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Home>Homework Answsers>Nursing homework helpNURSEsee attached2 years ago03.12.202315Report issuefiles (2)week6PPP.peds.docxcasestudyPPP.pdfweek6PPP.peds.docxInstructionsPediatricsPlease upload a case scenario from your typhon log that pertains to Pediatric health.Please submit a power point presentation with a cover slide and content slide.Your paper should cover the points presented below.Subjective Data:ROS:HPI: Describe the course of the patient’s illness:Onset, Location, Duration, Characteristics, Aggravating and Relieving Factors:Current Medications (if any):PMH:Allergies:Objective:CNS:HEENT:Resp:CVS:GI:GU:Extremities:Other assessments (if applicable like neuro, CMS, etc)Differential Diagnoses:Plan/Intervention:Patient Education (minimum of three top patient education entries provided to patient):Rx: (complete prescription name, dose, quantity, refills, etc.):Labs:Diagnostic: (i.e x-rays, endoscopy, CT scan, etc.)Preventative measures based on age and US Task Force Preventative Guidelines of Family Medicine: (pap smear, screening guidelines appropriate to age):Referrals: (endo, cardiologist, endocrine: provide justification):RTC: (Follow-up):casestudyPPP.pdfPatient Initials: AB. Student: Lianet Aroche.Date: 11/22/2023. Age: 10 y/o. Sex: FemaleAllergies: NKDA Race: Hispanic.SUBJECTIVE DATACC:“My daughter has Skin rash ”.HPI:A 10 -year-old female teenager, Hispanic, is brought to the office by her mother, who statedthat her has a rash near the mouth, on the right side, which began as a mosquito bite that nowextends to several centimeters of the face and around the curve of the lip, The mother says thatthe eruption began 4 days ago, and denies fever or other reported symptoms. Also deniedcontact with a friends or relatives with similar lesions, no allergies were reported.Current Medications:Patient is not taking any regular medications or over-the-counter drugs. Also does not take anysupplements or any herbal supplements.PMH: Negative for Chronic Disease. Unremarkable. Delivered at 39.2 W2D. Spontaneousvaginal delivery was uneventful. Normal birth weight, Apgar score 8/9. DC two days afterdeliveryMedication Intolerances: NoneChronic Illnesses/Major traumas: NoneScreening Hx/Immunizations Hx: Vaccines reactivations updated. (Flu Vaccine, TT Reat;Hib; Hep B, Covid).Hospitalizations/Surgeries: NoneFamily HistoryMother Alive: 36 y/o / HealthyFather Alive: 40 y/o/ Healthy1Sister Alive 16 HealthyNegative Hx for Cancer, Dead for CV event, Genetical diseaseSocial HistoryPatient lives with his married parents in an apartment. Normal, familiar dynamic, he has ahealthy sister 14 y/o. He is a middle school student with good/normal development and socialinteraction Denied smoke, alcohol intake and use or recreational drugs., No second-handsmoking exposure. Denies being sexually active.REVIEW OF SYSTEMS:GeneralPatient denied change in appetite; tired,weakness or sleep disorder.CardiovascularDenies chest pain, palpitations, or edema onthe lower extremities. Deny varicosities orhistory of DVT.SkinRefer her daugther has itching, and red rashnear lip right, no secretions, no burns, nokeloids.RespiratoryDenies shortness of breath, hemoptysis,wheezing, pleuritic pain or coughing.EyesDenies any changes in vision. Denies anytrouble seeing clearly, pain, itching, or drainingof eyes. Does not use glasses. Last eye exam 1year agoGIDenied appetite problems. No dysphagia.Denies heartburn or bleeding. Nocomplaints of flatulence. Denies nausea orvomiting. Denies hematochezia. Nodiarrhea or constipation. Last bowelmovement: (today); Denies abdominal pain,nausea, vomiting, diarrhea, constipation,bowel habit changes, jaundice, vomitingblood, blood in stool, tarry stools.EarsPatient denies pain or drainage from the ear,hearing loss or tinnitus.GUDenies changes in urinary habits, normalurinary frequency. Denies history of kidneystones, flank