Value: 100 points
Due: Day 7
Gradebook Category: Predictor Exam
Like you did at the beginning of this course, you have the opportunity to complete an additional Diagnostic Readiness Exam for the 3P courses (Advanced Pathophysiology, Advanced Pharmacology, and Advanced Health Assessment).
The exam will evaluate your readiness for the national certification exam related to the content covered within these classes. Completion of the exam will help you pinpoint areas of strength and areas needing further development for successful completion of the national certification exam. It is imperative that you put your full effort in taking this exam. By completing this additional 3Ps DRT in NU664B, you will have the opportunity to review your previously developed remediation plan and see the growth you have made this semester.
Instructions
3P DRT Exam
You will receive instructions regarding how to take your exam from your program director or course faculty member through the Course Announcements. This exam must be completed in one sitting.
Please submit your score report to the drobox. This exam does count towards your grade and will be graded as following:
DRT ScorePoints earned out of 1000–546055–667067–808081–909091–100100
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1. Atopic Dermatitis (AD): this is also known as eczema, it is an acute or chronic inflammation of the skin that results in itching (Garzon et al, 2019, p. 544). The onset of AD is common in children under five years old and is related to genetics and environmental irritants (Garzon et al, 2019, p.544). AD is linked with elevated levels of immunoglobulin E, and a family history of eczema, asthma, and allergic rhinitis (Howe, 2023). Symptoms of chronic AD in children include dry skin resulting in itching, and lichenification (Garzon et al, 2019). Taumi has recurrent skin infections with redness and itching in the back of his knees, the crease of his elbows, abdomen, and arms. He has Dennie lines, which are associated with AD (Garzon et al, 2019, p. 545). The areas in which Taumi is exhibiting symptoms are common in AD in children (Garzon et al, 2019, p. 544). Taumi has impetigo “crust-like” lesions with serum oozing on the left elbow. Taumi started to develop symptoms at the age of six, and he experienced bronchial asthma with a persistent cough. His risk factors include a history of asthma, his father has asthma, his younger sister has allergic rhinitis, and cow’s milk allergy, he is allergic to cats, milk, wheat, and eggs. and his mother has eczema. This diagnosis is highly likely based on his risk factors, history, and present symptoms. This diagnosis is based on clinical findings: a recurring itchy rash that is commonly found in creases of the skin such as the back of the knee and arm, and a family history of atopy is usually indicative of AD (Garzon et al, 2019, p. 546). Testing of the skin is not needed, however, it can be done to rule out other diagnoses or if there is a question of a fungal infection (Garzon et al, 2019, p. 546).
2. Psoriasis: This is a chronic skin disorder of keratin production, symptoms include raised, reddened plaques that are covered with silver-white scales that can be found on elbows, knees, and flexed surfaces of the body, with possible itching (Dunphy, 2019, p. 222). The cause of psoriasis is unknown, but it is believed to be related to genetics and environmental reasons (Garzon et al, 2019, p. 606). Guttate psoriasis stems from hemolytic strep (GABS), which can be the initial sign of psoriasis in children (Garzon et al, 2019, p. 606). Guttate psoriasis presents on the extremities in children, Taumi has scaly eczematous patches along the flexural areas of his upper and lower extremities. His risk factors for psoriasis are low, however, this diagnosis should be considered because it is still possible for him to have. To exclude this diagnosis, a complete physical exam of the skin will show well-demarcated inflamed plaques in areas such as the knee, elbows, or stomach (Feldman, 2023). If there is a further question of fungal involvement, a skin biopsy with an acid-Schiff-diastase (PAS-D) stain of the specimen can help (Feldman, 2023).
3. Allergic Contact Dermatitis (ACD): This is an acute or chronic inflammation of the epidermis from an allergen (Garzon et al, 2019, p. 596). Patients with ACD present with itchy skin where the allergen came into contact (Levy, 2023). Patients with acute symptoms have redness and edema with vesicles or bullae that rupture and crust, this is caused by poison ivy, oak, sumac, or nickel (Levy, 2023). In chronic conditions patients have lichenification, redness, and scaling (Levy, 2023). Taumi presents with scattered scaly eczematous patches along the flexural areas of his upper and lower extremities and impetigo “crust-like” lesions with serum oozing were found on the left elbow. Based on Taumi’s symptoms it is likely he could have ACD, a risk factor is his age (Yiannias, 2023). A diagnosis of ACD can be made by noting the features of skin irritation and the patient’s history including exposure and activities (Yiannias, 2023) Diagnostics such as patch testing to target allergens can be done, and KOH testing to rule fungal or bacterial infection is sometimes utilized, however, it is not necessary to diagnose ACD (Yiannas, 2023).
4. Seborrheic Dermatitis: This is a condition that causes chronic inflammation known as cradle cap in infants and dandruff in children (Garzon, 2019, p. 599). It occurs due to the oversecretion of sebum in areas of the body where there are a lot of sebaceous glands (Garzon, 2019, p. 599). In children, it can manifest as red or yellow greasy scales on the scalp, areas of the face, flexural surfaces, and skin folds (Garzon, 2019, p. 599). This type of condition does not cause itching, it is worse in the winter, and common in males (Sasseville, 2023). Although Taumi does not have all the symptoms of seborrheic dermatitis this diagnosis can still be considered. Diagnostic testing is not necessary to make this diagnosis, it can be determined based on examining the area of the lesions ( Sasseville, 2023).
