study on Herpes Zoster

Case Study on Herpes Zoster
History of Present Illness: This is a case of a 27 year old Asian female who came to the clinic complaining of pain on her right hand. She states that it feels like “pins and needles going up to my arm” She denies fever but states that she feels body malaise. She claims to have slight loss of appetite because of the pain. Pain level is about 7-8/10, occurs continuously and is temporarily relieved by Tylenol 500 mg. She noted the appearance of tiny blisters on her hand and upper arm which started about a week ago. The pain according to the patient is described as throbbing and tingling sensation. Patient otherwise has no other complaints.
Past Medical History: Patient denies prior hospitalizations, surgeries, accidents. Patient does not remember immunizations but she claims that she never had chickenpox
Family History: Both parents are alive. Her father is hypertensive and has coronary arterial disease. Her mother is apparently healthy. She is the only child.
Social History: She lives in an apartment with her parents. She works as an employee in the casino. She does not smoke and does not drink alcoholic beverages.
Review of Systems:
General: Well nourished female, not in acute respiratory distress
HEENT: Denies headache. No blurring of vision, hearing not impaired, no sore throat
Neck: No tenderness and lymphadenopathy
Cardiovascular: No chest pains and palpitations
Gastrointestinal: No change in bowel habits, slight loss of appetite
Genitourinary: No change in urinary habit
Musculoskeletal: Pain on right hand extending to right upper arm, feeling of “pins and needles” on right arm and hand, no limitation of movement both upper extremities, normal gait and posture
Neurologic/Psychiatric: Alert and oriented as to time, place and person
Physical Examination: Patient is a well nourished Asian female, ambulatory, in no acute respiratory distress
Vital Signs: BP 120/80 mmhg, Temp 97.6 F, RR 18/min, PR 85/min
Skin: Tiny blisters on dorsal aspect of right hand and lateral aspect of upper right arm, skin is warm and with good turgor, no other rashes on body
HEENT: Pupils equal in size and reactive to light and accommodation, extraocular muscles intact, otoscopic exam revealed normal auditory canal and eardrum, nares patent, oropharynx clear
Respiratory: Symmetrical chest, no abnormalities on palpation, resonant sounds on percussion, clear breath sounds, no rales or rhonchi
Cardiovascular: Normal on palpation of PMI, Regular rate and rhythm, no murmurs, no gallops
Abdomen: No lesions, tympanitic, normoactive bowel sounds
Musculoskeletal: No swelling of joints of upper and lower extremities, ROM of both extremities are normal
Assessment: Based on the classic lesion and presenting symptoms of the patient , she has a diagnosis of Shingles or Herpes Zoster and Pain related to nerve root inflammation and skin lesions Although herpes zoster typically resolves within 2 weeks, there may be ceratin complications that will pose health risks like secondary bacterial infection, motor involvement including weakness in “motor herpes zoster”, eye involvement with trigeminal nerve involvement which should be treated aggressively as this may lead to blindness. Another health risk is the development of postherpetic neuralgia which is a condition of chronic pain following herpes zoster. A variety of other conditions can cause a rash that may be confused with shingles, as prioritized, Herpes Simplex Virus (HSV) infection, contact dermatitis (especially toxic dermatitis from plant exposure, such as poison ivy), insect bite reaction, localized bacterial or viral skin infections which may all mimic symptoms of herpes zoster or shingles
Plan: Appropriate diagnostic studies: If the rash has appeared, identifying this disease and making a differential diagnosis requires only a visual examination, since very few diseases produce a rash in a dermatomal pattern. However, herpes simples virus (HSV) can occasionally produce a rash in such a pattern. The Tsanck smear is helpful for diagnosing acute infection with a herpes virus, but does not distinguish between HSV and VZV. Laboratory tests are available to diagnose herpes zoster. The most popular test detects VZV-specific IgM antibody in blood; this appears only during chickenpox or herpes zoster and not while the virus is dormant. In larger laboratories, lymph collected from a blister is tested by polymerase chain reaction for VZV DNA, or examined with an electron microscope for virus particles.
Therapeutic treatment Plan: The aims of treatment are to limit the severity and duration of pain, shorten the duration of a shingles episode, and reduce complications. For pain, this patient will be prescribed an over the counter analgesic such as Tylenol 500 mg 1 tablet PO every 4 hrs PRN for pain. Topical lotions containing calamine can be used on the rash or blisters and may be soothing. Once the lesions have crusted over, capsaicin cream (Zostrix) can be used. Bathe with cool water and wash the blisters twice a day with regular soap and water but do not bandage them .Apply cool compresses to the blisters to relieve the pain and itch.
Health Promotion and Education: and Prevention: All patients with herpes zoster should be educated on the disease process and natural course of the disease. The nursing /medical goal is to prevent infection and complications of the disease and to reduce the pain of shingles. Patients should be instructed on medications including dose, route, and side effects and when to report to PCP for redness, swelling, or drainage of the rash to PCP. Prevention of shingles include the chickenpox vaccine and avoidance of contact with infected persons. Although the chickenpox vaccine does not guarantee complete protection against chickenpox or shingles, it can reduce the severity of the disease and the risk of complications. High risk groups such as the Elderly, those with HIV, on steroids and pregnant women should avoid contact with infected persons
Follow-up: This patient is advised to take all medications as prescribed. If new symptoms or if the patient cannot control the pain or itching, she should contact her PCP immediately.