pain, cloudy urine or badsmell, denies being sexually active.Nose/ Mouth/ Throat/Neck:Denies sinus problems, dysphagia, nose bleedsor discharge, loss of sense of smell, dry sinuses,sinusitis, postnasal drip, sore tongue, bleedinggums, sores in the mouth, loss of sense of taste,dry mouth, frequent sore throats, hoarseness,waking up with acid or bitter fluid in the mouthor throat, food sticking in throat when swallowsor painful swallowing. Deny masses or pain onneck or thyroid diseases.MusculoskeletalPatient refers no has history of fallsreported, denies weakness, muscular pain,swollen or any other inflammatorysymptoms in the joints. Denies joint pain,limited ROM, difficulty walking or troublereaching above head.PsychiatricPatients deny no changes in mood, deniesanxiety, depression, or insomnia.Denies low self-esteem, feeling sad, socialisolation or attention deficit, no change inthought patterns. Deny associated suicidalideas, nor mental illness in past.NeurologicalDenies loss of memory, seizures, seizures orfainting lightheadedness, facial pain, gaitimbalance or changes in LOC. Deniestremors, muscle weakness, numbness,tingling or sleeping disturbances.OBJECTIVE DATA:Weight:156 pns.Height:5`7”BMI:21.4 m2.Temp:97.2 oFBP:108/66 mmhg.Pulse: 92 bmp Resp: 18 x min Pulse Ox: 99 % Pain scale 0/10.PHYSICAL EXAMINATION:General AppearancePatient normal percentile according height and weight, properly dressed, speech clear andappropriate, cooperative to the interview, alert, oriented in place, person, time. Discomfort dueto the pain is reflected in his face and posture. Well hydrated, well nourishedSkinin the physical exam is presents small, red, itchy sores and blisters on the skin, especiallyaround the face (nose and mouth) and some low in extremities. The child experiences itchingand discomfort around the affected areas. The surrounding skin is red and slightly swollen.HEENTHead: Normocephalic, symmetric head, no signs of trauma. Normal sinuses, maxillary andfrontal palpation.Eyes: No strabismus observed during exploration, normal extraocular muscle function, nodischarge from the eyes, sclera is white, conjunctiva pink. PERRLA.Ears: Normal tragus and external canal. Meatus are normal. Not swollen or reddened. Bilateraltympanic membranes were intact and pearly gray with light reflex. No erythematous, scarredor hemorrhage. No pus or serous exudate. No hearing loss on bilateral whisper test.Nose: No external deformities of the nose. Nasal mucosa moist and pink with clear drainage,septum midline. Nasal turbinate no erythematous, no swollen. No sinus tenderness.Oral Cavity: Oral mucosa moist and pink. No lesions suggestive of malignancy or infections.Normal gums and palate, no bleeding or hypertrophy. Good hygiene, no caries or abscessdetectable to single inspection, normal dentition.Pharynx: Moist and pink, no presence of plaques or exudate. No petechias, no strawberrytongue. Normal pharynx and uvula to inspection, gag reflex presents and unaltered.Neck: No visible mass. No lymphadenopathy noted. Thyroid in the middle, no palpable. Nopalpable masses or tenderness, trachea is midline. No JVD.CardiovascularNormal chest wall, absence of orthopnea, collateral circulation or edema on lower extremities,no clubbing or cyanosis observed. No pericardial friction rub heard. Regular rate and rhythm,heart sounds of S1 and S2, no bruits, murmurs found to auscultation, no extra heart sounds,PMI at 5th intercostal space, midclavicular line. No pericardial friction rub heard. No gallops,murmurs, or opening snaps. Carotid, apical, radial femoral and pedal pulses present andstrong, capillary refill 2 seconds.RespiratoryOn inspection, the chest is symmetrical and moves with respiration, No osseous abnormality,scars, hematomas, or edema. Normal thoracic breathing, no use of accessory muscle, no tripodposition. On palpation, no masses or crepitus, tactile fremitus equal bilaterally. On percussion,resonance. On