Six-year-old Lydia presents with her mother with a chief complaint of 'I don't feel well and I have a rash.' Mom states it started yesterday on her

Question Answered step-by-step Six-year-old Lydia presents with her mother with a chief complaintof “I don’t feel well and I have a rash.” Mom states it started yesterday on her face and is much worse today. Lydia has had a fever for two days and complains of a sore throat. What questions would you include in your history and what characteristics of the physical assessment would help in determining the origin?What would your differential diagnosis be? Be sure to include how you would determine your diagnosis and how you would treat the condition. Keep in mind there may be several different answers possible depending on what information you obtained during your assessment. Please answer with a discussion reply to BrandeeThe skin is the largest organ of the body, its functions include providing a protective barrier against mechanical, thermal, and physical injury and hazardous substances, prevents loss of moisture, reduces harmful effects of UV radiation, acts as a sensory organ, and helps regulate body temperature (“Structure and functions of the skin”, 2021). When a patient presents with complaints of not feeling well, having a rash on the face that has gotten worse, has had a fever for 2 days, and a sore throat. Obtaining a through history is important, for this case I would have a symptom focused information gathering of the skin condition (Duderstadt, 2019).In this case scenario, I would ask the patient and her mom what other symptoms are present with the rash, such as is it itching, pain, exudates, bleeding, and/or color changes. Next, I would ask when it started, sequence of occurrence, how fast was the onset, has this happened before, any known allergies, and any history of strep throat. Then I would ask any recent exposure to drugs, new skin products including insect repellent, detergent products, new foods, other environmental or occupational toxins, or family member or contact with similar condition, family history of psoriasis, and/or history of recent travel. Finally, I would ask what has been done to treat the problem, did the problem get better or worse (Duderstadt, 2019).The characteristics of the physical assessment that would help in determining the origin is making sure a complete examination of the skin using a consistent systematic approach will increase the likelihood that important findings critical to making a diagnosis will not be missed. In this case scenario, I would exam the location and type of the rash, the color, color changes, size, shape, arrangement, pattern, distribution, border, and consistency. Next, I would exam the throat, look for erythema, exudates, any signs of swelling around the tonsils or retropharyngeal area. Then I would exam for presence of enlarged, tender lymph nodes. (Fried, 2020).In this case scenario differential diagnosis can be scarlet fever, strep throat, fifth disease, and rubella. To determine the diagnosis, I would perform a rapid strep test and draw blood (CBC, ESR and rubella test). For my differential diagnosis, I would not need to perform a biopsy. A patient may need a skin biopsy if it is a persistent rash, scaly or rough skin, open sores, and/or a mole or other growth that is irregular in shape, color, and/or size (“Skin biopsy”, 2021). However, if my patient did need a punch biopsy, a hallow circular scalpel is used to cut into a lesion on the skin. The instrument is turned clockwise and counterclockwise to cut down about 4mm to the layer of fatty tissue below the dermis. A small sample of tissue is removed to checked under the microscope. Side effects include soreness and bruising. Some complications associated with punch biopsy include bleeding and bruising, pain, infection, allergic reaction to the numbing medicine (Gardner, 2020). Yes, a nurse practitioner can perform a punch biopsy. A punch and shave biopsy are considered to be a low-risk minimally invasive procedure with few potential complications.Based on the signs, symptoms, and diagnostics test, the diagnosis is scarlet fever. Treatment includes supportive care with acetaminophen and based on the throat culture results the patient needs antibiotics. Primary options to treat this is penicillin, however, if the patient is allergic, she can be prescribed a macrolide such as azithromycin or clarithromycin (“Scarlett fever”, 2021). Health Science Science Nursing NUR 648 Share QuestionEmailCopy link Comments (0)