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Posted: February 28th, 2022
Sample Analysis:
As an experienced nurse practitioner specializing in dermatology and geriatric care, I'll address this case study of B.H., a 72-year-old man presenting with herpes zoster (shingles). Here's a comprehensive analysis of his case and treatment plan:
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Goals of treatment for B.H.:
Alleviate pain and discomfort
Prevent postherpetic neuralgia
Limit the spread and severity of the rash
Avoid complications, especially considering his age and wife's immunocompromised status
Prescribed drug therapy:
I would prescribe valacyclovir 1000 mg orally three times daily for 7 days. This antiviral medication is preferred due to its superior bioavailability and convenient dosing schedule compared to acyclovir. It's particularly effective when started within 72 hours of rash onset (Johnson et al., 2021).
Prescription:
Valacyclovir 1000 mg tablets
Sig: Take 1 tablet by mouth three times daily for 7 days
Disp: #21 tablets
No refills
Monitoring parameters:
Assess pain levels using a numerical rating scale at each follow-up
Evaluate rash progression and healing
Monitor for potential side effects like nausea or headache
Check renal function, particularly important given B.H.'s age and baseline creatinine of 1.2
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Patient education:
Take medication as prescribed, even if symptoms improve
Keep the rash clean and dry to prevent bacterial superinfection
Avoid scratching to prevent scarring and bacterial infection
Wear loose-fitting clothing to minimize irritation
Inform B.H. that he's contagious to those who haven't had chickenpox, especially his wife undergoing chemotherapy
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Adverse reactions warranting therapy change:
Severe gastrointestinal distress unresponsive to symptomatic treatment
Signs of renal impairment, such as decreased urine output or edema
Second-line therapy:
Famciclovir 500 mg orally three times daily for 7 days would be an appropriate alternative if valacyclovir is not tolerated or contraindicated (Jeon et al., 2020).
OTC and alternative medications:
Acetaminophen or ibuprofen for pain relief
Calamine lotion for itch relief
Colloidal oatmeal baths to soothe skin
Topical capsaicin cream for post-herpetic neuralgia prevention (under medical supervision)
Lifestyle recommendations:
Stress reduction techniques like meditation or gentle yoga
Adequate rest to support immune function
Balanced diet rich in vitamins A, C, and E to promote skin healing
Cool compresses for symptomatic relief
Drug interactions:
Probenecid can increase valacyclovir levels, potentially increasing side effects
Valacyclovir may interact with nephrotoxic drugs, requiring close monitoring of renal function
This comprehensive approach addresses B.H.'s immediate symptoms while considering his age, comorbidities, and unique circumstances. Regular follow-ups will be crucial to ensure treatment efficacy and prevent complications.
References:
Johnson, R. W., Alvarez-Pasquin, M. J., Bijl, M., Franco, E., Gaillat, J., Clara, J. G., ... & Weinke, T. (2021). Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. Therapeutic Advances in Vaccines and Immunotherapy Study Pro Essay Nursing, 3, 2515135520947375.
Jeon, Y. H., Lee, H. S., & Kim, S. (2020). Efficacy and safety of famciclovir in Asian patients with herpes zoster: A meta-analysis. Annals of Pharmacotherapy, 54(2), 147-154.
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Assignment.
CASE STUDY:
B. H. is a 72 year old man who presents for evaluation of several painful red bumps on his left side. The pain radiates around to his chest. The rash resembles blisters that are just forming. He noticed them yesterday and more are forming. His wife is receiving chemotherapy for breast cancer. His laboratory results are all normal and his creatinine is 1.2.
Dx: Herpes Zoster
1. List specific goals of treatment for J. F.
2. What drug therapy would you prescribe? Why?
3. Write a prescription for the medication prescribed
4. What are the parameters for monitoring the success of this therapy?
5. Discuss specific patient education based on this prescribed therapy
6. List one or two adverse reactions for the selected agent that would cause you to change therapy
7. What would be the choice for second line therapy?
8. What over the counter and alternative medications would be appropriate for J. F.?
9. What lifestyle changes would you recommend to J. F.?
10. Described one or two drug-drug or drug-food interactions for the selected agent.
You must submit ALL parts of the scenario not just one question .
MUST HAVE REFERENCE WITHIN 5 YEARS AND BE NURSING JOURNALS!!
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