auscultation, clear lung without adventitious sounds.GastrointestinalAbdomen: Inspection: Symmetric, is watched flat, nondistended, no visible masses. No scarsAuscultation: Bowel sound active in all 4 quadrants. No bruits. Palpation: soft, no pain whenpalpating the abdomen, no involuntary guarding or rebound tenderness observed, no signs ofperitoneal irritation, no palpable masses. No hepatomegaly or splenomegaly. Percussion:Normal.GenitourinaryBimanual palpation does not reveal signs of enlarged kidneys. Costovertebral angles do notreveal tenderness. No palpable or percussed bladder.MusculoskeletalNormal gait. No muscular atrophies observed, no evident deformities, no stiffness observed,range of motion within normal limited, normal joints. Fingers, feet, and toes are normal. Spinewithout deformity.NeurologicalAAOx3. Keeps adequate communication ability, no concentration or attention deficit notedduring the exploration. Normal gait and balance observed. Sensation intact. Normal motoractivity. Deep tendon reflexes symmetrical and equal bilaterally. Normal function of all cranialnerves (from I to XII). Bilateral UE/LE strength 5/5.Psychiatric:Patient is euthymic, with normal level of mood, language and communication. The affect wasnormal. No past medical condition previous, no depression signs, no suicidal ideas presented.Main Diagnosis:ICD 10: L01.00: Impetigo, is a bacterial infection that involves the superficial skin. The mostcommon presentation is yellowish crusts on the face, arms, or legs. Less commonly there maybe large blisters which affect the groin or armpits. The lesions may be painful or itchy. Feveris uncommon. This most common form of impetigo, also called nonbullies impetigo, mostoften begins as a red sore near the nose or mouth which soon breaks, leaking pus or fluid, andforms a honey-colored scab, followed by a red mark which heals without leaving a scar. Soresare not painful, but they may be itchy. Lymph nodes in the affected area may be swollen, butfever is rare. Touching or scratching the sores may easily spread the infection to other parts ofthe body. (Hartman-Adams H, Banvard C, Juckett G.).Differential DiagnosisB00.9; Herpes viral infection, unspecified. Herpes viral infections in children refer to a groupof viral infections caused by the herpes simplex viruses (HSV). There are two main types ofherpes simplex viruses: HSV-1 and HSV-2. These viruses can cause a range of clinicalmanifestations, including oral herpes (HSV-1), genital herpes (usually caused by HSV-2 butcan also be caused by HSV-1), and other less common infections. Oral Herpes (HSV-1): Oralherpes is commonly known as “cold sores” or “fever blisters.” It typically presents as painful,fluid-filled blisters or sores on or around the lips, mouth, or gums. And Genital Herpes (HSV-2 or HSV-1): Genital herpes in children is less common than in adults but can occur, usuallydue to sexual abuse. It presents as painful sores or blisters in the genital or anal area.Treatment with antiviral medications is typically necessary to manage symptoms and reducethe risk of complications. Herpes Gladiatorum (HSV-1): Also known as “mat herpes,” thiscondition can affect children participating in contact sports like wrestling. It presents asclusters of painful blisters on the face, neck, or other exposed areas of the body. (Hartman-Adams H, Banvard C, Juckett G.)ICD 10: B01.9; Varicella without complication. Varicella, commonly known as chickenpox, isa contagious viral infection that primarily affects children. It is caused by the varicella-zostervirus (VZV), which belongs to the herpesvirus family. Chickenpox is characterized by adistinctive rash of itchy, fluid-filled blisters and is typically a mild childhood illness. Here’s adescription of varicella in children: Initial Symptoms: Chickenpox typically begins with a fewdays of mild, flu-like symptoms, including: Fever, Fatigue, Loss of appetite, Headache