A nurse is assessing a client who presents with a prodrome of fever, headache, malaise, anorexia, and pharyngitis. The nurse observes a generalized pruritic rash that progresses from macules to papules to vesicles to pustules to crusts, starting on the face and trunk and spreading to the extremities. The number of lesions varies from a few to hundreds. Which of the following complications should the nurse be aware of?

Choice A rationale:

Topical corticosteroids can help reduce inflammation in various skin conditions, but they are not the best option for managing pain associated with shingles (herpes zoster) Corticosteroids primarily target inflammation and do not provide effective pain relief in neuropathic pain, which is characteristic of shingles.

Choice B rationale:

Antibiotics are not useful for managing the pain caused by shingles. Shingles is a viral infection, not a bacterial one, so antibiotics would not be effective in reducing pain or preventing secondary infection.

Choice C rationale:

Starting antiviral drugs, such as acyclovir, valacyclovir, or famciclovir, within 72 hours of rash onset is essential for managing shingles. These medications can help reduce the severity and duration of the illness and may also decrease the risk of developing complications like postherpetic neuralgia.

Choice D rationale:

Topical capsaicin is an appropriate option for neuropathic pain relief in shingles. Capsaicin, derived from chili peppers, works by desensitizing the nerve endings and reducing pain signals. However, it may cause a burning sensation initially, and the client should be advised on proper application and hand hygiene afterward.

Choice A rationale:

Administering the Td vaccine only if the wound is severe is not the correct response. Tetanus prophylaxis is recommended based on wound type and vaccination history, not just the severity of the wound.

Choice B rationale:

This is the correct response. Tetanus prophylaxis involves giving Tetanus Immunoglobulin (TIG) for immediate protection against tetanus toxin, along with the Tetanus and Diphtheria (Td) vaccine to promote long-term immunity. The decision to administer TIG and Td vaccine depends on the patient's wound type and their vaccination history.

Choice C rationale:

Tetanus prophylaxis is necessary even if the client received the DTP vaccine in childhood. The immunity from childhood vaccines may wane over time, and tetanus prophylaxis is recommended after potential exposure to the tetanus-causing bacteria.

Choice D rationale:

Giving the Td vaccine every 5 years is not the correct approach. The recommended schedule for Td booster doses is every 10 years, not every 5 years.