Ihuman Case Week #2 6531 36 Year Old Female Reason For Encounter: Itchy Rash On Her Inner, Exams of Nursing

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Ihuman Case Week #2 6531

36 Year Old Female Reason For

Encounter: Itchy Rash On Her

Inner Thighs And Her Left Inner

Forearm

1. Reason for Encounter (Chief Complaint)

"Itchy rash"

• The patient presents with an itchy rash located bilaterally on the inner thighs and left inner forearm.
• Rash started 36 hours ago after going hiking in a nearby park.

2. History of Present Illness (HPI) – ELABORATE

HPI should be documented in OLDCARTS format : Component Information Onset 36 hours ago after hiking Location Bilateral inner thighs + left inner forearm Duration Persistent since onset Characteristics Red, itchy, raised rash (erythematous maculopapular lesions) Aggravating Factors Scratching, heat, sweating Relieving Factors Nothing makes it better Timing Constant, worse at night Severity Itching severity: 8/

3. Review of Systems (ROS)

Ask the patient about the following:

6. Physical Examination

General Appearance : Well-nourished, no distress Vital Signs :

• Temperature: 98.6°F
• BP: 118/76 mmHg
• HR: 72 bpm
• RR: 16 breaths/min Skin Examination (Most Important Step) Area Findings Description Inner Thighs Erythematous rash Maculopapular, well-defined edges, bilateral Left Forearm Itchy rash Linear streaks, red, small blisters Other Areas No rash Clear skin elsewhere

7. Differential Diagnoses with Explanation

Based on the patient's presentation, here are the possible differential diagnoses: Diagnosis Explanation Why?

Diagnosis Explanation Why?

1. Allergic Contact Dermatitis Rash from plant exposure (Poison Ivy/Oak) Hiking history + itchy rash in exposed areas
2. Irritant Contact Dermatitis Reaction to sweat or clothes Rash on thighs + no blisters
3. Insect Bite Dermatitis Bites from insects like mosquitoes No clear bite marks, less likely
4. Tinea Corporis (Ringworm) Fungal infection Circular rash but not itchy enough
5. Atopic Dermatitis Chronic itchy skin condition No previous history, less likely

Most Likely Final Diagnosis:

Allergic Contact Dermatitis (ACD) ➡ Caused by exposure to Poison Ivy or Poison Oak during the hiking trip.

8. Diagnostic Tests

The following diagnostic tests will help confirm the diagnosis: Test Purpose Expected Result KOH Test Rule out fungal infection Negative Patch Test Identify allergen Positive for poison ivy/oak Skin Biopsy (if severe) Rule out eczema Not necessary in this case

11. Follow-Up

• Return to the clinic if: o Rash worsens o Blisters become infected o Fever develops

Final Diagnosis:

Allergic Contact Dermatitis (Poison Ivy or Oak)

What to Submit:

Section Explanation HPI Detailed using OLDCARTS ROS Include skin, general, HEENT PE Findings Focus on skin Differential Dx 3 - 5 diagnoses with explanation Diagnostic Tests Justify why each test is necessary Final Diagnosis Clear explanation Treatment Plan Medications + Non-Pharmacological Education Preventive Measures

1. Chief Complaint

What to Do: Start with the patient's presenting reason for visiting.

Explanation: The patient is complaining of an itchy rash that will guide the rest of

the examination. Ask the following questions:

How long has the rash been present?

Where did it start, and has it become generalized?

Describe the itchiness (mild, moderate, or severe)?

Are there factors that exacerbate or worsen it?

Is the rash burning, painful, or swollen?

2. History of Present Illness (HPI)

What to Do: Take a good history of the rash.

Explanation: Use the OLDCARTS mnemonic:

Onset: When did it start?

Location: Where is it?

Duration: How long?

Characteristics: What does it look like (red, raised, scaly, or blistering)?

Aggravating Factors: What makes it worse (scratching, heat, specific fabrics)?

Relieving Factors: What gets better (creams, cool compresses)?

Treatment: Were there any medications or home treatments administered?

Severity: How much pain or itchiness is it on a scale of 1-10?

3. Past Medical History

What to Do: Obtain information about previous medical conditions.

Explanation: Certain conditions put patients at risk for skin issues:

History of eczema, psoriasis, or allergies?

Chronic illnesses such as diabetes, asthma, or autoimmune disease?

Previous skin infections?

Any recent illness or fevers?

Hair loss or change in nails?

7. Physical Examination

What to Do: Perform a thorough skin examination.

Explanation:

Inspect the rash (color, shape, size, distribution).

Palpate the skin (warmth, tenderness, texture).

Inspect for any swelling, blisters, or oozing.

Inspect mucous membranes, scalp, and nails.

8. Differential Diagnosis

What to Do: Enumerate differential causes of itchy rash.

Explanation: Typical differentials are:

Eczema (Atopic Dermatitis)

Contact Dermatitis (Allergic or Irritant)

Psoriasis

Fungal infection (Tinea corporis)

Urticaria (Hives)

Scabies

Drug reaction

Autoimmune disorders (Lupus, Dermatitis Herpetiformis)

9. Diagnostic Tests

What to Do: Order appropriate tests.

Explanation:

Skin scraping or KOH test (for fungal infections)

Patch testing (for allergic dermatitis)

CBC (for infection or autoimmune markers)

IgE levels (for allergies)

Skin biopsy (in case of suspected autoimmune or rare conditions)

10. Final Diagnosis

What to Do: Make the final diagnosis based on history, exam, and tests.

Example: Atopic Dermatitis or Allergic Contact Dermatitis.

11. Treatment Plan

What to Do: Develop an overall treatment plan.

Explanation:

Topical corticosteroids (for eczema or contact dermatitis)

Antihistamines (for itching)

Emollients and moisturizers

Antibiotics (if secondary infection)

Patient education about triggers and skin care

12. Patient Education

What to Do: Teach the patient about skin care and prevention.

Explanation: Include:

Importance of moisturizing

Avoidance of triggers

Medication application

Follow-up

13. Follow-Up

What to Do: Schedule follow-up visits.

Explanation: Assess whether the condition improves with treatment or if tests need

to be conducted.