Shingles Sheila — Herpes Zoster: The One-Sided Band of Blisters and Airborne Rules
A stripe of blisters wraps one side of her chest like a belt that stops at the midline — and the pain arrived days before the rash
Sheila's left chest burned for three days before a stripe of blisters appeared, wrapping from her spine to her breastbone and stopping dead at the midline.
Sheila had chickenpox as a child; the virus slept in her nerve roots for fifty years and woke as shingles. Herpes zoster follows a single dermatome — a unilateral band of grouped vesicles that stops at the midline, often preceded by burning pain. Antivirals like acyclovir work best within 72 hours of the rash. Two exam traps: disseminated zoster or any zoster in an immunocompromised client requires airborne AND contact precautions, and vesicle fluid is contagious to anyone who never had chickenpox until every lesion has crusted. Pain that outlasts the rash is postherpetic neuralgia. Eye involvement (lesions on the nose tip) threatens vision.
Read Shingles Sheila's full story →The story arc
The setup
For three days Sheila's left chest burned and stung with no rash. Today a band of grouped blisters appeared on one side only.
The turn
The blisters follow the path of a single nerve like a belt across one side. Sheila cannot bear clothing touching them.
The crisis
A lesion appears near the tip of Sheila's nose and her eye is watering. On the next unit, a client on chemotherapy has blisters on both sides of the body.
The save
Sheila starts acyclovir within the 72-hour window, keeps lesions covered, and learns the fluid can give chickenpox to the unvaccinated until every blister crusts over.
NCLEX study section — Herpes Zoster: The One-Sided Band of Blisters and Airborne Rules
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Safety & Infection Control
Take this chapter into practice questions on the same topic.