May 23, 2003
Question from a home healthcare nurse in the USA:
I have cared for a developmentally disabled elderly lady with diabetes and rheumatoid arthritis for six years. During my assessment this morning, I noted that she had a rash that extended from her left shoulder blade, and under her left breast. The rash had several fluid filled blisters, and looked very painful. When I questioned her about it, she stated that "It itched, and hurt all the time". She had been complaining of pain in that area for a while, and had been to see her rheumatologist because I thought it was her arthritis causing the pain. She has also been vomiting quite a bit in the morning, and it looks to only be mucus. She complains of "feeling tired", and just not like herself. I think she has shingles, but I have some limited knowledge except that it's a virus, and can be treated with anti-herpes agents. Due to the day of the week, I cannot make an appointment for her the with her physician. What should I do? I could possibly purchase something over-the-counter; would that work? Please assist me with my friend, and patient. I am really the only care-giver she has, and I would very much like to relieve her pain.
The physician needs to see the lesion. Many things can look like the lesion you describe. For specific therapy, this is a necessity. I would not give empirical anti-viral therapy to someone who may be relatively immunosuppressed.