Assignment A 9-year-old boy, Taumi, with a history of recurrent skin infections presents with extensive redness and pruritus of the popliteal and antecubital fossae, arms, and abdomen.
A 9-year-old boy, Taumi, with a history of recurrent skin infections presents with extensive redness and pruritus of the popliteal and antecubital fossae, arms, and abdomen. He’s scratched the lesions, especially at night, with the result that his sleep was disturbed. Despite the use of chronic moisturizing therapy and topical corticosteroids, he is having a seasonal flare of his condition. When he was 6 years old, he also experienced bronchial asthma with a persistent cough. This is not the first time he’s experienced this type of rash and has had issues since he was 4 years old. His mothers, Patricia and Fran, are bringing him into the clinic today for another exacerbation. They have tried the following: diphenhydramine 25mg q8h prn, hydrocortisone 2% QID, Zyrtec 10mg QD, and Aquaphor QID. The medications help some, but he’s still uncomfortable.
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Family history: His father has asthma, and his younger sister has allergic rhinitis and cow’s milk allergy.
Physical Exam:
• Vitals: BP 102/60, HR 68, RR 18, Wt 88 lbs (22 kg), Ht 4’11”
• HEENT: Injected conjunctivae and presence of Dennie-Morgan lines. There was a ‘cobblestone’ appearance of his posterior pharynx.
• Respiratory: Lungs were clear bilaterally with good aeration.
• Cardiac and abdominal examinations were unremarkable.
• Integumentary: Skin examination demonstrated scattered scaly eczematous patches along with the flexural areas of his upper and lower extremities. Impetigo “crust-like” lesions with serum oozing were found on the left elbow.PLEASE MAKE SURE TO COMPLETE THE FOLLOWING:
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• Four appropriate differential diagnoses and rationales with references. For each differential diagnosis, explain why this is an appropriate differential and how it was/would be ruled in or out. Support your answers with references.
• Pick one differential and create a plan of care for that patient.
o Plans must include Pharmacology, Non-Pharmacology, Labs/Diagnostics, Referrals/Interprofessional Communications, Patient Education (10–15 individual items minimum) and follow up.
o Make sure to pick one health maintenance item for this patient (primary or secondary) and explain to the patient why this is important.
o Address one social determinant of the health this patient may face during your visit. How will you help the patient overcome this obstacle to health care? NU-664B Week 13
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