NURS 6512 Assessment of the Skin, Hair, and Nails
SUBJECTIVE DATA.
Chief Complaint (CC): The patient complained of rashes and swelling on the skin that had existed for three months.
History of Present Illness (HPI): A 34 years old Hispanic woman came to the clinic complaining of rashes and lesions on the skin that had been existed for a month. The patient was oriented and alert, but concerned about the skin lesions which seemed to be spreading faster to other parts of the body. The lesion was mainly dominant in the chest and back regions. The patient indicated the need to seek treatment. She fee uncomfortable about the condition and is prompted to touch from time to time. The patient reported that the symptom worsened during her period.
Medications: The patient reported having used prednisone 10 mg PO once a day to manage the allergic reactions.
Allergies: NKDA
Past Medical History (PMH): The patient does not present with any childhood illnesses. Furthermore, she denies having been admitted in the past year.
Past Surgical History (PSH): The patient denies past medical surgery history.
Sexual/Reproductive History: The patient is married and they have two children. She denies engaging in extramarital sexual affairs. The patient’s LMP was five days before coming to the clinic.
Personal/Social History: The patient denies using alcohol or smoking cigarette
Immunization History: The patient received all the childhood immunizations. Furthermore, she recently received the yellow fever vaccine a month ago because she was traveling out of the country.
Significant Family History: The patient has a family history of diabetes and cardiovascular disease. The grandfather is diabetic and hypertensive.
Lifestyle: The patient believes in Christianity and regularly attends church services.
Review of Systems: The patient is well oriented and alert. The patient has not gained or lost weight in the past six months. The patient demonstrates normal hair distribution and skin moisture. However, there are rashes and painless lesions on the skin. Occasionally the lesions turn red and the patient has to squeeze to remove the pus. The HEENT is well functioning. There are no edema or muscle pain recorded by the patient. The patient indicates the normal range of motion.
OBJECTIVE DATA:
Physical Exam:
Vital signs: The patient’s vitals were as follows, B.P 132/76mmHg, PR =76bmp, Ht; 5’3’’ Wt, 134 lbs, and BMI 23.4.
General: The patient is conscious and does not present with dyspnea, edema, or cyanosis. There are no murmurs from the heart.
HEENT: Normal ear and functioning. Normal visual acuity.
Neck: No swelling noted
Chest/Lungs: No murmurs or wheezing sound noted.
Heart/Peripheral Vascular: Regular heartbeat.
Abdomen: Non-distended and no-tender
Genital/Rectal: No discharge, or swelling noted.
Musculoskeletal: Normal range of motion
Neurological: Conscious and oriented
Skin: Skin rashes seen
ASSESSMENT
Differential diagnosis
- Impetigo
The typical characteristic of impetigo is the red sores that rupture and oozes to form yellow crusts. The conditions generally mild and can affect any part of the body. The formed yellow crusts heal within time and leave no scar. The condition result from various causes including bacterial infections. In severe cases, the condition may lead to kidney complications (May, et al., 2019).
- Chronic acne vulgaris: The non-inflammatory acne are sebaceous plugs that are extruded from the open comedones. On the other hand, inflammatory acne is characterized by irritation of the inflammatory responses which disrupts the epithelium. The patient presented with rushes and swelling in the skin which could be chronic acne Vulgaris. Furthermore, the fact that the symptoms increased during the period suggests that the condition is related to the hormonal changes in the body system (Acne vulgaris, 2019).
- The papulopustular rosacea is a condition characterized by extra sensitivity of the skin to the environment. The patients may experience red papules that give the appearance of acne. Updating rosacea diagnosis to improve treatment strategy: Recommendations from the global ROSacea consensus (ROSCO) panel. (2017), the common symptoms of the skin condition include pustules, skin inflammations, telangiectasia, and lymphedema. Furthermore, some patients may experience a burning sensation in the affected regions.
