Shingles pain

i wouldnt have been jumping to the conclusion of shingles pain with a palpable mass in the abd. But ativan would have mellowed out the patient even if it were pain from another source......was patient febrile? do they still have their appendix? if it a female? how old?

no fever, still has appendix, 80 year old female.

Also, what is the risk of transmission with shingles? I understand the chicken pox vaccination helps prevent it, but isn't it true anyone who has had chicken pox can get shingles?

The doctor diagnosed shingles from a phone call?

Do you know what tests were done to diagnose shingles in this pt? Do you know if anything was ruled out?

Yes, anyone who has had chicken pox can get shingles, but not from exposure. Once you have chicken pox, you have a dormant varicella virus in you, which can "activate" at some point later on in life, or if your immune system is suppressed. If you HAVEN'T had chicken pox and you are exposed to shingles, my understanding is that you CAN contract the disease and get very sick. If you've had the varicella vaccine, you are not likely to get shingles, AND you should be safe if you are exposed to it. If you are pregnant, I'd stay away from anyone with active varicella disease.

If I've gotten any of this wrong, please say something because I don't want to mislead anyone. This is my understanding without consulting a book or the net, and historically I have had confusion about this.

-Kan

The doctor diagnosed shingles from a phone call?

No, sorry, she is already known to have shingles

i need new glasses......i thought i read rlq, which is why i asked the questions did...ruq, i would be thinking gallbladder....and that pain can go straight thru to the back.....and can wax and wane.....so maybe the ativan wasnt responsible at all......good luck

i need new glasses......i thought i read rlq, which is why i asked the questions did...ruq, i would be thinking gallbladder....and that pain can go straight thru to the back.....and can wax and wane.....so maybe the ativan wasnt responsible at all......good luck

lol I need new fingers because I meant RLQ but typed RUQ. Funny, huh? Hey it was a long night.

lol I need new fingers because I meant RLQ but typed RUQ. Funny, huh? Hey it was a long night.

hmmm i was "seeing" what you meant......lol

back to appendicitis then, ages when common (~) 6-8,16-18, and the elderly

If the pain you notified the doc about had a sudden onset, but the patient already had a diagnosis of shingles, I would still be worried about another cause. Also, if the pt was already known to have shingles, they should have had a range of pain medications available--narcs for acute, visceral pain and something for neuropathic pain. Perhaps their shingles was resolving and this pain was post-herpetic? I would still be concerned about a GI/GU or maybe a vascular cause.

The links posted by NRSKaren are excellent, in regards to presentation and treatment of shingles!

were her bowel sounds ok before u palpated? the elderly are obssessed for a reason-decreased mobility,meds,dehydration,etc place elderly pts at increased risk for constipation/obstruction..

i recently got called on the carpet by the DON and the NP for getting a patient increased pain meds from the doc on call for the pain associated with her shingles. both said that "shingles doesnt hurt THAT bad". seriously, they said that.

all i had done was gotten the order to increase the hydrocodone to 7.5mg/325 from 5/325.

sometimes it is just easier to beat your head against a brick wall.