Herpes Zoster (shingles) — NCLEX Cheat Sheet

Apply contact precautions for localized zoster, and add airborne precautions if disseminated or the patient is immunocompromised. Administer antiviral therapy (acyclovir, valacyclovir) promptly, ideally within 72 hours of rash onset. Manage pain with prescribed analgesics, and gabapentin or other agents for neuropathic pain. Keep lesions clean, dry, and covered to reduce transmission, and avoid scratching to prevent infection.

A rash involving the eye or the tip of the nose (ophthalmic involvement) needs urgent ophthalmology evaluation to prevent blindness. Disseminated zoster (rash crossing multiple dermatomes or widespread) signals immunosuppression and requires airborne precautions and provider notification. Signs of bacterial superinfection (increasing redness, warmth, purulent drainage, fever) should be reported. Never let staff or visitors who are pregnant or non-immune to varicella care for or contact the patient until lesions crust.

The rash is unilateral, follows a single dermatome, stays on one side of the body, and does not cross midline. Burning, tingling, or pain often precedes the rash by days, followed by grouped vesicles on an erythematous base. It results from reactivation of latent varicella-zoster virus in someone who previously had chickenpox. Vesicle fluid is contagious; a person who never had chickenpox or the vaccine can develop chickenpox from contact.

The rash is contagious to people who never had chickenpox until all lesions crust over; keep it covered and avoid contact with pregnant women, infants, and immunocompromised people. Start antivirals as early as possible and take the full course; report eye involvement immediately. Get the recombinant shingles vaccine (Shingrix) after age 50 or as advised to prevent recurrence and reduce severity.