Value: 100 points
Due: Day 7
Gradebook Category: QBank
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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.
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.
1. When did this episode of redness and itching start? How has it changed since it started?
2. Did the itching start prior to the redness? (Dunphy, 2019)
3. Is this episode like previous episodes he has had? How is it different?
4. Does Taumi have any known environmental, seasonal or food allergies? (Howe, 2022)
5. Do you have hard water in your home? (Howe, 2022)
6. How often does Taumi bathe? (Maaks et al., 2020)
7. Tell me about Taumi’s living situation such as how many siblings, does he share a room? Would he have been sharing clothing or towels with anyone? (Maaks et al., 2020)
8. Do any other close contacts have the same redness (Maaks, 2020)
9. Do you have pets in the home? (Howe, 2022)
10. Has there been any recent travel history?
11. Any exposure to farm animals? (Howe, 2022)
12. Has Taumi had any recent infections including Strep throat? (Howe, 2022)
References:
Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary care: Art and science of advanced practice nursing – An interprofessional approach. (5th ed.). F.A. Davis.
Maaks, D.,Starr, N.,Brady, M. et al., (2020). Burns Pediatric Primary Care. (7th ed.).Elsiver.
Howe, W. (2022).Atopic dermatitis (eczema): Pathogenesis, clinical manifestations, and diagnosis. Up to Date. Retrieved From
https://www-uptodate-com.regiscollege.idm.oclc.org/contents/atopic-dermatitis-eczema-pathogenesis-clinical-manifestations-and-diagnosis?search=eczema%20children&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=2