Similar Documents

Free Essay

Herpes Simplex Virus

...Genital Herpes Virus In this world today there are many viruses that effects the human population. Herpes is one of these diseases. It is no less then a self-limited communicable disease. Yet its "victims" describe it as devastating, and society treats those with it like lepers. Until recently most people had never heard of herpes virus. Even doctors were familiar with the virus, yet in the past few years , it has become an epidemic. Why I chose to study this topic is more on how herpes affects a person emotionally. Why should a disease like this which rarely causes great physical problems, be such trouble to many people? It is not as devastating as tuberculosis. Its not a killer like cancer. And it is not as disabling as the flu. It isn't as bad a smoking is to your health, so why should so many people care about it. I think that the main reason is that herpes affects the persons personality. To many, there is nothing more important then that persons genitals. One's genitals gives one the ability to love and to be loved. Another reason is that this virus, unlike many in today's society, is incurable. With todays fast food restaurants, great health insurance, and one hour prescriptions, people have a hard time dealing with herpes being incurable. The incurability and recurrent nature of herpes makes it a control issue and no one likes to lose control. There is an unbuilding factor in this issue. There...

Words: 1155 - Pages: 5

Free Essay

Bells Palsy

...Bell's palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve VII (the facial nerve) causing an inability to control facial muscles on the affected side. Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or the cornea may be permanently damaged, resulting in impaired vision. In some cases denture wearers experience some discomfort. The common presentation of this condition is a rapid onset of partial or complete paralysis that often occurs overnight. In rare cases, it can occur on both sides resulting in total facial paralysis. Bell’s palsy is defined as a one-sided facial nerve paralysis of unknown cause. Several other conditions can also cause facial paralysis, e.g., brain tumor, stroke, myasthenia gravis, and Lyme disease; however, if no specific cause can be identified, the condition is known as Bell's palsy. It is thought that an inflammatory condition leads to swelling of the facial nerve. The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition or damage. Usually it gets better on its own with most people achieving normal or near-normal function. Corticosteroids have been found to improve outcomes, when used early, while anti-viral drugs have not.[3][4] Many show signs of improvement as early as 10 days after the onset, even without treatment. Bell's palsy is the most common......

