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Shingles in Older Adults

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Shingles in Older Adults
Kim Walton, RN
Olivet Nazarene University
GNS 312 Strategies for Student Success
BSN 190 NRSG 102
Cathi Schlosser
December 14, 2013

Certification of Authorship: I certify that I am the author of this paper and that any assistance I received in its preparation is fully acknowledged and disclosed in the paper. I have also cited any sources from which I used data, ideas, or words, either quoted directly or paraphrased. I also certify that this paper was prepared by me specifically for the purpose of this assignment.

Your Signature: Kim Walton, RN________________________________

You are a nurse working in a physician’s office. You are rooming a 75-year-old woman that arrives today complaining of a rash on her torso that is itching and painful to touch. As you question her about her symptoms you find that the rash developed last night but she had been experiencing a low grade fever and general malaise for the last three days prior to the rash developing. You immediately suspect shingles and await the diagnosis confirmation by the physician. When you re-enter the room the woman is tearful and has many questions along with stories of prolonged severe pain, even after resolution of the rash, from two of her closest friends. Your job is to educate your patient regarding the origin of the disease, its treatment including anti-viral medication along with medications for possible prolonged pain, and the vaccine to help reduce her chances of getting a reoccurrence of the disease. Begin by explaining that herpes zoster, known as shingles, is the same virus that causes chickenpox. “The term ‘shingles’ is thought to derive from the Latin cingulum (girdle), and ‘herpes zoster’ from the Greek herpein (to creep) and zoster (girdle) (Oakley & Goodband, 2013 p. 550). It lays dormant in the nerves for years waiting to be reactivated. “Herpes zoster [virus] is common, with nearly 1,000,000 individuals in the United States affected annually” (Gilden, 2011, p. 496). When the zoster virus is awakened in the body, which has been linked to a body’s declining immunity to the varicella zoster virus (VZV) as we age (Harkness, 2010, p. 52), it follows a specific nerve path on the body called a dermatome. This causes the rash to only appear on one side of the body during the outbreak. “The dermatomes most commonly affected are those of the abdomen, thorax, and ophthalmic branch of the trigeminal branch” (Harkness, 2010, p. 52). Also, it is important to educate the patient that even though the virus is dormant in her body, she could also contract the disease via respiratory droplets from a person that has active lesions (Gilden, 2011, p. 499). As this disease is caused by a virus, antibiotics are not prescribed. The drugs used to help shorten the duration of the disease are known as antivirals. The most common antivirals medications, according to Harkness, 2010, p. 53, include acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex). “The CDC (2008) recommends beginning treatment and controlling the acute symptoms with antiviral medications within 72 hours of development of the rash, thus reducing the pain and length of the outbreak” (Harkness, 2010, p. 53). Unfortunately, even with antiviral medications being started immediately after onset of the rash, patients can sometimes have continued pain along the dermatome, even after the resolution of all other symptoms. The pain is usually at its most intense during the second week of a breakout (Harkness, 2010, p. 52). However, patients have reported continued, sometimes severe pain, called post-herpetic neuralgia for weeks to months to years after an outbreak of shingles. This pain is described as constant, burning, stabbing and severe. Post-herpetic neuralgia is diagnosed once the pain associated with shingles is present for more than 90 days after resolution of the lesions (Gilden, 2011, p. 497). Along with opioid drugs and topical lidocaine patches physicians are prescribing tricyclic antidepressants such as gabapentin (Neurontin) or pregabalin (Lyrica) to treat post-herpetic neuralgia (Christo, Hobelmann & Maine, 2007, p. 5). Finally, there is a vaccine that has been shown to reduce the number of cases of shingles in patients over the age of 60 known as Zostavax. This is a one-time vaccine used to actually prevent the disease. It is given subcutaneously in a patient’s arm. It is important to educate the patient that even though it is a proven immunization for fighting shingles, Medicare Part B (the patient’s medical coverage) does not cover the vaccine. The patient may have Part D coverage (prescription coverage) that will cover the vaccine, however, it must be given at a pharmacy, not a physician’s office or clinic setting. This is confusing for the patient, causing some of them to forego the vaccine altogether. Some patients believe that once they have had the shingles they do not need to get the vaccine. However, this is untrue. As this is a virus that stays within the body even after an outbreak, the best way of preventing further outbreaks is with the immunization. If a patient presents with active skin lesions, the vaccine literature advises waiting until resolution of these lesions prior to receiving the vaccine. As our children have an immunization schedule, it is now becoming practice that our aging adults also have an immunization schedule. This schedule now includes pneumovax (pneumonia vaccine), influenza vaccine, TDaP (tetanus, diphtheria and pertussis) vaccine and Zostavax. In conclusion, it is estimated that over 90% of our aging population has had chickenpox during their childhood thusly have the latent herpes zoster virus present in their bodies, and of that 90% that live to age 85, 50% of these patient’s will develop shingles. (Harkness, 2010 p. 53). We now have a vaccine that is proven to help prevent outbreaks. As nurses, we must educate our aging population to help prevent this disease by encouraging them to get vaccinated.

References
Christo, P., Hobelmann, G., & Maine, D. (2007). Post-Herpetic neuralgia in older adults. Drugs & Aging, 24(1), 1-19.
Harkness, T. (2010). Why should older adults receive the shingles vaccine? Journal of Gerontological Nursing, 36(10), 51-55. doi:10.3928/00989134-20100504-06
Gilden, D. Efficacy of live zoster vaccine in preventing zoster and post-herpetic neuralgia. Journal of Internal Medicine [serial online]. May 2011; 269(5):496-506. Available from: CINAHL Plus with Full Text, Ipswich: MA. Accessed December 14, 2013
Oakley, S. & Goodband, A. (2013, August 13). The introduction of a new preventive vaccine for shingles. Practice Nursing, 24(11).

GNS 312 - GRADING RUBRIC

Paper on Topic of Clinical Expertise Due Week 5, Day 7
|CONTENT |POSSIBLE |EARNED |FACULTY COMMENTS |
|Title page followed APA formatting for page set up |1 | | |
|Introductory paragraph logically outlined what to expect in the |1 | | |
|paper | | | |
|(No abstract necessary) | | | |
|Paper topic was related to student’s area of clinical expertise.|1 | | |
| | | | |
|(It is not uncommon for students to write about something other | | | |
|than the assigned topic. No matter how well written, they end | | | |
|up losing points.) | | | |
|Paper followed the outline presented in the introductory |1 | | |
|paragraph | | | |
|Paper included a minimum of four quotations. |1 | | |
|Quotations were formatted appropriately based on their |4 | | |
|circumstances: | | | |
|short quote | | | |
|long quote | | | |
|paraphrased material | | | |
|reference citation | | | |
|deleted content from original source | | | |
|added content to the original source | | | |
|(One point awarded for each properly cited quotation.) | | | |
|Paper concluded with a summary paragraph |1 | | |
|Reference page following APA guidelines for title, alphabetical |1.5 | | |
|order, a minimum of three articles used, and inclusion of all | | | |
|the references cited | | | |
|Reference citations followed APA guidelines for proper |3.5 | | |
|formatting based on the type of reference- | | | |
|book | | | |
|journal | | | |
|c. personal communication | | | |
|References used were from scholarly sources |1 | | |
|Paper was free from spelling and grammatical errors |2 | | |
|Paper following a logical flow and development of thought |2 | | |
|Total Points |20 |Earned | |

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