Treatment of Shingles in Elderly: A Case Study Presentation

This presentation provides a case study on the treatment of shingles in an elderly patient. The presentation begins with a definition of shingles, its characteristics, and the causative agent, the Varicella zoster virus. The case study involves a 63-year-old man named Martin who presented with symptoms of shingles, including itching, burning sensations, and fatigue. The presentation details the vital signs, clinical investigations, and diagnosis of Herpes Zoster. A comprehensive care plan is outlined, including medication administration (Valacyclovir and Aceclofenac), referral to a psychotherapist and a nutritionist. The rationale behind each referral is explained. The presentation concludes with a summary highlighting the challenges of shingles in senior adults and the importance of prioritizing patient needs. Additionally, it includes peer questions about preventive measures and medication recommendations for patients with diabetes.

-PRESENTED BY
TREATMENT OF SHINGLES IN ELDERLY

SHINGLES:
 Shingles can be defined
as a viral infection
 It is characterized by the
manifestation of painful
rashes
 The rashes generally
occur in the form of a
single strip of blister at
either the left or right
side of the body
 The causative agent of
Shingles is Varicella
zoster virus1.

SHINGLES IN ELDERLY:
 Shingles in elderly lead to a
wide range of
complications
 Some of which include
bacterial skin infection to
vision and auditory
impairment and
postherpetic neuralgia
(PHN)4
 Cases of encephalitis,
transverse myelitis and
peripheral motor
neuropathy has also been
reported in the elderly4

CASE STUDY:
 “Martin, a 63 year old man was brought to the outpatient clinic by his
dependent spouse Carol who is 60 years old. Martin complained of
having an itching sensation on the left side of his chest. He was
agitated and complained of experiencing a burning sensation on his
chest as well as back. He further stated he had been experiencing a
feeling of stinging pain and numbness in the left side of his chest. The
client further stated that he felt extremely tired and fatigued and had
no energy to walk or move. The client also had red eruptions on his
forehead and had high body temperature. The patient had a medical
history of depression. Carol stated that Martin would complain of
intense pain and itching and would refuse meals. He would stay in bed
most of the times and say that his body was decaying and that he

VITAL SIGN ASSESSMENT:
 The vital signs of the patient indicated
the following:
 Temperature: 100ᵒF
 Blood Pressure: 140/80
 Pulse rate: 65 beats per minute
 Respiration rate: 16 breaths per minute
 Oxygen saturation: 96%

CLINICAL INVESTIGATION:
 Absence of edema
 Absence of cyanosis
 No abnormality detected in the nails, upper and lower limbs and
gait
 Absence of icetrus
 Absence of clubbing
 Absence of lymphadenopathy
 Presence of clusters of vesicles on the left side of chest, back
around sixth intercostals away from the midline and forehead.
 Pain score: 4/10
 Eruptions dimensions: 2mm x 3mm
 External margin of the eruptions were erythematous and edges
were sloped
 Tenderness with sensation of burning and itching on palpating

DIAGNOSIS:
 On the basis of the clinical findings, the
patient was diagnosed with Herpes
Zoster.
 Immediately contact precaution was
implemented so as to prevent the
transmission of infection to his wife
Carol

OVERVIEW OF CARE PLAN:
 The care plan would be based upon
three important considerations:
 Administration of medication to
manage symptoms and provide pain
relief
 Consideration of previous medical
history of depression
 Adapting a family-centred approach
and inclusion of Carol in the recovery
process

CARE OBJECTIVES:
 Administration of medication to
manage symptoms of pain and
eruptions
 Nutrition management to boost
immune system and prevent side-
effects
 Health literacy

TREATMENT PLAN:
 Administration of Oral
Valacyclovir2(1000mg, thrice a day) to
the rashes and prevent itching
 Administration of Aceclofenac3 (500mg,
thrice a day) for pain relied
 Referral to a psychotherapist
 Referral to a nutritionist

REFERRAL 1:
 Taking into consideration the medical
history of depression and the low mood
of the patient, the patient would be
referred to a psychotherapist.

RATIONALE:
 The psychotherapist would administer
mindfulness based therapies that
would help in motivating the patient
and ensure a faster recovery.