Words: 735 - Pages: 3

Premium Essay

Bacterial, Parasitic and Viral Infections

...and malignancies that are called 'opportunistic infections' because they take advantage of the opportunity offered by a weakened immune system. A partial list of the world's most common HIV-related opportunistic infections and diseases includes: Bacterial diseases such as tuberculosis, MAC, bacterial pneumonia and septicaemia (blood poisoning) Protozoal diseases such as toxoplasmosis, microsporidiosis, cryptosporidiosis, isopsoriasis and leishmaniasis Fungal diseases such as PCP, candidiasis, cryptococcosis and penicilliosis Viral diseases such as those caused by cytomegalovirus, herpes simplex and herpes zoster virus HIV-associated malignancies such as Kaposi's sarcoma, lymphoma and squamous cell carcinoma. Different conditions typically occur at different stages of HIV infection. In early HIV disease people can develop tuberculosis, malaria, bacterial pneumonia, herpes zoster, staphylococcal skin infections and septicaemia. These are diseases that people with normal immune systems can also get, but with HIV they occur at a much higher rate. It also takes longer for a person with HIV to recover than it takes for someone with a healthy immune system. When the immune system is very weak due to advanced HIV disease or AIDS, opportunistic infections such as PCP, toxoplasmosis and cryptococcosis develop. Some infections can spread to a number of different organs, which is known as 'disseminated' or 'systemic' disease. Many of the opportunistic infections that......

Words: 4703 - Pages: 19

Premium Essay

Vaccinations Protect from Nasty Diseases, but the Anti- Immunisation Voice Is Getting Louder.

...Vaccinations protect from nasty diseases, but the antiimmunisation voice is getting louder. Introduction Whilst some, or all of us, hate getting needles jabbed in us, it is sometimes necessary so we don’t get sick, or worse, die. There are terrible diseases i.e. Rubella, Polio, Whooping Cough, out there which we try to avoid. Vaccinations may help prevent getting them. Though we get immunised, we still need to be careful in making a well informed decision on behalf of this we love and care about. It is still possible to contract the disease we were vaccinated against, as in the case of chicken pox, where a person can come down with a slight case of it. We will look at the pros and cons of the immunisation debate and understand the benefit of proper decision making when deciding to get immunised. Body It is thought that vaccinations can help stop, and even get rid of, nasty diseases. It is reported that “Polio, for example, was eliminated in the United States by 1979 after widespread vaccination efforts” - as quoted from But while some people vaccinate their children, others do not. (Research from the National Health Performance Authority has found 77,000 Australian children are not fully immunised. As reported by Amy Simmons for ABC News. April 2013) In numerous parts of the world, it is thought that people need vaccines to stop the spread of disease. While some countries aren’t plagued with deadly diseases, there are some countries......

Words: 1956 - Pages: 8

Free Essay

Epidemiology of Chickenpox

...Epidemiology of Chickenpox Erica N. Huckaby Grand Canyon University: NRS-427V February 28, 2016 Epidemiology of Chickenpox Epidemiology is the study of the distribution and determinants of health related states or events in specified populations and the application of this study to control health problems (Farlex Partner Medical Dictionary, 2012). Epidemiology can be applied to any disease. It has helped to develop the methodology used in research and public health. For the purpose of this paper, we will explore the childhood illness chickenpox, the factors that contribute to it’s development, the epidemiological triangle, and the role of the community health nurse as related to reporting and follow-up of cases. Description of Chickenpox Chickenpox, also known as varicella, is a highly contagious viral illness caused by the herpes virus, HHV3.4 or varicella zoster virus (Lowth, 2013). Chickenpox is mainly considered a childhood illness but can affect anyone at any age. Symptoms In children the illness generally begins with fever and malaise followed by development of papules on the skin. The day following the first fever a rash often appears on the face and scalp. Within the next 24 hours more papules appear as the first ones turn into vesicles. The rash generally will spread to the trunk, abdomen and limbs. Vesicles can be so few that they go unnoticed and leave the virus undiagnosed or they can cover the entire body including the mucous membranes. The course...