andRash development: After the initial symptoms, a rash appears. This rash is a hallmark ofchickenpox and progresses through several stages: Red Spots: Small, red, itchy spots developon the skin. These can appear anywhere on the body. (Bowen AC, Mahé A, Hay RJ, et al.).ICD 10: L73.9; Follicular disorder, unspecified. Follicular disorders in children refer to agroup of skin conditions that affect hair follicles. These disorders can result in a variety ofsymptoms and can be caused by various factors. Here are a few examples of folliculardisorders that can occur in children: Folliculitis: Folliculitis is a common condition in whichhair follicles become inflamed. It can occur in children and is often caused by bacterial orfungal infections. It presents small red or pimple-like bumps around hair follicles and can beitchy or painful. Keratosis Pilaris: This is a common and usually harmless skin condition thatcan affect children. It results in small, raised bumps on the skin, often on the arms, thighs, orbuttocks. These bumps are caused by the buildup of keratin, a protein that can block hairfollicles. And others disease. (Elliot AJ, Cross KW, Smith GE, et al.).Plan:Lab exams: no at this time.Medications:Amoxicillin 250 mg 1 tab PO every 6 hours x 7 days(Considered oral antibiotics (e.g., cephalexin, dicloxacillin) for more extensive or severe casesof impetigo or if multiple family members are affected. And Prescribed antibiotics as needed,and provide clear instructions on dosage and duration of treatment.)Mupirocin 2% topical ointment apply in lesions 3 x times per day.Ibuprofen 400 mg1 tab each 8 hrs orally.Preventions:Emphasize the importance of handwashing with soap and water before and after touching theaffected areas.Encourage good personal hygiene practices, including daily baths or showers.Recommended using a mild, antibacterial soap to clean the affected areas gently.Advise against sharing towels, clothing, or personal items to prevent the spread of theinfection.Washing hands, linens, and affected areas will lower the likelihood of contact with infectedfluids.Scratching can spread the sores; keeping nails short will reduce the chances of spreading.Infected people should avoid contact with others and eliminate sharing of clothing or linens.Children with impetigo can return to school 24 hours after starting antibiotic therapy as long astheir draining lesions are covered.Infection Control Measures at Home: Disinfect surfaces, toys, and clothing that may havecome into contact with the child’s skin.Wash and change bed linens, towels, and clothing regularly to prevent reinfection.Monitoring and Follow-Up:Follow-up in 1 week. Schedule follow-up appointments to monitor the progress of treatmentand ensure that the infection is resolving. Assess for any complications or the development ofnew lesions.Referral: No.References:Hartman-Adams H, Banvard C, Juckett G. (2021), Impetigo: diagnosis and treatment. AmFam Physician.; 90 (4):229-35.Bowen AC, Mahé A, Hay RJ, et al. (2020), The global epidemiology of impetigo: a systematicreview of the population prevalence of impetigo and pyoderma.; 10 (8): 0136789.Elliot AJ, Cross KW, Smith GE, et al. (2021), The association between impetigo, insect bitesand air temperature: a retrospective 5-year study (1999-2019) using morbidity data collectedfrom a sentinel general practice network database. (5): 490-6.casestudyPPP.pdfPatient Initials: AB. Student: Lianet Aroche.Date: 11/22/2023. Age: 10 y/o. Sex: FemaleAllergies: NKDA Race: Hispanic.SUBJECTIVE DATACC:“My daughter has Skin rash ”.HPI:A 10 -year-old female teenager, Hispanic, is brought to the office by her mother, who statedthat her has a rash near the mouth, on the right side, which began as a mosquito bite that nowextends to several centimeters of the face and around the curve of the lip, The mother says thatthe eruption began 4 days ago, and denies fever or other reported