A 72-year-old client is diagnosed with herpes zoster (shingles). To be most effective in arresting the infection, the nurse should anticipate administering which type of medication within the first 24 hours of the eruption?

1. A

   Oral antiviral agent

2. B

   Topical antibiotic cream

3. C

   Systemic corticosteroid

4. D

   Non-steroidal anti-inflammatory drug (NSAID)

Appeared in: NORCET 1 - 2020

Explanation

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• Herpes zoster (shingles) is a viral infection caused by the reactivation of the varicella-zoster virus (VZV).
• The primary goal of treatment is to 'arrest the infection,' which means stopping the virus from multiplying.
• Oral antiviral agents (e.g., acyclovir, valacyclovir, famciclovir) are specifically designed to inhibit viral replication.
• Evidence strongly supports that initiating antiviral therapy within 24-72 hours of rash onset significantly reduces the severity, duration, and risk of complications like postherpetic neuralgia (PHN).
• Therefore, an oral antiviral agent is the most effective medication to administer promptly.

Why Other Options Were Wrong

• Option B: Antibiotics treat bacterial infections, not viral infections like herpes zoster.
• Option C: Systemic corticosteroids reduce inflammation but do not stop viral replication. They are not the primary treatment for arresting the infection.
• Option D: NSAIDs are used for pain relief (analgesia) and to reduce inflammation. They do not have any antiviral properties.

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Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pharmacological management of Herpes Zoster (Shingles) in acute care settings.
• A nurse's primary role includes recognizing the signs of shingles and understanding the urgency of initiating antiviral treatment. Patient education on completing the full course of medication is crucial.
• Nurses must assess the patient's pain level and advocate for appropriate analgesic management, which may include NSAIDs, neuropathic pain agents, or even opioids for severe pain.
• Infection control is key. While shingles itself isn't contagious, the varicella-zoster virus can be transmitted to non-immune individuals (those who haven't had chickenpox or the vaccine), causing chickenpox. The nurse should advise the patient to keep lesions covered until they crust over.

How to Approach the Question

• First, identify the core clinical problem: The patient has herpes zoster (shingles), a viral infection.
• Next, analyze the question's specific goal: to find the medication that is 'most effective in arresting the infection' within the 'first 24 hours'.
• The keyword 'arresting' means stopping the progression. This points to a medication that targets the cause of the infection.
• Evaluate the options based on their mechanism of action:
• Oral antiviral agent: Directly inhibits viral replication.
• Topical antibiotic cream: Fights bacteria, not viruses.

Concept Tested & Keywords

• Concept Tested: Pharmacological management of Herpes Zoster (Shingles)
• Stem keywords: herpes zoster, shingles, 72-year-old, arresting the infection, first 24 hours
• Lead-in keywords: most effective
• Clinical cues: The patient's age of 72 is significant, as older adults are at higher risk for more severe disease and complications like postherpetic neuralgia.
• Clinical cues: The phrase 'arresting the infection' points directly to a treatment that stops the causative agent (the virus) from replicating.

Question ID

QZCbwVz0suJQ995DLGa-yv

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 75-77

E6 Pharmacology Nursing Lilley 11e Part 3 p. 8-10