Final Diagnosis: Atopic Dermatitis
Pharmacology:
Discontinue:
Diphenhydramine 25mg q8h prn
Hydrocortisone 2% QID
Continue:
Zyrtec 10mg QD ( lowest dose in children is 5 mg, I would consider decreasing to 5 mg).
Aquaphor QID
(Garzon et al, 2019, p. 546)
Start:
1. Hydrocortisone butyrate 0.1% ointment (apply to arms, legs, and abdomen) BID x 2 weeks followed by:
2. Hydrocortisone 0.5% cream (apply to arms, legs, and abdomen) twice a week for up to four months
(Garzon et al, 2019, p. 572)
Mupirocin 2% ointment (apply to left elbow) TID for 5-10 days – for impetigo (Mupirocin, 2023).
Nonpharmacology:
Aquaphor or vaseline applied before or after a bath with damp skin
Lukewarm baths
(Garzon et al, 2019, p. 548)
Wet dressing can be used to soothe itching
(Howe, 2023)
Labs/Diagnostics:
Acid-Schiff-diastase (PAS-D) stain (Feldman, 2023)
Patch test (Yiannias, 2023)
KOH test (Yiannias, 2023)
Referrals/Interprofessional communications:
Pediatric dermatology if symptoms do not improve (Garzon et al, 2019, p. 548)
Patient Education:
Please stop taking diphenhydramine 25 mg, this medication may not be useful for your symptoms and is sedating.
Please take medications exactly as prescribed.
If your child’s skin is still irritating after treatment, please give us a call to determine further management.
Please give us a call if your symptoms are worse or if you notice signs of infections such as pus, fever, or increased inflammation.
When applying ointment and cream, only apply a small amount (about half an inch). The amount can be measured using your fingertip to the first joint of your finger.
Avoid irritating items such as wool clothes or products with lanolin.
Keep fingernails short to prevent further skin irritation or infection.
Avoid bathing or showering in hot water.
Avoid scented products, fragrance free is best.
Keep skin moisturized at all times, and use products such as vaseline or petrolatum jelly.
Atopic dermatitis will continue to reoccur, however, the goal of treatment is to prevent itching and discomfort.
Please try to remain dry, after playing sports it is important to shower and moisturize the skin.
(Garzon et al, 2019, p. 548-549)
Avoid triggers such as high temperatures, sweating, and stress as these can irritate your skin
Cotton clothing is best and not irritating to the skin
(Howe, 2023)
Follow up:
Follow up in one week to assess if skin and itching are improving.
Health Maintenance:
An important health maintenance topic is vaccines. Taumi is an adolescent, it is important at his age to receive vaccinations following the standard schedule (Drutz, 2023). Childhood vaccines are beneficial because they decrease illness and promote immunity from life-threatening illnesses (Nandi & Shet, 2020, p. 1901).
Social Determinant of Health:
Taumi is an adolescent who is unable to advocate for himself. He relies on his mothers to advocate and care for him. This is important for a provider to recognize as it can be helpful towards his growth and knowledge. A provider can serve as a resource for adolescents by providing support that can assist in their ability to grow and thrive (Wang et al, 2020).
REFERENCES
Drutz,J. (2023). Standard immunizations for children and adolescents: overview. Up To Date. Retrieved on February 17, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/standard-immunizations-for-children-and-adolescents-overview?search=vaccine%20schedule%20children&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H81498659
Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary care: Art and science of advanced practice nursing – An interprofessional approach. (5th ed.).Philadelphia, P.A., F.A. Davis.
Garzon, D., Starr, N., Brady, M., Gaylord, N., Driessnack, M. & Duderstadt. (2019). Burns’ pediatric primary care. (7th ed.). Elsevier Publishing Company. ISBN: 978-0323581967
Howe, W. (2023). Atopic dermatitis (eczema): pathogenesis, clinical manifestations and diagnosis. Up To Date. Retrieved on February 16, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/atopic-dermatitis-eczema-pathogenesis-clinical-manifestations-and-diagnosis?source=history_widget
Mupirocin: drug information. (2023). Up To Date. Retrieved on February 17, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/mupirocin-drug-information?source=auto_suggest&selectedTitle=1~1—1~4—mupiro&search=mupirocin#F198538
Nandi, A., & Shet, A. (2020). Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Human vaccines & immunotherapeutics, 16(8), 1900–1904. https://doi.org/10.1080/21645515.2019.1708669
Feldman, S. (2023). Psoriasis: epidemiology, clinical manifestations, and diagnosis. Up To Date. Retrieved on February 16, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/psoriasis-epidemiology-clinical-manifestations-and-diagnosis?search=psoriasis&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H23
Wang, K., Zhang, A., Zheng, H., Kim, Y., & Padilla, Y. (2020). Proximal Social Determinants of Adolescents’ Health: The Importance of Everyday Life Circumstances. Youth & Society, 53(6), 913–933. https://doi.org/10.1177/0044118X20918436
Yiannias, J. (2023). Clinical features and diagnosis of allergic contact dermatitis. Up To Date. Retrieved on February 16, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/clinical-features-and-diagnosis-of-allergic-contact-dermatitis?search=contact%20dermatitis&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4#H27385242