symptoms. Also deniedcontact with a friends or relatives with similar lesions, no allergies were reported.Current Medications:Patient is not taking any regular medications or over-the-counter drugs. Also does not take anysupplements or any herbal supplements.PMH: Negative for Chronic Disease. Unremarkable. Delivered at 39.2 W2D. Spontaneousvaginal delivery was uneventful. Normal birth weight, Apgar score 8/9. DC two days afterdeliveryMedication Intolerances: NoneChronic Illnesses/Major traumas: NoneScreening Hx/Immunizations Hx: Vaccines reactivations updated. (Flu Vaccine, TT Reat;Hib; Hep B, Covid).Hospitalizations/Surgeries: NoneFamily HistoryMother Alive: 36 y/o / HealthyFather Alive: 40 y/o/ Healthy1Sister Alive 16 HealthyNegative Hx for Cancer, Dead for CV event, Genetical diseaseSocial HistoryPatient lives with his married parents in an apartment. Normal, familiar dynamic, he has ahealthy sister 14 y/o. He is a middle school student with good/normal development and socialinteraction Denied smoke, alcohol intake and use or recreational drugs., No second-handsmoking exposure. Denies being sexually active.REVIEW OF SYSTEMS:GeneralPatient denied change in appetite; tired,weakness or sleep disorder.CardiovascularDenies chest pain, palpitations, or edema onthe lower extremities. Deny varicosities orhistory of DVT.SkinRefer her daugther has itching, and red rashnear lip right, no secretions, no burns, nokeloids.RespiratoryDenies shortness of breath, hemoptysis,wheezing, pleuritic pain or coughing.EyesDenies any changes in vision. Denies anytrouble seeing clearly, pain, itching, or drainingof eyes. Does not use glasses. Last eye exam 1year agoGIDenied appetite problems. No dysphagia.Denies heartburn or bleeding. Nocomplaints of flatulence. Denies nausea orvomiting. Denies hematochezia. Nodiarrhea or constipation. Last bowelmovement: (today); Denies abdominal pain,nausea, vomiting, diarrhea, constipation,bowel habit changes, jaundice, vomitingblood, blood in stool, tarry stools.EarsPatient denies pain or drainage from the ear,hearing loss or tinnitus.GUDenies changes in urinary habits, normalurinary frequency. Denies history of kidneystones, flank pain, cloudy urine or badsmell, denies being sexually active.Nose/ Mouth/ Throat/Neck:Denies sinus problems, dysphagia, nose bleedsor discharge, loss of sense of smell, dry sinuses,sinusitis, postnasal drip, sore tongue, bleedinggums, sores in the mouth, loss of sense of taste,dry mouth, frequent sore throats, hoarseness,waking up with acid or bitter fluid in the mouthor throat, food sticking in throat when swallowsor painful swallowing. Deny masses or pain onneck or thyroid diseases.MusculoskeletalPatient refers no has history of fallsreported, denies weakness, muscular pain,swollen or any other inflammatorysymptoms in the joints. Denies joint pain,limited ROM, difficulty walking or troublereaching above head.PsychiatricPatients deny no changes in mood, deniesanxiety, depression, or insomnia.Denies low self-esteem, feeling sad, socialisolation or attention deficit, no change inthought patterns. Deny associated suicidalideas, nor mental illness in past.NeurologicalDenies loss of memory, seizures, seizures orfainting lightheadedness, facial pain, gaitimbalance or changes in LOC. Deniestremors, muscle weakness, numbness,tingling or sleeping disturbances.OBJECTIVE DATA:Weight:156 pns.Height:5`7”BMI:21.4 m2.Temp:97.2 oFBP:108/66 mmhg.Pulse: 92 bmp Resp: 18 x min Pulse Ox: 99 % Pain scale 0/10.PHYSICAL EXAMINATION:General AppearancePatient normal percentile according height and weight, properly dressed, speech clear andappropriate, cooperative to the interview, alert, oriented in place, person, time. Discomfort dueto the pain is reflected in his face and posture. Well hydrated, well nourishedSkinin the physical exam is presents small, red, itchy sores and blisters on the skin, especiallyaround the face (nose and mouth) and some low in