Managing herpes zoster in older adults: Prescribing considerations.

NPs must be aware of special prescribing considerations for medication safety when managing the care of older adults with herpes zoster. Age-related physiologic changes of the body impact the pharmacokinetics and pharmacodynamics of antiviral and pain medications and can lead to potential adverse events.

Shingles vaccination: background and advice for community nurses.

Shingles (or zoster) is a reactivation of an existing varicella-zoster virus (VZV) infection. During the initial infection, VZV causes a systemic disease known as varicella or chickenpox, and this initial infection normally occurs early in childhood in the absence of routine vaccination. Although varicella is normally a mild disease, shingles is associated with significant morbidity and some mortality, particularly in older people. The most significant severe consequence is post-herpetic neuralgia. There is an effective vaccine available for this, known as Zostavax, which is a live-attenuated VZV vaccine. Guidelines in the UK recommend that this is offered to everyone when they become 70 years of age, plus those aged 79 years as part of a catch-up campaign, with those between these ages not being eligible. It is important for all health-care professionals, including district and community nurses, to proactively promote this vaccine, so that those eligible can make an informed decision about whether to receive it.

Herpes zoster: A rash demanding careful evaluation.

This article discusses the incidence, epidemiology, clinical presentation, diagnosis, and treatment of herpes zoster, complications such as postherpetic neuralgia, and prevention through vaccination. Information on vaccine cost and insurance coverage is provided as well as two case studies illustrating various clinical presentations.

Herpes zóster tratado con flores de bach. A propósito de un caso / Herpes zóster treated with bach flowers

Se presenta el caso clínico de un paciente de 78 años con pluripatología que es atendido por una enfermera comunitaria en su centro de salud. Se le somete a una terapia floral y se realiza un seguimiento de su evolución a partir de las fórmulas administradas (oral y tópica) y las intervenciones de enfermería. Metodología. Diversas visitas al centro de salud y realización de un seguimiento de las lesiones. Conclusiones. Las lesiones se curan en un período relativamente corto de tiempo y se mejora la ansiedad que presentaba el paciente ante su estado de salud, todo ello con una gran implicación de este y su familia en el proceso de curación (AU)

This report describes the case of a man of 78 years old who suffers multiple disorders. This man was attended by a communitarian nurse in a health care center. The patient was treated with floral therapy, and the evolution of the patient, the prescriptions (oral and topic) and the interventions of the nurse are explained with detail in the report. Methodology. Visits at the health center and a monitoring of the injuries. Conclusions. The result of the treatment was a short recovery time for the different injuries. The implication of the family and the patient himself in the treatment helped to get these good results and reduce the anxiety of the patient (AU)

Postherpetic neuralgia in older adults: culture, quality of life, and the use of alternative/complementary therapies.

The purpose of this article is to describe current knowledge and standards of care for postherpetic neuralgia (PHN) among older persons. Three influencing factors are considered: cultural implications, quality of life (QOL), and current practice of alternative/complementary therapy. A review of literature published between 2001 and 2006 was conducted. The findings indicate that PHN has debilitating effects on older adults regardless of culture. The impact of PHN on culture and ethnicity, particularly on the relationship between culture and patient's self-report of herpes zoster and/or PHN, has not been well investigated as evidenced in the literature. PHN is found to be associated with decreased health-related QOL among the elderly, with the most affected domains being sleep, mood, and general activity. Alternative and complementary therapy offers many advantages such as ease of use, availability, and low cost. However, due to lack of controlled trials and insufficient evidence, alternative therapy is not currently used widely and recommended. As the US population ages, the incidence of herpes zoster and PHN is expected to rise. Clinical trials that explore the response of the culturally diverse older adults to current treatment guidelines, strategies for prevention of PHN and its corresponding decrease in QOL, as well as controlled trials of alternative/complementary remedies should be considered.

Diagnosis and treatment of herpes zoster: role of the nurse practitioner.

DATA SOURCES: Case example and review of clinical trials, meta-analyses, and reviews provide relevant data regarding the management of herpes zoster. CONCLUSIONS: Herpes zoster is a relatively common disease in elderly patients. It results from reactivation of varicella zoster virus (chickenpox). Characteristic vesicular lesions are often accompanied by significant acute pain. The risk of complications, such as postherpetic neuralgia (PHN), increases when patients age or are inadequately treated. IMPLICATIONS FOR PRACTICE: Appropriate diagnosis and management of herpes zoster may shorten the overall disease course, accelerate cutaneous healing, and reduce the risk of PHN, a chronically painful complication. Greater understanding of the epidemiology, clinical manifestations, diagnosis, and available treatment options is essential for nurse practitioners and other primary care providers to initiate early treatment in patients with suspected herpes zoster infection.

Managing the comorbidities of postherpetic neuralgia.

PURPOSE: To discuss the impact of pain and its associated comorbidities in elderly patients with postherpetic neuralgia (PHN). To review the pharmacologic treatments available for patients with chronic pain and concurrent sleep disturbance, depression, and/or anxiety. DATA SOURCES: Relevant clinical literature pertaining to the management of common comorbid conditions in patients with PHN and chronic pain syndromes. CONCLUSIONS: Chronic pain strongly influences physical and psychological function in elderly patients. Comorbid illnesses, such as insomnia, depression, or anxiety, often develop in patients with chronic pain and complicate overall pain management and worsen prognosis. Pharmacologic treatment strategies that reduce pain frequently result in concurrent improvements in common pain-associated comorbidities. Pharmacologic treatment should be selected based on the efficacy of the selected agent(s), potential for adverse effects, and impact on pain-associated comorbidity. A multidisciplinary pain care management approach is essential to alleviate pain, manage pain-associated comorbidities, and improve function and quality of life. IMPLICATIONS FOR PRACTICE: Elderly patients who often deny their chronic pain are at increased risk for such conditions as sleep disturbance, depression, and/or anxiety. Nurses and nurse practitioners are in a unique position to improve pain care management by recognizing pain and its associated comorbidities early, educating patients regarding their perception of pain, and facilitating rational pharmacotherapy with the goal to improve function and quality of life.