Words: 1203 - Pages: 5

Free Essay

Bells Palsy

... Petruzelli (1991) states that Bell’s palsy is an acute paralysis of the facial nerve first described by the Scottish surgeon and anatomist, Sir Charles Bell . Niparko (1993) elaborates that it is a generally unilateral paralysis or weakness of facial musculature consistent with facial nerve damage and dysfunction. The anatomy of the facial nerve can be found in appendix two. Pietersen (2002) states that the cause is unknown, however, whilst the exact aetiology of Bell’s palsy is still debated, viral infections, vascular ischaemia, autoimmune inflammatory disorders and heredity have been postulated as causative. (Adour 1982, Burgess 1984, Lorber 1996). Murakami et al (1996) proposed that reactivation of herpes simplex virus in the geniculate ganglia was causative. A herpes simplex cause is corroborated by Stjernquist-Desatnik, Skoog, and Aurelius (2006). Whilst the exact aetiology is disputed, a greater consensus is reached when considering the pathophysiology. Tiemstra and Khatkhate (2007) state that Bell’s palsy is thought to be caused by inflammation at the geniculate ganglion. This appears corroborated by Fisch and Esslen (1972) who noted oedematous swelling proximal to the...

Words: 3268 - Pages: 14

Premium Essay

Case Studies

...Microbiology Case Studies 1.1-1.8 Case 1.1 1. The fertility specialist recommended the rubella vaccine because if the rubella virus is contracted early in pregnancy there is an increased risk of miscarriage or birth defects such as deafness, cataracts, mental retardation, heart defects, liver and spleen damage. There are contraindications related to conceiving within four weeks of receiving the rubella vaccination because it is a “live” vaccine and could still cause complications. 2. In the United States it is recommended that children receive the first dose of the MMR (measles, mumps rubella) vaccination between 12-15 months (not earlier) and then to receive a second dose around 4-6 years of age. 3. The client’s description does not correlate with the rubella virus. Symptoms of the rubella infection typically only last 3 days and are often referred to as the “3 day measles”. 4. In order to check the immune status of the client the test would be checking for IgG antibodies. The absence of IgG rubella antibodies indicates that the person has likely not been exposed to the rubella virus or vaccine. IgG are also the only antibodies that can cross the placenta to protect the fetus. 5. To test for a current rubella infection using only the IgG antibody test the physician should order the initial IgG for a baseline and then perform the test again in 2-3 weeks to check if there was a significant increase (titer) present. An increase would indicate recent or current infection.......

Words: 1503 - Pages: 7

Premium Essay

Hiv Human Immunodeficiency Virus Research Paper

...HIV Human Immunodeficiency Virus HIV Human Immunodeficiency Virus Suanchirae Williams Devry Unviersity BIO 260 Professor Daudi Langat Suanchirae Williams Devry Unviersity BIO 260 Professor Daudi Langat INTRODUCTION Growing up my little brother was the man of our house, a household of seven with my little brother being the only boy, such a heavy burden on such small shoulders. It seemed to be a role that he just woke up one day and assumed he needed to fill. My mother was a single mother of six children so she worked long hours every day which left me, being the oldest, as the secondary mother. It seemed to become my role as caregiver and my little brother, who is almost 5 yrs. younger than me, the protector. As we all grew up and started branching off into our own little worlds my little brother became a more private person. It was a surprise in late 2005 when he brought home a girl and announced her as his girlfriend and that he loved her. She was a great girl we all took a shine to her and welcomed her into our family. After a few months this new girlfriend decided it was time for us all to have a family meeting, there was something that she felt she needed to share with us all before anything more happened with her and my brother. She sat us all down and started to explain her family to us ending with......