extremities. The child experiences itchingand discomfort around the affected areas. The surrounding skin is red and slightly swollen.HEENTHead: Normocephalic, symmetric head, no signs of trauma. Normal sinuses, maxillary andfrontal palpation.Eyes: No strabismus observed during exploration, normal extraocular muscle function, nodischarge from the eyes, sclera is white, conjunctiva pink. PERRLA.Ears: Normal tragus and external canal. Meatus are normal. Not swollen or reddened. Bilateraltympanic membranes were intact and pearly gray with light reflex. No erythematous, scarredor hemorrhage. No pus or serous exudate. No hearing loss on bilateral whisper test.Nose: No external deformities of the nose. Nasal mucosa moist and pink with clear drainage,septum midline. Nasal turbinate no erythematous, no swollen. No sinus tenderness.Oral Cavity: Oral mucosa moist and pink. No lesions suggestive of malignancy or infections.Normal gums and palate, no bleeding or hypertrophy. Good hygiene, no caries or abscessdetectable to single inspection, normal dentition.Pharynx: Moist and pink, no presence of plaques or exudate. No petechias, no strawberrytongue. Normal pharynx and uvula to inspection, gag reflex presents and unaltered.Neck: No visible mass. No lymphadenopathy noted. Thyroid in the middle, no palpable. Nopalpable masses or tenderness, trachea is midline. No JVD.CardiovascularNormal chest wall, absence of orthopnea, collateral circulation or edema on lower extremities,no clubbing or cyanosis observed. No pericardial friction rub heard. Regular rate and rhythm,heart sounds of S1 and S2, no bruits, murmurs found to auscultation, no extra heart sounds,PMI at 5th intercostal space, midclavicular line. No pericardial friction rub heard. No gallops,murmurs, or opening snaps. Carotid, apical, radial femoral and pedal pulses present andstrong, capillary refill 2 seconds.RespiratoryOn inspection, the chest is symmetrical and moves with respiration, No osseous abnormality,scars, hematomas, or edema. Normal thoracic breathing, no use of accessory muscle, no tripodposition. On palpation, no masses or crepitus, tactile fremitus equal bilaterally. On percussion,resonance. On auscultation, clear lung without adventitious sounds.GastrointestinalAbdomen: Inspection: Symmetric, is watched flat, nondistended, no visible masses. No scarsAuscultation: Bowel sound active in all 4 quadrants. No bruits. Palpation: soft, no pain whenpalpating the abdomen, no involuntary guarding or rebound tenderness observed, no signs ofperitoneal irritation, no palpable masses. No hepatomegaly or splenomegaly. Percussion:Normal.GenitourinaryBimanual palpation does not reveal signs of enlarged kidneys. Costovertebral angles do notreveal tenderness. No palpable or percussed bladder.MusculoskeletalNormal gait. No muscular atrophies observed, no evident deformities, no stiffness observed,range of motion within normal limited, normal joints. Fingers, feet, and toes are normal. Spinewithout deformity.NeurologicalAAOx3. Keeps adequate communication ability, no concentration or attention deficit notedduring the exploration. Normal gait and balance observed. Sensation intact. Normal motoractivity. Deep tendon reflexes symmetrical and equal bilaterally. Normal function of all cranialnerves (from I to XII). Bilateral UE/LE strength 5/5.Psychiatric:Patient is euthymic, with normal level of mood, language and communication. The affect wasnormal. No past medical condition previous, no depression signs, no suicidal ideas presented.Main Diagnosis:ICD 10: L01.00: Impetigo, is a bacterial infection that involves the superficial skin. The mostcommon presentation is yellowish crusts on the face, arms, or legs. Less commonly there maybe large blisters which affect the groin or armpits. The lesions may be painful or itchy. Feveris uncommon. This most common form of impetigo, also called nonbullies impetigo, mostoften begins as a red sore