PLAN
Treatment Plan: The patient will be initiated on topical medications. The medical intervention will aim at reducing sebum production and alternation of epithelial cohesiveness.
Health Promotion: The patient is concerned about her skin condition; therefore, counseling and patient education will be important to help her understand that the condition is manageable. The education will focus on helping the patient identifying the aggravating factors to her condition and the need to avoid them. Furthermore, proper dietary intake and skincare techniques will be recommended for the patient. Furthermore, the patient will be educated on proper wound care practices. Inappropriate management of the wounds could result in septic infections that may result in other complications. The patient will be educated on the need to wash the wounds appropriately and keep them aseptic. Other than wound hygiene, proper dietary intake is also required to facilitate wound healing (Juliandri et al., 2019). The patient will be educated on the need to consume a lot of fruits and vegetables to boost the immune system.
Disease Prevention: The disease prevention measures will include avoiding skin irritants and maintain good skin hygiene practices.
REFLECTION
The clinical experience was educating and created an opportunity to understand the skin conditions better. On the other hand, there are many skin conditions and this makes it difficult to make the right diagnosis of the skill illnesses a patient presents with a glance. The differential diagnosis helps in further analyzing the possible illness a patient present with and the correct medicine to manage the condition (Liu et al., 2020). Obtaining relevant patient history is important in making the right diagnosis as evident during the clinical experience. I took time to understand the patients’ social and cultural factors that could affect the outcomes of the treatment process. Furthermore, there are no definite laboratory tests for diagnosing skin lesions unless they are related to fungal or bacterial infections.
Given another opportunity, I would embrace collaboration and consult with other healthcare providers in the department to help in the patient diagnosis process. Consulting with experienced healthcare providers could help reach the most accurate diagnosis of the skin condition. I agree with the preceptor based on the evidence.
Furthermore, providing relevant patient education is important. In this case, addressing the psychological needs characterized by the worries associate with the skin condition was important. The patient managed to calm down and believed that ion would improve.
References
Acne vulgaris. (2019). Canadian Family Practice Guidelines.
Juliandri, J., Wang, X., Liu, Z., Zhang, J., Xu, Y., & Yuan, C. (2019). Global rosacea treatment guidelines and expert consensus points: The differences. Journal of cosmetic dermatology, 18(4), 960-965.
Liu, Y., Jain, A., Eng, C., Way, D. H., Lee, K., Bui, P., Kanada, K., De Oliveira Marinho, G., Gallegos, J., Gabriele, S., Gupta, V., Singh, N., Natarajan, V., Hofmann-Wellenhof, R., Corrado, G. S., Peng, L. H., Webster, D. R., Ai, D., Huang, S. J., … Coz, D. (2020). A deep learning system for differential diagnosis of skin diseases. Nature Medicine, 26(6), 900-908.
May, P. J., Tong, S. Y., Steer, A. C., Currie, B. J., Andrews, R. M., Carapetis, J. R., & Bowen, A. C. (2019). Treatment, prevention and public health management of impetigo, scabies, crusted scabies and fungal skin infections in endemic populations: a systematic review. Tropical Medicine & International Health, 24(3), 280-293.
Updating rosacea diagnosis to improve treatment strategy: Recommendations from the global ROSacea consensus (ROSCO) panel. (2017). Journal of the American Academy of Dermatology, 76(6), AB275.
Hypertension is one of the health problems in the elderly populations. Hypertension increases the risk of health problems that include heart failure, stroke and renal failure. The risk for hypertension in the elderly populations is attributed to factors that include obesity, physical inactivity, smoking and alcohol abuse. Therefore, this essay examines the factors associated with hypertension, sensitive issues and targeted questions for EB, who has hypertension.
Hypertension is associated with a number of socioeconomic factors. One of them is ethnicity. The risk of hypertension is increased in individuals from ethnic minorities such as African Americans in the US. The client in the case study is black, which increases her risk for developing hypertension. The other socioeconomic factor is income. The level of income influences the affordability of care that the patient needs. Level of income also determines the patient’s ability to utilize health promotion interventions in the community that can be explored for optimum health and management of hypertension (Kanwar et al., 2019).
