NR 576 Week 2 iHuman Virtual Patient Encounter Attempt 2761371 - Victoria Lewis

History Notecard by Jennifer Tyson on case Victoria Lewis 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 Rash Sx Sx Sx Sx Sx = = = = = Onset 36 hours ago Location left upper thigh, left FA Duration Characteristics itchy, tender Aggravating Relieving Timing / Constant Treatments Severity severe Attempt: 2761371 Report generated on 5/21/2023, 7:13:28 PM America/Denver Management Plan by Jennifer Tyson on case Victoria Lewis Diagnostic Tests None Medications Hydrocortisone 1 % Cream, apply a thin layer over the affected area 2-3 times daily for red, itchy, or swollen skin. Dispense 1 tube, no refills (Hydrocortisone (Topical Application Route), 2023) An over-the-counter treatment should be attempted at first to alleviate the inflammation of dermatitis such as antihistamines, calamine lotion, and hydrocortisone cream. In extreme cases or clients with multiple sites, a tapered oral corticosteroid lasting 14-21 days should be used. (Butt et al., 2022)A short-term course of glucocorticoid can be used to treat allergic contact dermatitis.(Li & Li, 2021) glucocorticoids on a long-term basis can cause skin atrophy, damage to the barrier of the skin, and an increase in sensitivity to irritants. (Lee et al., 2021) Suggested Consult/Referrals None at this time. Referral to Dermatology if the rash worsens or does not improve with treatment. Client Education When exposed to potential skin irritants wash skin with soap and water as soon as possible to decrease the chances of irritation. Remove and wash affected clothing. Wear protective clothes and gloves for possible exposure Use cool compresses to relieve irritation of the rash. Avoid scratching. (Li & Li, 2021) Follow-up If the rash persists you should return to see a dermatologist. (Butt et al., 2022) Return to the clinic sooner if your symptoms worsen, if you start running a fever, or develop any other concerns. If you should develop symptoms such as trouble breathing you should call 911 or seek emergent care. References Butt, M., Flamm, A., Marks, J., & Flamm, A. (2022). Poison ivy dermatitis treatment patterns and utilization: A retrospective claims-based analysis. Western Journal of Emergency Medicine, 23(4), 481–488. https://doi.org/10.5811/westjem.2022.march.55516 Hydrocortisone (topical application route). (2023). Mayo Clinic. Retrieved May 18, 2023, from https://www.mayoclinic.org/drugs-supplements/hydrocortisone-topical-application-route/proper- use/drg-20073814 Lee, C., Choe, S., Kim, D., Kim, E., Eom, M., Hong, S., & Choi, E. (2021). Skin atrophy caused by topical glucocorticoids is less common in patients with atopic dermatitis than in those with psoriasis. Experimental Dermatology, 31(2), 182–190. Retrieved May 18, 2023, from https://doi.org/10.1111/exd.14441 Electronic Health Record by Jennifer Tyson on case