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NURS 680A Advanced Health/Physical Assessment Week 5 Discussion Forum

NURS 680A Advanced Health/Physical Assessment Week 5 Discussion Forum

NURS 680A Advanced Health/Physical Assessment Week 5 Discussion Forum

Complete your weekly discussion prompt.

Select one of the following case studies to address:

  1. A 49-year old man reports feeling fullness in his right armpit and nipple discharge at his right areola . He denies other symptoms, significant medical history, or allergies.
  2. A 31-year old Black woman reports her breasts get swollen, hard, and lumpy at times and she has pain that comes and goes. She has heard that Black women have a high rate of breast cancer.
  3. A 27-year old woman complains of multiple small tender lumps in her right and left axillae. She explains that she has noticed that they seem to make “tunnels” and sometimes open and smell bad.

For the case you have chosen, post to the discussion:

  • Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.
  • In SOAP format, list:
    • Pertinent positive and negative information
    • Differential and working diagnosis
    • Treatment plan, including: pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.
  • Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
  • In your peer replies, please reply to at least one peer who chose a different case study.

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Sample solution

A 27-year old woman complains of multiple small tender lumps in her right and left axillae. She explains that she has noticed that they seem to make “tunnels” and sometimes open and smell bad.

Subjective data.

  1. The patient complains of uncomfortable/painful lumps that tunnel, open and smell bad.

Objective data

The possible question which might be asked to the patient include the following:

  • Medical history, has this happen to you before or this is something you have experienced for the first time?
  • Medication history= Are you currently using any medications?
  • Social history- do you smoke? How much ? Do you drink? How much? Any substance abuse? Any recreational drug use?
  • Do you sweat excessively? Do you use any antiperspirant?
  • Nutrition- do you have any special diet? are you allergic to certain foods?

Age-usually occurs between 19-30 years.

Laboratory results

Assessment.

From the gathered information of patient subjective data ,objective data and  chief complaint I will come up with the diagnosed as Hidradenitis Suppurativa.

Hidradenitis suppurative is a skin condition that causes small, painful lumps that develop under the skin. The lumps can open up and drain and the drainage can smell bad. These lumps usually develop in areas that the skin might be rubbing together such as the armpits, groin, buttock and breasts (Elsevier. (2017). The exact pathogenesis is still unknown. There are some common factors that may cause HS.

Follicular occlusion

An abnormal cutaneous or follicular microbiome.

Release of pre-inflammatory cytokines.

Inflammation causing rupture of the follicular wall, destroying sebaceous and apocrine glands and ducts (dermnetnz.org).

On  physical assessment, it is important to assess.

Site of lumps and note the color, size and shape.

Character- Is there any draining form the lump or it is dry.

Since Hidradenitis suppurativa is usually present on the armpits, groin, buttocks and breasts, I will ask the patient if she has noticed any lumps on those area and see if I can assess the skin on those areas.

Differential diagnosis

  1. Boil
  2. Pilonidal sinus
  3. Carbuncle, furuncle

Treatment plans.

  • Although Hidradenitis suppurativa is an inflammatory skin condition , studies have shown that topical and systemic antibiotics help with the bacterial pathogens that cause soft tissue and skin infections in the lesions in hidradenitis suppurativa.
    • Treat with antibiotics-Topical or systemic antibiotics can be used according to patient conditions.
    • Corticosteroids- which have anti-inflammatory properties, may help to avoid the outbreak.
  • Complimentary therapy.To relieve discomfort and swelling, apply a warm compress or warm washcloth to the affected area.
  • Over the counter treatment options in Hidradenitis suppurativa. Ibuprofen and other nonsteroidal anti-inflammatory medications (NSAIDs) are used to relieve discomfort and inflammation.
    • Lidocaine may be used to deliver numbness in the affected area.
  • Health education .

Explain to the patient the importance of keeping the environment clean and dry at all times. Some soaps and other skin products may be irritating the skin with hidradenitis. Using awash with benzoyl peroxide and switching to a gentle antiperspirant has shown to help the skin with hidradenitis. (aad.org).
laser hair removal will reduce the number of hair on the skin and with HS is can reduce the number of HS lumps. This is a safe and effective treatment option which can be done every 4 to 6 week.

FDA has also approved Botulinum toxin as a medication to treat excessive sweating. Excessive sweating may cause infection in HS (dermnetnz.org).

In cases when the HS abscess becomes very painful draining the abscess will help relieve the pain. An incision will be made on the abscess and it will be drained.

In more severe cases deroofing procedure will be performed. In this procedure the skin covering the top of the abscess will be removed. There won’t be any sutures as the skin will be left open to heal on its own. In most cases the wound will be packed with iodine or non-iodine packing strips. The strips will help to drain the wound.
Exercise on a daily basis.
There are dietary recommendations for individuals suffering from HS. Consume nutritious foods. Eliminating dairy products such as milk and cheese. These products increases the insulin levels. This leads to the overproduction of hormones called androgens which play a role in Hidradenitis suppurativa.

Consume less sugar in diet for the same reason as mentioned above, because it increases the insulin level.

Avoid foods containing brewers yeast. Avoiding these products will help with healing of the skin.

References

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