NR 511 Week 2 iHuman Virtual Patient Encounter Attempt 3776521 - Kaylee Hales

History Notecard by Sydney Smith on case Kaylee Hales Use this worksheet to organize your thoughts before developing a differential diagnosis list. 1. Indicate key symptoms (Sx) you have identified from the history. Start with the patient's reason(s) for the encounter and add additional symptoms obtained from further questioning. 2. Characterize the attributes of each symptom using "OLDCARTS". Capture the details in the appropriate column and row. 3. Review your findings and consider possible diagnoses that may correlate with these symptoms. (Remember to consider the patient's age and risk factors.) Use your ideas to help guide your physical examination in the next section of the case. HPI Sx = Sx = Sx = Sx = Sx = Sx = Onset 2 days ago Location inner thighs and left forearm Duration x2 days Characteristics itching/tender Aggravating none Relieving none Timing / Treatments after hike Severity n/a Attempt: 3776521 Report generated on 1/14/2026, 4:23:40 AM America/Denver Management Plan by Sydney Smith on case Kaylee Hales Plan Diagnostics No diagnostic testing is indicated at this time. Rationale: The diagnosis of contact dermatitis is primarily clinical and based on characteristic history, exposure, and physical examination findings. Diagnostic testing is reserved for cases that are severe, atypical, persistent, or refractory to initial treatment (Bolognia et al., 2023; Fonacier et al., 2015). If symptoms fail to improve or worsen, further evaluation such as patch testing may be considered. Pharmacologic Treatment Alclometasone dipropionate 0.05% cream Apply a thin layer to affected areas two to three times daily for up to 3 weeks. Rationale: Topical corticosteroids are the first-line treatment for allergic and irritant contact dermatitis. Low- to mid-potency topical corticosteroids, such as alclometasone dipropionate, are effective in reducing inflammation, pruritus, and erythema while minimizing adverse effects when used on non-facial, non-intertriginous skin (Bolognia et al., 2023; Fonacier et al., 2015). Consults / Referrals No referrals are indicated at this time. Rationale: Contact dermatitis can be effectively diagnosed and managed in the primary care setting. Referral to dermatology is recommended only if symptoms persist despite appropriate therapy, worsen, or if the diagnosis becomes uncertain (Fonacier et al., 2015). Patient Education Use topical corticosteroid exactly as prescribed and do not exceed 3 weeks of use. Avoid suspected offending agents, including brush plants (e.g., poison ivy) encountered during hiking. Wear protective clothing such as long sleeves and pants during outdoor activities to reduce future exposure. Use mild, fragrance-free soaps, detergents, and moisturizers. Consider colloidal oatmeal baths to relieve pruritus. Avoid scratching affected areas to prevent skin breakdown and secondary infection. Monitor for signs of infection including increasing redness, warmth, swelling, tenderness, oozing, or fever ≥100.4°F (38°C) and report these promptly. Rationale: Both pharmacologic and non-pharmacologic interventions are essential in the management of contact dermatitis. Avoidance of irritants/allergens and supportive skin care significantly reduce recurrence and promote healing (Bolognia et al., 2023; Fonacier et al., 2015). Follow-Up Patient to contact primary care provider if symptoms worsen or do not improve within 7 days. Rationale: Contact dermatitis can lead to complications such