Words: 2545 - Pages: 11

Free Essay


...Integumentary Disorders Anatomy of the skin The skin consists of 3 layers: 1. Epidermis- non vascular outermost layer, continuously dividing cells 2. Dermis- takes the largest portion of the skin and provides strength and structure. It consists of glands (sebaceous, sweat), hair follicle, blood vessels, and nerve endings 3. Subcutaneous tissue (hypodermis)- the inner most layer. contains major vascular networks, fat, nerves, and lymphatics Function of the skin • Protection- protection of underlying structures from invasion by bacteria, noxious chemicals and foreign matter. • Sensory perception- transmits pain, touch, pressure, temperature, itching, etc • Fluid balance (excretion)- absorption of fluids and evaporation of excess. • Temperature regulation- produced heat released through skin by radiation, conduction, and convection 1|Page • Vitamin synthesis- skin exposed to ultra violet light can convert substances necessary for synthesizing vitamin D3 (cholecalciferol). • Aesthetic- affects appearance Factors influencing skin integrity • Immoblity is the major factor leading to pressure sore development . • The pt who is confined to bed & unable to change position is at greatest risk . • Trauma most likely occur – over the prominent areas – weight bearing areas • • Prolonged pressure impairs blood flow to tissue & resulfs in ischemia & inferction The extent of pressure necessary to cause tisue......

Words: 3350 - Pages: 14

Premium Essay

The Feasibility of Aloe Vera as Lipbalm

...ntroduction The Aloe vera plant has been known and used for centuries for its health, beauty, medicinal and skin care properties. The name Aloe vera derives from the Arabic word “Alloeh” meaning “shining bitter substance,” while “vera” in Latin means “true.” 2000 years ago, the Greek scientists regarded Aloe vera as the universal panacea. The Egyptians called Aloe “the plant of immortality.” Today, the Aloe vera plant has been used for various purposes in dermatology. History Aloe vera has been used for medicinal purposes in several cultures for millennia: Greece, Egypt, India, Mexico, Japan and China.1 Egyptian queens Nefertiti and Cleopatra used it as part of their regular beauty regimes. Alexander the Great, and Christopher Columbus used it to treat soldiers’ wounds. The first reference to Aloe vera in English was a translation by John Goodyew in A.D. 1655 of Dioscorides’ Medical treatise De Materia Medica.2 By the early 1800s, Aloe vera was in use as a laxative in the United States, but in the mid-1930s, a turning point occurred when it was successfully used to treat chronic and severe radiation dermatitis.2 Plant The botanical name of Aloe vera is Aloe barbadensis miller. It belongs to Asphodelaceae (Liliaceae) family, and is a shrubby or arborescent, perennial, xerophytic, succulent, pea- green color plant. It grows mainly in the dry regions of Africa, Asia, Europe and America. In India, it is found in Rajasthan, Andhra Pradesh, Gujarat, Maharashtra and......

Words: 3057 - Pages: 13

Premium Essay


...broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases usually affect people not only physically, but also emotionally, as contracting and living with many diseases can alter one's perspective on life, and their personality. Death due to disease is called death by natural causes. There are four main types of disease: pathogenic disease, deficiency disease, hereditary disease, and physiological disease. Diseases can also be classified as communicable and non-communicable disease. Terminology In many cases, the terms disease, disorder, morbidity and illness are used interchangeably.[2] In some situations, specific terms are considered preferable. [edit]Disease The term disease broadly refers to any condition that impairs normal function. Commonly, this term is used to refer specifically to infectious diseases, which are clinically evident diseases that result from the presence of pathogenic microbial agents, including viruses, bacteria, fungi, protozoa, multicellular organisms, and aberrant proteins known as prions. An infection that does not and will not produce clinically evident impairment of...

Words: 3516 - Pages: 15

Free Essay


...Aloe Vera: History, Science, and Medicinal Uses Presented by Many people are looking to nature for answers to their present health challenges. Aloe has never been more popular as a natural and holistic approach to many of today‟s modern diseases. People across the world with Diabetes, Arthritis, Gout, Psoriasis, Irritable Bowel Syndrome (IBS), Ulcers, Inflammation, and other conditions are looking to Liquid Aloe Vera for help. Even more people believe “an ounce of prevention is worth a pound of cure”, and numerous scientific studies on Aloe Vera are demonstrating its analgesic, anti-inflammatory, wound healing, immune modulating and anti-tumor activities as well as antiviral, anti-bacterial, and antifungal properties. Aloe‟s medicinal properties can be attributed to the synergistic effect of the combined nutritional elements producing a more powerful effect than the individual components. This book will serve to educate and inform you as you decide to make Aloe part of your daily health program. CONTENTS 1 2 3 4 5 6 7 8 9 10 Historical Information Early Medicinal Uses Preparation for Use Nutritional Overview of Aloe Medicinal Benefits External Healing Internal Healing Maximize Your Benefits What‟s Next? References 2 2 3 5 7 8 8 11 11 12 1 1. Historical Information Aloe Vera (Aloe barbadensis Miller) is a specific species of Aloe. There are over 400 species of Aloe Vera plants in the Lily Family. Aloe plants tend to......

