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Instructions Response posts to peers have no minimum word requirement but must
Instructions
Response posts to peers have no minimum word requirement but must demonstrate topic knowledge and scholarly engagement with peers. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments unless specified in the instructions. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.
Initial Response(FOR REFERENCE)
Instructions:
Scenario: A 35-year-old woman presents to the walk-in clinic with an erythemic rash along her left lateral rib area, somewhat under her breast, which she describes as “very painful.” You note it has a few vesicles developing. The woman has a 6-month-old infant who is breastfeeding and three other children over 3 years of age, all of whom the parents have chosen not to vaccinate against common childhood illnesses. The woman describes recent stress related to providing 24-hour care in her home to her mother, who is seriously ill. The woman is seeking treatment for the painful rash.
Which conditions should be included in your list of differentials?
What additional information should be gathered to make the diagnosis?
Which condition is the woman likely experiencing?
What treatment plan should you prescribe for the woman? Provide full prescription details.
Based on the likely diagnosis, what are your concerns about the other members of the family?
What patient teaching should you include?
Please be sure to validate your opinions and ideas with citations and references in APA format.
Peer Response
Instructions:
Please respond to at least two of your fellow classmates postings as well and challenge each other to go beyond just the surface.
Share your thoughts on how you support their ideas and explain why.
Present new references that support your opinions.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Please respond to each students post individually.
(Hey Sarah, great post! I agree/disagree with….)
Ashley’s Post:
1. Which conditions should be included in your list of differentials?
The differential diagnoses for this patient should focus on the location of the vesicular rash and the current presentation stage. The differentials should include the following:
Herpes zoster
Herpes simplex virus
Impetigo
Medication reaction
Cellulitis
Smallpox
Insect bites or stings
Candidiasis infection
Coxsackievirus infection
(Kelley, 2022)
2. What additional information should be gathered to make the diagnosis?
The collection of a thorough history is essential to diagnose this patient accurately. The patient should be questioned on whether she has previously had the chickenpox infection or has been vaccinated against varicella. Information should be gathered about the patient’s daily medication regimen and whether she has started any new medications recently. The patient should be asked about any history of herpes outbreaks or exposure to anyone with herpes virus. The patient cares for four children, so it would be essential to ask if her children are experiencing similar symptoms or have been sick recently (Kelley, 2022).
Information should be collected on the patient’s past medical history, including any medication allergies, family history, and past medical history, such as HIV or disease resulting in an immunocompromised state. Information should be collected on any additional symptoms with the symptoms described. The patient should be asked about the pain at the site of the rash and if the pain was present in the area before the rash appeared. The patient should be questioned on any outdoor or known exposure to insects that could have caused the development of the rash from bites or stings. The patient should be assessed for a fungal infection (Dunphy et al., 2023).
3. Which condition is the woman likely experiencing?
The patient is most likely experiencing a herpes zoster infection. She exhibits many risk factors for the development of herpes zoster, including increased stress levels and living with small, unvaccinated children. The patient’s clinical presentation is consistent with herpes zoster in that the vesicular rash is presented in a dermatomal pattern that is very painful (Kelley, 2022).
4. What treatment plan should you prescribe for the woman?
The treatment plan should focus on obtaining pain relief, treatment with antiviral medication, and prevention of secondary infection (Dunphy et al., 2023). The treatment plan for patients with herpes zoster is focused on antiviral treatment started within 72 hours of symptoms onset. It is essential to know the initial onset of symptoms, including pain. The patient needs treatment with antiviral therapy (Kelley, 2022). Considering a pharmacological treatment plan, it is necessary to consider that this patient is breastfeeding. Antiviral medications are safe for breastfeeding mothers as the dosage of Acyclovir in breast milk is less than 1% of an expected infant dose and is not likely to cause any harm to the breastfed infant (Drugs and Lactation Database, 2018).
Valtrex 1 gram tablet, PO, one tablet three times a day by oral route as directed for seven days, # 21, 0 refills
Ibuprofen 400 mg tablet, PO, one tablet every six hours as needed for pain, #28, 0 refills
(Kelley, 2022)
5. Based on the likely diagnosis, what are your concerns about the other members of the family?
The most significant concern for the other members of the family, including the 6-month-old infant, small children, and the patient’s mother, who is seriously ill, is the transmission of varicella-zoster virus. The patient’s children have not been vaccinated against varicella, putting them at increased risk for the development of chickenpox. The patient’s mother is most likely immunocompromised, placing her at risk for the development of a herpes zoster infection (Kelley, 2022).
