Fever And Rash


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  • A presenting complaint of fever and rash is a typical primary care problem domain. This presentation will explore the complexity of this common medical problem. What is seemingly a simple patient complaint actually demands extrapolation of various concepts and terms that are both distinct and yet interdependent with one another.
  • Fever And Rash

    1. 1. Fever and Rash A Sick College Student Lisa B. Goben Domain Terminology Project N409 Spring Duke University School of Nursing
    2. 2. Fever and Rash <ul><li>Measles (rubeola) in the 21 st century </li></ul><ul><ul><li>A clinical syndrome characterized by fever, malaise, coryza, cough, and rash. Death is rare, usually from pneumonia or encephalopathy. </li></ul></ul><ul><ul><li>It is highly contagious and was once considered “as inevitable as death and taxes.” </li></ul></ul><ul><ul><li>Because of aggressive vaccination programs in the U.S. starting in the late 1980’s, case reports have fallen from 250,000 in 1990 to a provisional 105 cases in 2003. </li></ul></ul>So a college kid walks into the ER……
    3. 3. Fever and Rash
    4. 4. Demographic Data
    5. 5. Living Situation <ul><li>Dormitory </li></ul><ul><li>Apartment </li></ul>Family Support <ul><li>Relative </li></ul><ul><ul><li>Mother </li></ul></ul>Age College Student
    6. 6. Biophysical Attributes
    7. 7. Medical History <ul><li>Symptoms </li></ul><ul><li>Past Medical History </li></ul>
    8. 8. Symptoms <ul><li>Sick </li></ul><ul><li>Achy </li></ul><ul><ul><li>Arthralgias </li></ul></ul><ul><li>Felt bad </li></ul><ul><li>Headache </li></ul><ul><li>Itching </li></ul>
    9. 9. Past Medical History <ul><li>Medical Problems </li></ul><ul><li>Immunization History </li></ul><ul><li>Medication Use </li></ul><ul><li>Tobacco Use </li></ul>
    10. 10. Medication Use <ul><li>Alternative Medications </li></ul><ul><li>Tetracycline </li></ul><ul><ul><li>Doxycycline </li></ul></ul><ul><ul><li>Side effects </li></ul></ul><ul><ul><ul><li>Photosensitivity </li></ul></ul></ul><ul><li>Illegal Drugs </li></ul>
    11. 11. Vital Signs <ul><li>Temperature </li></ul><ul><ul><li>39.0 Centigrade </li></ul></ul><ul><ul><li>Fever </li></ul></ul><ul><li>Blood pressure </li></ul><ul><li>Heart Rate </li></ul><ul><ul><li>Postural (links to Dehydration) </li></ul></ul><ul><li>Respiration Rate </li></ul><ul><li>Oxygen Saturation </li></ul>
    12. 12. Physical Exam <ul><li>Physical Signs </li></ul><ul><ul><li>Neck </li></ul></ul><ul><ul><ul><li>Nucal Rigidity </li></ul></ul></ul><ul><ul><ul><li>Lymphadenopathy </li></ul></ul></ul><ul><ul><li>Skin </li></ul></ul><ul><ul><ul><li>Rash </li></ul></ul></ul><ul><ul><ul><ul><li>Face </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Acne </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Chest </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Stomach </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Thighs </li></ul></ul></ul></ul>
    13. 13. Physical Exam <ul><li>Psychosocial Exam </li></ul><ul><li>Reexamining </li></ul>
    14. 14. Laboratory Tests <ul><li>Blood Tests </li></ul><ul><ul><li>Complete Blood Count </li></ul></ul><ul><ul><li>Mono Spot </li></ul></ul><ul><ul><li>Antibodies </li></ul></ul><ul><ul><ul><li>Rubeola IgM (links to Public Health Concerns) </li></ul></ul></ul><ul><ul><ul><li>Rubeola IgG </li></ul></ul></ul><ul><li>Results </li></ul><ul><ul><li>Positive </li></ul></ul><ul><ul><li>Negative </li></ul></ul><ul><ul><li>Levels </li></ul></ul>
