NUR 52203 Advanced Health Assessment & Differential Diagnosis
Chief Complaint
A 19 y.o. female patient presents to your student health clinic complaining of a rash and says that she thinks she has the flu or something. She returned 3 weeks ago from a spring break trip to the beach. The rash started out like acne, located on her face, back, and chest. She now thinks she must have caught something during her trip, as she has developed joint pain in addition to the rash. The pain is most notable in her hands, although she has some stiffness and pain in both of her wrists, ankles, and knees.
Past Medical History
- Denies surgeries or serious illnesses/hospitalizations
Physical Examination
- Vital signs: T 99.6, BP 110/78, RR 20, HR 82, HT 58, WT 124 lbs.
- General: Well-developed and neurologically intact. No acute distress.
- CV: RR&R, no murmurs.
- Respiratory: Clear A&P.
- MS: Notable for mild swelling bilateral hands; other joints without visible abnormalities. ROM of fingers slightly decreased with mild stiffness of movement and tenderness to interphalangeal palpation. ROM to other joints is intact, but with mild discomfort on motion to bilateral elbows, wrists, ankles, and knees.
- Skin: Warm and dry with resilient turgor. Red maculopapular lesions scattered on cheeks and nose, more sparsely scattered on upper chest and back. No other lesions identified.
Questions
1. What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)?
2. What further history, further examination, and diagnostic studies are warranted to explore your differential diagnosis?
Laboratory Results
- CBC: WBC 6000/mcL; RBC 4.4 million/mcL; HCT 34.8%; HGB 00.8 gm/dL
- Chemistries: All WNL
- Urinalysis: WNL
- ANA: positive
- ESR: 210 mm/hr
- VDRL: Negative
3. What is the final diagnosis?
NUR 52203 Advanced Health Assessment & Differential Diagnosis
Module 6 Skin, Hair, Nails, Lymphatic System
Case Study 1: Skin
Grading Tool
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