Words: 3735 - Pages: 15

Free Essay

Dm Case Study

...Case Study Three CC: Jose Santa Cruz (JS) is a 68 y/o Native American male and retired construction worker. JS no longer works at this time, except to watch his grandchildren occasionally. ID: 68 y/o Native American Male, retired construction worker. CC: Rt knee pain x many years; epigastric burning with food x 2 weeks with dark stools. HPI: Pt c/o previous history rt knee pain for many years. He also c/o epigastric burning over past 2 weeks, and newly noted dark stools with no other prior history. Onset of rt knee pain approximately 7-8 years ago and increasing at this time. Epigastric burning onset is described as 2 weeks ago with dark stools noticed over past couple days. The location of his knee pain is centered over knee joint. Epigastric pain is focused in the mid to rt upper abd per Pt. Characteristics of his rt knee pain include occasional sharpness with an ongoing ache. His epigastric pain is characterized as burning which occasionally wakes him at night. He describes his stools over the past 1-2 days as dark-black in color, but not tarry in texture. JS denotes aggravating knee pain with movement especially getting up and down, or any activities which put pressure on his knee. He states his epigastric burning is aggravated by certain foods, especially high spice foods. His stools are recently dark- no aggravating of the color change noted. Relief of rt knee pain has been attempted with Advil 800mg po tid without good pain control. JS has also......

Words: 2163 - Pages: 9

Premium Essay

Microbiology Made Ridiculously Simple

...Preface A well-developed knowledge of clinical microbiology is critical for the practicing physician in any medical field. Bacteria, viruses, and protozoans have no respect for the distinction between ophthalmology, pediatrics, trauma surgery, or geriatric medicine. As a physician you will be faced daily with the concepts of microbial disease and antimicrobial therapy. Microbiology is one of the few courses where much of the "minutia" is regularly used by the practicing physician. This book attempts to facilitate the learning of microbiology by presenting the information in a clear and entertaining manner brimming with memory aids. Our approach has been to: 4) Create a conceptual, organized approach to the organisms studied so the student relies less on memory and more on logical pathophysiology. The text has been updated to include current information on rapidly developing topics, such as HIV and AIDS (vaccine efforts and all the new anti-HIV medications), Ebola virus, Hantavirus, E. coli outbreaks, Mad Cow Disease, and brand-new antimicrobial antibiotics. The mnemonics and cartoons in this book do not intend disrespect for any particular patient population or racial or ethnic group but are solely presented as memory devices to assist in the learning of a complex and important medical subject. We welcome suggestions for future editions. 1) Write in a conversational style for rapid assimilation. 2) Include numerous figures serving as "visual memory tools" and summary......

Words: 117402 - Pages: 470

Premium Essay

Benchmark Assignment: Hiv Epidemiology Paper the U.S. Centers for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s. ("STOP AIDS," 2009)     Acquired Immune Deficiency Syndrome(AIDS) is a disease caused by the Human Immunodeficiency Virus (HIV). HIV attacks the  human immune system, and progressively reduces its effectiveness, leaving the host susceptible to opportunistic infections and tumors. Due to the extended incubation period, the time between being infected with the virus and the manifestation of symptoms, an infected individual can transmit these the virus to other hosts unknowingly. The period between infection and the appearance of AIDS can take from 7 to 12 years, resulting in AIDS having reached pandemic proportions. The first cases were reported in 1981 and in 2007 it was estimated that more than 33 million people worldwide suffered from the disease and over 2 million...

Words: 4429 - Pages: 18