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KRISTA HAMPTON NURS 5308 GRADE A Latest
update 2024
Instructions: Type patient encounter information directly into each box of the template similarly to your case studies. CC: 25 y/o F “I have this ugly looking rash on my upper thighs” HPI: Ms. Hampton is a 25 y/o female presenting with an itchy and tender rash bilaterally on her inner thighs, and her left inner forearm. The rash started about 36 hours ago after hiking in Napa with her boyfriend. She states she spent time hiking, tried a new sunscreen, tried new foods such as scallops and a new drink, as well as spending time in the hot tub with her boyfriend. She reports that her boyfriend does not have similar symptoms, and that she has not tried any treatments for the rash. PMHx: SurgHx Child: “usual coughs and tummy ache nothing remarkable.” Adult Illness: Denies Medical: None Surgical: None Obstetric: None Hospitalizations: None
FamHx SHx Maternal grandfather died of CVD at age 81. Grandmother (age 88) has prior heart attack, stent Tobacco: Denies and HTN. ETOH: Socially Mother alive and well. Illicit Drugs: Denies Father alive and well, treated for HTN. Occupation: English teacher for 7 th^ and 8 th^ grade Brothers - 35 and 32 both alive and well. Sister - 21 alive and well.
Review of Systems: (ROS) Use this column to document the ROS below. General: Denies unintentional weight loss or gain, chills, fever, and night sweats Eyes: Denies any vision changes, discharge, discomfort, dryness, or itching ENT: Denies any swelling, redness, rhinorrhea, or pain Pulmonary: Denies SOB at night or at rest or when lying down, denies cough, wheezing or difficulty catching breath CV: Denies palpitations denies heavy feeling or From the ROS: list/highlight the current symptoms/complaints to generate a list of pertinent “reported or denied” symptoms below:
sensation of a “pounding heart GI: Denies NVD, constipation, or heartburn. States normal bowel movements GU: Denies pain, burning, blood in urine, denies difficulty starting or stopping urinating, dribbling, incontinence, urgency during night or day, or any changes in the frequency of urination MS: Denies muscle weakness, joint pain, stiffness, or swelling Heme: Denies bruising, bleeding gums, nose bleeds, abnormal bleeding, or history of anemia Endocrine: Denies heat and cold intolerance, increased thirst, increased sweating, frequent urination, or changes in appetite Derm: Patient states” Ugly looking rash on my upper thighs, now it’s on my left inner forearm too”, rash is “itchy and getting more tender” D
Case: Krista Hampton
Blood pressure: 106/60 mmHg - upon standing Respiratory rate: 12 bpm SpO2: 94% on room air General: Thin, pleasant, cooperative female, alert and oriented x Skin: Skin on head, neck, back, chest, abdomen, right arm: warm, dry, intact, no redness, itching or swelling. Left inner forearm is noted with itchy erythematous papules in linear configuration with vesicles. Bilateral inner thighs noted with raised confluent erythematous papules with vesicles in various stages Eyes: Lashes without crusting, eyelids without edema, erythema. Conjunctivae pink, no discharge. No orbital edema, redness, tenderness ENT: Deferred D Skin: Skin on head, neck, back, chest, abdomen, right arm: warm, dry, intact, no redness, itching or swelling. Left inner forearm is noted with itchy erythematous papules in linear configuration with vesicles. Bilateral inner thighs noted with raised confluent erythematous papules 10x12cm with vesicles in various stages
Case: Krista Hampton
Neck: Deferred Pulm: Respirations even and unlabored bilaterally, good chest wall expansion, lung sounds clear to auscultation bilaterally both anterior and posterior CV: Heart rate and rhythm normal, no significant change while standing, squatting and during Valsalva maneuver, no JVD. 2+ peripheral pulses x4 extremities, PMI in the 5th intercostal (ICS) at the midclavicular line (MCL) GI: Lean, non-distended, no scars noted, bowel sounds audible in all 4 quadrants, no hepatosplenomegaly, mass or herniation
Case: Krista Hampton
List the differential diagnoses (Must not Miss/Leading/Alternate/Concluding – total of 3 *Include ICD 10 codes after each
**1. MNM/Leading/Concluding: Allergic Contact Dermatitis L23.
- MNM: Cellulitis L03. 90
- MNM: Herpes Zoster (Shingles) B02. Plan** Treatment: - Steroid creams or ointments. These
Case: Krista Hampton
topically applied creams or ointments help soothe the rash of contact dermatitis. A topical steroid may be applied one or two times a day for two to four weeks.
- Oral medications. In severe cases, your doctor may prescribe oral corticosteroids to reduce inflammation, antihistamines to relieve itching or antibiotics to fight a bacterial infection. Mild cases: - Domeboro to dry the vesicles and minimize spreading - Clobetasol propionate cream Severe cases: - Prednisone (20mg tabs) 3 tabs QDx3 days; (^) D
Case: Krista Hampton
- The oral corticosteroid is tapered over a 2 - week period, but a complicated tapering regimen probably is not necessary given the short duration of systemic corticosteroid use. - The systemic corticosteroids must be administered for 2 weeks, because shorter courses are notorious for allowing poison ivy dermatitis to relapse. - Long-acting intramuscular triamcinolone acetonide (Kenalog) 40-60 mg may be used in place of oral prednisone. To help reduce itching and soothe inflamed skin, try these self-care approaches and education: D
Case: Krista Hampton
- Avoid the irritant or allergen. - The key to this is identifying what's causing your rash and staying away from it. - Your doctor may give you a list of products that typically contain the substance that affects you. - Also ask for a list of products that are free of the substance that affects you.
Case: Krista Hampton
- Moisten soft washcloths and hold them against the rash to soothe your skin for 15 to 30 minutes. - Repeat several times a day. - Avoid scratching. - Trim your nails. - If you can't keep from scratching an itchy area, cover it with a dressing. - Topical soaks with cool tap water. - Burrow solution (1:40 dilution), saline (
Case: Krista Hampton
tsp/pint) can be soothing.
- Cool compresses with saline or aluminum acetate solution are helpful for acute vesicular dermatitis (eg, poison ivy). Some individuals with widespread vesicular dermatitis may obtain relief from lukewarm oatmeal baths.
- Soak in a comfortably cool bath.
- Sprinkle the water with baking soda or an oatmeal-based bath product. Protect your hands.
- Rinse and dry hands well and gently after washing.
- Use moisturizers throughout the day. D
Based on patient’s age/risk factors, what preventive screening would be recommended at today’s or a future visit: STI screening Flu vaccine if necessary Well woman’s exam with pap smear every 3 years per guidelines
Reflective Thinking Exercises Instructions: Review the Case summary of your IHUMAN case, noting strengths and areas of needed improvement. Answer the following questions below in brief essay format. Essay should be no longer than 1 - 1.5 pages in APA format in length. Points will be assigned as to the quality/depth of the student’s reflection.
- History-Taking: Describe your history taking scores and strengths you identified when gathering data. What went well? Also, describe your challenges in gathering data and list areas of your personal needed improvement. Note any missed areas that could be safety issues/errors leading to missed or incorrect diagnosis. The history portion of this case was very straightforward and short. The number of questions required by the expert were not that many in number and were easily discovered by using OLDCARTS. While going through the ROS the patient had denied
