Shingles can be a very serious concern for all adults and especially those over 60 or with existing medical conditions. What kind of risk does it pose? According to the CDC, 1 in 3 people will develop shingles in their lifetime and approximately half of these cases occur in patients over 60. With the older population at such a high risk and those who may already be experiencing health issues, it is vital for caregivers to know how to care for a patient with shingles and to be aware of complications that can arise.
Cause and Symptoms
Shingles is caused by a reactivation of the herpes zoster virus, which is the same virus that causes the chicken pox. It manifests itself in the form of a painful skin rash that can last up to four weeks. The pain can be described as aching, burning and even stabbing. This can be very debilitating and affect quality of life to the point of :
- Depression
- Anxiety
- Difficulty Concentrating
- Loss of Appetite
- Weight Loss
Shingles can also interfere with daily activities such as :
- Dressing
- Bathing
- Meal Preparation
- Eating
- Shopping
- Mobility
- Sleep
Pain Management with Medication
Careful dosing and monitoring of medication for pain is essential for treating the elderly.
“Acute pain should… be treated starting with acetaminophen and increasing the analgesic effect as needed to include codeine, oxycodone, and morphine, depending on the effectiveness of treatment, severity of pain, and side effects of the analgesics.” (MHC) It is also important to consider the other medications the patient may be taking and how these analgesics could interact with them. Caregivers should be sure to look for adverse side effects to analgesics including constipation, urinary retention, dry mouth, or confusion. If the patient is unable to tolerate a high dose of opioid pain medication, the lowest effective dose should be used in conjunction with other pain management therapies (MHC)
Complications
Postherpetic Neuralgia or PNH is the most common complication from shingles and is a continuation of the pain after the rash itself has healed. Age increases the risk. The severity of the pain can remain and is treated with medication ranging from painkillers to anti-seizure medication to skin creams (Iliades)
Bacterial infections are another complication to be aware of. The shingles rash presents as a blisters that rupture. Once ruptured, bacteria can get into the sore and cause an infection, most commonly as a result of scratching. (Iliades) Bacterial infections are treated with antibiotics.
Blurry vision or even vision loss can also occur. If the patient has pain on one side of the face or a rash on the tip of the nose, this is a sign that the infection may be spreading to the eye. If the patient has decreased vision, eye pain or discomfort, eye redness, or sensitivity to light or eye swelling, the patient should see an eye doctor right away to prevent serious complications. Antiviral medication can be prescribed in this situation. (Iliades)
Ramsey Hunt Syndrome is a complication where shingles attacks the facial nerves. This presents as a rash on one side of the face, ear pain, or facial drooping. The patient may also complain of dizziness, loss of hearing, ringing in the ears, or loss of taste. These symptoms may be permanent, but most cases clear up after a combination of antivirals and steroids. (Iliades)
Herpes Zoster Encephalitis is a rare but very serious complication occurring when the virus enters the brain. This leads to a swelling of the brain requiring hospitalization and a combination of IV medications. Symptoms start quickly and include confusion, headaches, vomiting, and fever. (Iliades)
Care Tips for Shingles
Monitor medication compliance. “The risk of patient nonadherence increases with the more times per day a drug is dosed.” (MHC) Make sure the patient is taking every dose, every day. If pain is being controlled with NSAIDs, make sure they are being administered around the clock.
Be observant for medication side effects. Consider a prophylactic laxative to prevent constipation. (MHC) Also, be aware of medications the patient may be taking regularly to treat other issues to make sure there are no adverse reactions between those and the required medications to treat the shingles outbreak.
Practice good wound care of lesions to avoid infection. Caregivers should always wear gloves to prevent the spread of bacteria to the patient and the spread of the virus. Wounds should be carefully cleaned with mild soap and warm water. Good hand washing must also be practiced.
Watch for signs of complications and seek treatment immediately if any should occur.
If you or a loved one has shingles, a private duty nurse can help with pain management, medication management, wound care, and other skilled services. Learn more about our services at NurseRegistry.com/private-care or call us at 650-462-1001 to speak with a Care Coordinator.
Sources
“Prevent Shingles.” Centers for Disease Control. https://www.cdc.gov/features/shingles/
Iliades, Chris. “5 Complications of Shingles.” Healthgrades. https://www.healthgrades.com/conditions/5-complications-of-shingles
“Ask the Expert: Managing Shingles in Older Adults.” Managed Healthcare Connect. March 14, 2014. http://www.managedhealthcareconnect.com/article/managing-shingles–older-adults-ask-the-expert
