Assignment task:
You should respond to both discussions separately--with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts.
Minimum 150 words each reply with references under each reply.
Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).
Case #1
The patient is a 45-year-old woman that presents with a red rash on her arms and legs. She has been visiting the local YMCA for summer camp. The symptoms are two weeks old, prompting questions regarding possibly allergic, contagious, or environmental origins. A further evaluation can be helpful to clarify if the patients have been in contact with irritants, infectious pathogens, or outside allergens. One of the main presenting symptoms is the intense pruritus indicated by the rash's macular papular lesions with secondary excoriations. The distribution on forearms, upper arms, chest, thighs, and knees are suggestive of either contact dermatitis, bug bites, or a fungal illness requiring further assessment to discard other diagnosis.
More subjective information would be helpful in deciding the rash origin and etiology. Asking about changes in soap, detergent, or skin care products may identify contact dermatitis provocations. Enquiring about exposure to plants such as poison ivy or recent outdoor activities could be useful in seeking an environmental cause (Dunphy et al., 2022). The finding of similar symptoms in the camp children could be suggestive of a viral exanthem or a contagious condition, as scabies. Her history of atopic dermatitis or allergies might precondition her for particular skin responses. The timing of symptom onset may help to confirm the association with an environmental exposure if it coincided with YMCA visits.
Objective information should focus on lesions, as the physical distribution and appearance can be diagnostic such as burrows in scabies, vesicles in allergic contact dermatitis and annular plaques in tinea corporis. Irradiating the rash with a Wood's lamp (black light) may show fluorescence if fungus is present (Jarvis, 2019). The presence of palpable lymphadenopathy may suggest an infectious process. With the excoriations, look for USD or secondary bacterial infection with findings of warmth, pus, or worsening erythema. The absence of fever or systemic symptoms makes widespread infection less likely but doesn't rule out localized processes.
Diagnostic tests may also consist of a skin scraping with a KOH preparation to reveal fungal hyphae for tinea as a possible cause (Dunphy et al., 2022). Scabies preparation may be indicated if burrows are observed. Patch testing could reveal allergens where contact dermatitis is suspected but it is usually reserved for cases that are either persistent or recurrent. Bloodwork is probably not indicated unless a systemic reaction is concerned about, and a CBC might be ordered for a look at eosinophilia in allergic conditions.
The three main differential diagnoses that can be considered are allergic contact dermatitis, scabies and tinea corporis. Allergic contact dermatitis fits due to a pruritic, erythematous rash involving exposed areas. The lines might suggest scratching rather than the typical linear pattern of poison ivy, but one could easily incite this with exposure to an irritant at the YMCA (pool chemicals, cleaning agents). Scabies needs to be included in the differential diagnosis due to the intense pruritus and the possibility of contagion in a group situation like summer camp. Lack of burrows or interdigital involvement would make this less likely, although not impossible. In tinea Corporis is suggested where the lesions are annular with central clearing, particularly in the setting of exposure to fungi in community pools and/or in napkin rooms (pools where children wear diapers).
The history and examination findings of the patient are consistent with allergic contact dermatitis as the primary diagnosis. However, excluding infection is imperative. If contact dermatitis is diagnosed, treatment would be topical steroids for inflammation and antihistamines for pruritus (Fitzgerald, 2017). For scabies, you would need permethrin cream, and for tinea, antifungals. The education provided should focus on avoiding potential triggers and correct skin care for proper resolution and prevention. Need Assignment Help?
Case Study 2 -- Additional Subjective Data
Additional subjective information related to a red sclera with dried, crusted exudates is necessary for an accurate diagnosis. When gathering this information, the practitioner should ask the patient direct questions because the patient is eleven years old and probably able to communicate subjective data point inquiries. Subjective data collection for the eye includes onset, quality, location, severity, precipitating factors, related symptoms, and alleviating factors. The patient should be asked by the clinician if she was near sand and when the sensation of sand started. The patient should be asked whether she experiences discomfort in a particular area of her eye, how severe the pain is, whether there are any visual abnormalities, blurriness, or loss of vision, and whether there is anything that eases the irritation or sand-like feeling (Rhoades and Peterson, 2021). In addition, I would like to know if the eye is hurting or merely itching. I would ask the patient to rate the intensity of any reported pain on a scale of 0 to 10. Regarding causative causes, I would inquire. I would like to know whether there has been any harm to the eye or if it has come into contact with foreign objects. I would also inquire about any related symptoms, including changes or eye sight loss.
Additional Objective Data:
According to Rhoades and Peterson (2021), objective data collection of the eye includes a basic fundoscopic examination without pupil dilation, corneal reflex measurement, palpation, and inspection. During the examination, the healthcare professional would check for redness and edema on the lids, feel for extra exudate on the lower lid, and assess the color and consistency of the fluid. The provider should check for foreign bodies by evertting the upper lid. To check for foreign objects, retinal exudate, and background hemorrhages or lesions, the healthcare professional would utilize a fundoscope.
Diagnostic Exams:
The practitioner should swab the eye and order a culture to check for bacterial infection, even though the patient may have described a foreign body or an allergic reaction (Delugash& Story, 2021).
Differential Diagnosis and Rationale:
There are three possible differential diagnoses for this patient: bacterial conjunctivitis of the left eye, allergic conjunctivitis of the left eye, or a foreign body in the left eye. No matter the cause of the initial onset, the patient's inability to open her eyes in the morning because of crusted exudate is probably a sign that the conjunctivitis may not be allergic and has now developed into a bacterial infection (Delugash& Story, 2021).
The first differential diagnosis based on the patient's symptoms is a foreign body in the left eye. The diagnosis of allergic conjunctivitis of the left eye may be made since the symptoms are similar and include itching, clear watery discharge, and redness of the sclera, conjunctiva, and occasionally the lids (Dupuis et al., 2020). Despite the patient's denial of any allergy history, environmental allergies may develop in her at this age based on potential new exposures. Redness of the sclera, conjunctiva, and occasionally lids, itching, and crusty or pus-like discharge that frequently has a yellow or green tint are the symptoms of bacterial conjunctivitis (Delugash & Story, 2021).