    15. 15. Medical Knowledge
    16. 16. Medical Knowledge <ul><li>Medical Provider </li></ul><ul><ul><li>Nurse Practitioner </li></ul></ul><ul><ul><li>Doctor </li></ul></ul><ul><ul><li>Consultant </li></ul></ul><ul><li>Literature </li></ul><ul><ul><li>Dermatology Textbook </li></ul></ul><ul><ul><li>On-line Resources </li></ul></ul>
    17. 17. Diagnosis
    18. 18. Diagnosis <ul><li>Disease </li></ul><ul><ul><li>Differential </li></ul></ul><ul><ul><li>Probability </li></ul></ul>“ The terrors of disease are always with us.” Thomas A. Dooley (1927-1961)
    19. 19. Differential <ul><li>Allergic reaction </li></ul><ul><ul><li>or </li></ul></ul><ul><li>Infectious Disease </li></ul>
    20. 20. Infectious Disease <ul><li>Measles </li></ul><ul><ul><li>Rubeola </li></ul></ul><ul><ul><li>Atypical Measles </li></ul></ul><ul><li>Mononucleosis </li></ul><ul><li>Meningitis </li></ul><ul><ul><li>Meningococcal rash </li></ul></ul>
    21. 21. Drug Allergic Reaction
    22. 22. Measles Rash
    23. 23. Mononucleosis Rash
    24. 24. Infectious Disease <ul><li>Non-specific Viral Illness </li></ul><ul><ul><li>Viral Syndrome </li></ul></ul><ul><ul><ul><li>Influenza A </li></ul></ul></ul><ul><ul><ul><li>Influenza B </li></ul></ul></ul><ul><ul><ul><li>Garbage Pail Diagnosis </li></ul></ul></ul><ul><ul><li>Viral Exanthem </li></ul></ul><ul><li>Contagious </li></ul><ul><ul><li>Public health concerns </li></ul></ul>
    25. 25. Disease <ul><li>Secondary Diagnosis </li></ul><ul><ul><li>Dehydration </li></ul></ul>
    26. 26. Treatment
    27. 27. Intravenous Fluids <ul><li>Normal Saline </li></ul>Medications <ul><ul><ul><ul><li>Antipyretic </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>-Tylenol </li></ul></ul></ul></ul></ul>
    28. 28. Patient Teaching <ul><li>Explanation </li></ul><ul><li>Patient Education </li></ul><ul><ul><li>Self Help </li></ul></ul><ul><li>Reassurance </li></ul>Comfort measures <ul><li>Warm Blanket </li></ul>
    29. 29. Outcome
    30. 30. Discharged <ul><li>Called </li></ul><ul><ul><li>Resolved </li></ul></ul><ul><ul><li>Sequelae </li></ul></ul><ul><li>Public Health Reporting </li></ul>
    31. 31. Public Health Concerns
    32. 32. Immunization <ul><li>MMR </li></ul><ul><li>Immunity </li></ul><ul><ul><li>Wanes </li></ul></ul>Community Health <ul><li>Officials </li></ul><ul><li>Outbreak </li></ul><ul><ul><li>Epidemic </li></ul></ul>
    33. 33. Take Home Message <ul><li>“ Common things are common” </li></ul><ul><li>Think “horses” not “zebras ” </li></ul><ul><li>Analysis improves patient care </li></ul>
    34. 34. Bibliography <ul><li>Barinaga, J. L., & Skolnik, P. R. (2005). Clinical presentation and diagnosis of measles, from http://uptodateonline.com . </li></ul><ul><li>Charters, K. G. (2003). Nursing informatics, outcomes, and quality improvement. AACN Clinical Issues: Advanced Practice in Acute & Critical Care., 14 (3), 282-294. </li></ul><ul><li>Cohen, B. A., & Lehmann, C. U. (2005). Dermatlas.Org, from http://dermatlas.med.jhmi.edu/derm/ . </li></ul><ul><li>Mengert, T., Eisenberg, M. S., & Copass, M. K. (1996). Emergency medical therapy (4th ed.). Philadelphia: W.B.Saunders. </li></ul>