Ramsay-Hunt syndrome results from VZV reactivation in the geniculate ganglion of the facial nerve. After primary varicella infection, VZV establishes latency in sensory ganglia. Immunosenescence, immunosuppression, or physiological stress can trigger viral reactivation. The reactivated virus travels anterograde along sensory nerve fibers to produce the characteristic herpetiform vesicular rash on the auricle and ear canal (sensory territory of the nervus intermedius). Simultaneously, inflammatory infiltration of the facial nerve within the tight bony fallopian canal causes compressive ischemic neuropathy, resulting in peripheral facial palsy. The geniculate ganglion's proximity to the vestibulocochlear nerve explains the frequent cochlear and vestibular involvement. The nurse performs comprehensive cranial nerve assessment, manages the complex interplay of antiviral therapy, corticosteroids, pain management, and eye protection, differentiates Ramsay-Hunt from Bell's palsy and central facial weakness, and monitors for complications including corneal ulceration, postherpetic neuralgia, and secondary bacterial infection.