6. What patient teaching should you include?
Education and teaching are crucial in managing patients with herpes zoster. The patient should be educated on the importance of completing the entire course of Valtrex, even if symptoms significantly improve before finishing the prescribed course. The patient should be instructed to take the prescribed medications with food to prevent potential side effects. The patient should be educated on the possible side effects of Valtrex and Ibuprofen and advised to contact the office if any side effects develop so the treatment plan can be appropriately altered (Dunphy et al., 2023).
The patient should be educated on the stages of herpes zoster infection and how to appropriately care for the vesicular rash. Education should include that others should not be exposed to the fluid from ruptured vesicles. The patient should be the only person to handle linens, towels, clothes, and dressings. The patient should limit contact with the children as much as possible to prevent the development of chickenpox. The decision should be made with the patient on whether she should strictly pump breastmilk and provide bottle feedings until the rash has completely crusted over. The patient should be educated on avoiding scratching to prevent delayed healing and secondary infections. The patient should be educated on the importance of limiting contact with her mother as much as possible and potentially asking others for help until the rash has completely crusted over (Dunphy et al., 2023).
References
Drugs and lactation database [LactMed]. (2018, October 31). National Library of Medicine. Retrieved July 23, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK501262/Links to an external site.
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2023). Primary care: The art and science of advanced practice nursing – an interprofessional approach (6th ed.). F.A. Davis Company. https://bookshelf.vitalsource.com/reader/books/9781719649469/epubcfi/6/8[vnd.vst.idrefcop]!/4/2/2/2[cop]/14/1:89[ecomme]Links to an external site.
Kelley, A. (2022). Herpes zoster. JAAPA, 35(12), 13–18. https://doi.org/10.1097/01.jaa.0000892712.73041.aeLinks to an external site.
Natasha’s Post:
Scenario: A 35-year-old woman presents to the walk-in clinic with an erythemic rash along her left lateral rib area, somewhat under her breast, which she describes as “very painful.” You note it has a few vesicles developing. The woman has a 6-month-old infant who is breastfeeding and three other children over 3 years of age, all of whom the parents have chosen not to vaccinate against common childhood illnesses. The woman describes recent stress related to providing 24-hour care in her home to her mother, who is seriously ill. The woman is seeking treatment for the painful rash.
Which conditions should be included in your list of differentials?
Herpes simplex virus, herpes zoster, impetigo, varicella- zoster, cocksackie virus, cellulitis, contact dermititis, bite, sting, or drug eruptions (Dunphy et al., 2022).
What additional information should be gathered to make the diagnosis?
When did this start? Character and quality of the pain? Does she have h/o immuosupression, recent surgery, trauma, HIV? Any associated sumptoms such associated symptoms fever, fatigue, weakness? (Domino, 2024).
Which condition is the woman likely experiencing?
Herpes Zoster- shingles
What treatment plan should you prescribe for the woman? Provide full prescription details.
The goal of treatment is to control symptoms and prevent complications. Initial management would involve the use of antiviral agents such as acyclovir or valcyclovir. If initiated within 72 hours of skin eruptions can help to relieve symptoms, heal faster, and prevent or mitigate postherpatic neurolgia. Corticosteroids, such as prednisone, may be given in conjunction with antivirals to reduce pain associated with acute neuritis. Calamine lotion may assist in soothing the lesions, prevent scratching, improve healing time, and prevent secondary infection. Gabapentin may also assist in neuropathic pain control. Medication management will be individualized per the patient (Domino, 2024).
Based on the likely diagnosis, what are your concerns about the other members of the family?
The patient and family should be educated on the potential for spread of the herpes virus from ruptured vesicles. The children should be vaccinated for chicken pox or risk contracting the virus.
What patient teaching should you include?
The patient should be educated to complete the antiviral regimen prescribed even if they feel the virus has gone away. The virus may take longer to eradicate than they expect. The patient needs to be educated that the rash can spread until it crusts, so proper handeling of dressings, towels, linens, and clothes is essential to prevent spread. The patient should be educated on al medications prescribed and the importance of follow up appointments (Dunphy et al., 2022).
References
Domino, F.J. (2024). The 5-Minute Clinical Consult (32nd Edition). Wolters Kluwer
Dunphy, D. J., Winland-Brown, L. M., Porter, J. E., & Thomas, B. O. (2022). Primary care: The art and science of advanced practice nursing – An interprofessional approach. (6th ed.). F.A. Davis. ISBN -13: 978-1719644655