The presence of social support for the client in the case is another socioeconomic factor influencing the health of the client in the case study. Since the client is single, she might be lacking the social and emotional support she needs for the optimum management of hypertension. Therefore, the lack of social support might have predisposed the patient to poor adherence to the treatment regime for the hypertension. The last socioeconomic factor that influences the management of hypertension and risk factors in the patient is level of knowledge or awareness. The effective management of hypertension requires the adept understanding of the patient on its management. The patient in the case study appears to have low level of understanding about the management of hypertension (Ahammed et al., 2020). Therefore, there could be an effect of level of education or awareness on the management of the disease.
There exist lifestyle factors that predispose the patient to hypertension and its poor management. The risk for hypertension is elevated
in individuals who engage in minimal physical activity. There is also the enhanced risk for the disease in obesity and engaging in unhealthy dietary habits such as high intake of salt, alcohol and fats (Diaz Keith M. et al., 2017). Therefore, it is important to educate the patient about the lifestyle and behavioral modifications that are needed for the effective management of hypertension and its complications.
The nurse should consider sensitive issues in assessing the client. One of the sensitive issues is her values and beliefs related to the medical management of hypertension. The nurse should elicit information from the client concerning her attitude towards conventional management of hypertension. African American patients place more emphasis on the use of alternative and complementary medicine in disease management than conventional methods. The nurse should therefore obtain information concerning her attitude, values and beliefs concerning the medical management of hypertension. This will aid in the determination of barriers to the effective management of hypertension. The other sensitive issue that the nurse should explore in patient assessment is the lifestyle and behavioral interventions that the patient uses for managing hypertension. As shown above, the effective management of hypertension requires interventions that include living healthy lifestyle such as engaging in moderate physical activities, minimizing salt intake in diet, alcohol intake and smoking (Galiè et al., 2019). Consequently, the patient should be educated on the interventions that are effective for the management of hypertension.
Targeted Questions
The nurse should ask the patient the following targeted questions:
- What are your beliefs and attitude towards the use of medicines for the management of hypertension?
- What interventions do you use to manage the symptoms of hypertension?
- What do you think are some of the factors that hinder you from adhering to the treatment prescribe for the management of hypertension?
- What is the nature of your typical diet in a day?
- Do you think that you have adequate support in your society that enables you to manage effectively your condition?
References
Ahammed, B., Maniruzzaman, Md., Talukder, A., & Ferdausi, F. (2020). Prevalence and Risk Factors of Hypertension Among Young Adults in Albania. High Blood Pressure & Cardiovascular Prevention. https://doi.org/10.1007/s40292-020-00419-5
Diaz Keith M., Booth John N., Seals Samantha R., Abdalla Marwah, Dubbert Patricia M., Sims Mario, Ladapo Joseph A., Redmond Nicole, Muntner Paul, & Shimbo Daichi. (2017). Physical Activity and Incident Hypertension in African Americans. Hypertension, 69(3), 421–427. https://doi.org/10.1161/HYPERTENSIONAHA.116.08398
Galiè, N., Channick, R. N., Frantz, R. P., Grünig, E., Jing, Z. C., Moiseeva, O., Preston, I. R., Pulido, T., Safdar, Z., Tamura, Y., & McLaughlin, V. V. (2019). Risk stratification and medical therapy of pulmonary arterial hypertension. European Respiratory Journal, 53(1). https://doi.org/10.1183/13993003.01889-2018
Kanwar, M., Raina, A., Lohmueller, L., Kraisangka, J., & Benza, R. (2019). The Use of Risk Assessment Tools and Prognostic Scores in Managing Patients with Pulmonary Arterial Hypertension. Current Hypertension Reports, 21(6), 45. https://doi.org/10.1007/s11906-019-0950-y
