Question

Vera Cella is a 59-year-old patient who is seen in the clinic today for a painful rash that runs in a half-circle along her rib line. The rash is composed of raised, fluid-filled lesions. The patient describes the pain as the most severe pain she has ever experienced. The physician makes a diagnosis of shingles and gives the patient a prescription for acyclovir (Zovirax). The patient has some questions for the nurse regarding the disease and the medication.

1. The patient asks the nurse why she has developed shingles. How will the nurse respond?

2. S.C. asks what side effects she can expect. How will the nurse respond?  What can the nurse encourage S.C. to do to lessen the most common side effects?

3. S.C. asks the nurse “can’t I just have this medicine in an IV?”  How should the nurse respond?  Would intravenous administration be appropriate for this patient?  Explain why or why not.

4. What are the serious adverse effects of acyclovir?  What labs should the nurse monitor?

5. S.C. returns to the clinic in 4 weeks stating she still have severe pain where the blisters once were. What would the nurse instruct S.C.?

6. Eight months later, S. C. returns to the clinic with another outbreak of shingles.  What medication does the nurse anticipate will be ordered for S. C.?

Anne Chovy, a 57 year-old female, comes to the office with c/o of blood-tinged sputum; she reports having a productive cough for “about a month”.  Upon further questioning, Anne mentions that she has been having “really bad night sweats but thought it was probably due to menopause”.  She tells you she has lost 15 pounds since her annual check-up, which was 6 months ago.  She lives in a rural home with her spouse and is the volunteer coordinator at the county homeless shelter.  She is given a PPD test and the result is positive.  

PMH:  optic neuritis

1. List the manifestations that helped you make Anne’s diagnosis.   

2. What additional tests may be done next to diagnose/confirm her diagnosis?

3. Anne is hospitalized and placed on special precautions to prevent the spread of illness to others.  What type of precautions do you think will be initiated?

4. Anne is started on 4 different medications:  Isoniazid, Rifampin, pyrazinamide & ethambutol.  Anne asked why she is taking so many medications.  What is the nurse’s best response?

5. What labs will be assessed before initiating drug therapy?  Any special exams?  What labs do you anticipate will be monitored during therapy?  How will you monitor for therapeutic response?

6. Anne is discharged home with prescriptions for a isoniazid/rifampin combo drug and instructions to take pyridoxine (vitamin B6) daily.  Her husband, Bon Chovy, is prescribed isoniazid.  Why is Anne being told to take vitamin B6? Why is her husband Bon also prescribed medication?  What patient teaching will you provide to Anne and Bon?  (Be thorough!)

Answer 1

Shingles :

It is the reactivation of the chicken pox virus( Varicella sister virus) in the body causing a painful rash.

A) If the patient asks why she has developed shingles, then the nurse answers she might have suffered from chicken pox before and now the rash is due to the reactivation of the latent virus.

If she has not developed chicken pox before, she may in direct contact with the fluid from the blisters of the patient who has shingles.

B) The nurse tells that the possible complications are lost-therapeutic neuralgia, pain will persist long after the blisters are cleared.

Neurological problem.

Skin infection.

Vision loss if another shingle may happen in or around the eye.

The nurse advices the patient tototally cover the wound.

Avoid touching and scratching the rash.

Frequent hand washing. Take proper medication.

2 vaccines may prevent the complications of shingles :

Chickenpox vaccine.

Shingles vaccine.

C) The nurse tells that the medication is also available in IV form which is only given by health care provider.

Yes the intravenous administration is appropriate for the latent because guideline included the use of IV acyclovir also in the treatment of Varicella zoster virus.

She is willing to take the drug in the IV form.

She doesn't have any renal disease to cut down the IV dose. ​​​​​​

D) Adverse effects of acyclovir :

Drowsiness.

Dizziness.

Feeling of pins and needles on the skin.

Diarrhea.

Agitation.

Hair loss.

Headaches.

Irritation of stomach or intestine.

The nurse should monitor the renal functions test periodically during the treatment.

Nurse monitor Comple blood count values to assess the infection.

E) The nurse tells that the pain will persist for some days even after the rash idisappear.

The treatment is same as that of previous. The patient is also given the chicken pox vaccine. The recurrence is due to weak immune system.