NR 603 Week 6 Assignment and Collaboration Cafe _ CEA Pre-Diagnostic Case Study Part 1 and Part 2.

• History of Present Illness: T.R. presents with a 9-day history of a progressively spreading pruritic rash. The rash initially appeared on the right wrist and gradually extended to involve the bilateral forearms, anterior neck, and upper chest. She describes the rash as red, dry, and intensely itchy, with pruritus rated at 7/10 in severity. Symptoms are most pronounced at night and following hot showers. She reports scratching to the point of superficial skin breakdown in several areas. She denies fever, chills, fatigue, joint pain, facial swelling, oral lesions, shortness of breath, or wheezing. She has not started any new prescription medications but reports beginning an over-the-counter immune supplement approximately two weeks prior to symptom onset. She notes recent inflammatory responses, and exacerbates the itch–scratch cycle once symptoms begin (Schmuth et al., 2024). This barrier dysfunction, combined with recent exposure to fragranced skin products and ongoing scratching, increases the likelihood of persistent or worsening rash rather than spontaneous resolution. Together, these factors support maintaining a broad differential for a pruritic rash complaint and emphasize the importance of identifying modifiable exposures and barrier-restoring strategies in management. References Schmuth, M., Eckmann, S., Moosbrugger-Martinz, V., Ortner-Tobider, D., Blunder, S., Trafoier, T., Gruber, R., & Elias, P. M. (2024). Skin barrier in atopic dermatitis. Journal of Investigative Dermatology, 144(5), 989–1000.e1. https://doi.org/10.1016/j.jid.2024.03.006 Uter, W., Johansen, J. D., Macan, J., Symanzik, C., & John, S. M. (2023). Diagnostics and prevention of occupational allergy in hairdressers. Current Allergy and Asthma Reports, 23(5), 267–275. https://doi.org/10.1007/s11882-023-01076-z NR603 Week 6 Assignment: Clinical Education Associated (CEA) Pre- Diagnostic Exam Case Study Part 2 Name: Nicole Owens General Instructions This assignment builds on the case study in this week’s collaboration café. Carefully read the assignment guidelines and rubric and complete each case study section below. Use of this template is required. Differential Diagnoses (List three common differential diagnoses, including their pathophysiology and rationale for inclusion.) • Diagnosis 1: Allergic Contact Dermatitis o Pathophysiology: Allergic contact dermatitis is a delayed type IV hypersensitivity reaction that occurs when cutaneous exposure to an allergen activates sensitized T lymphocytes (Schmuth et al., 2024). Subsequent cytokine release leads to epidermal inflammation, barrier dysfunction, and pruritic erythematous lesions (Schmuth et al., 2024). • Comparison and contrast of presentation: All three conditions may present with erythema and pruritus; however, allergic and irritant dermatitis typically correlate with exposure patterns, while scabies is distinguished by intense nocturnal itching and potential involvement of close contacts (Simonart & Lam Hoai, 2024). Lesion distribution and symptom timing assist in differentiating these conditions in primary care. Diagnostic Testing, Guidelines, and Expected Results (Describe the necessary tests to diagnose and assess the severity of the three differential diagnoses. Discuss the relevant clinical practice guidelines (CPGs) for diagnosing and conducting diagnostic tests for each condition. Include expected diagnostic results consistent with the client’s chief complaint, HPI, and physical exam findings.) • Diagnostic testing for diagnosis 1 (including relevant CPG): Diagnosis is primarily clinical, with patch testing recommended for persistent or recurrent cases to identify specific allergens (Uter