near the nose or mouth which soon breaks, leaking pus or fluid, andforms a honey-colored scab, followed by a red mark which heals without leaving a scar. Soresare not painful, but they may be itchy. Lymph nodes in the affected area may be swollen, butfever is rare. Touching or scratching the sores may easily spread the infection to other parts ofthe body. (Hartman-Adams H, Banvard C, Juckett G.).Differential DiagnosisB00.9; Herpes viral infection, unspecified. Herpes viral infections in children refer to a groupof viral infections caused by the herpes simplex viruses (HSV). There are two main types ofherpes simplex viruses: HSV-1 and HSV-2. These viruses can cause a range of clinicalmanifestations, including oral herpes (HSV-1), genital herpes (usually caused by HSV-2 butcan also be caused by HSV-1), and other less common infections. Oral Herpes (HSV-1): Oralherpes is commonly known as “cold sores” or “fever blisters.” It typically presents as painful,fluid-filled blisters or sores on or around the lips, mouth, or gums. And Genital Herpes (HSV-2 or HSV-1): Genital herpes in children is less common than in adults but can occur, usuallydue to sexual abuse. It presents as painful sores or blisters in the genital or anal area.Treatment with antiviral medications is typically necessary to manage symptoms and reducethe risk of complications. Herpes Gladiatorum (HSV-1): Also known as “mat herpes,” thiscondition can affect children participating in contact sports like wrestling. It presents asclusters of painful blisters on the face, neck, or other exposed areas of the body. (Hartman-Adams H, Banvard C, Juckett G.)ICD 10: B01.9; Varicella without complication. Varicella, commonly known as chickenpox, isa contagious viral infection that primarily affects children. It is caused by the varicella-zostervirus (VZV), which belongs to the herpesvirus family. Chickenpox is characterized by adistinctive rash of itchy, fluid-filled blisters and is typically a mild childhood illness. Here’s adescription of varicella in children: Initial Symptoms: Chickenpox typically begins with a fewdays of mild, flu-like symptoms, including: Fever, Fatigue, Loss of appetite, Headache andRash development: After the initial symptoms, a rash appears. This rash is a hallmark ofchickenpox and progresses through several stages: Red Spots: Small, red, itchy spots developon the skin. These can appear anywhere on the body. (Bowen AC, Mahé A, Hay RJ, et al.).ICD 10: L73.9; Follicular disorder, unspecified. Follicular disorders in children refer to agroup of skin conditions that affect hair follicles. These disorders can result in a variety ofsymptoms and can be caused by various factors. Here are a few examples of folliculardisorders that can occur in children: Folliculitis: Folliculitis is a common condition in whichhair follicles become inflamed. It can occur in children and is often caused by bacterial orfungal infections. It presents small red or pimple-like bumps around hair follicles and can beitchy or painful. Keratosis Pilaris: This is a common and usually harmless skin condition thatcan affect children. It results in small, raised bumps on the skin, often on the arms, thighs, orbuttocks. These bumps are caused by the buildup of keratin, a protein that can block hairfollicles. And others disease. (Elliot AJ, Cross KW, Smith GE, et al.).Plan:Lab exams: no at this time.Medications:Amoxicillin 250 mg 1 tab PO every 6 hours x 7 days(Considered oral antibiotics (e.g., cephalexin, dicloxacillin) for more extensive or severe casesof impetigo or if multiple family members are affected. And Prescribed antibiotics as needed,and provide clear instructions on dosage and duration of treatment.)Mupirocin 2% topical ointment apply in lesions 3 x times per day.Ibuprofen 400 mg1 tab each 8 hrs orally.Preventions:Emphasize the importance of handwashing with soap and water before and after touching theaffected areas.Encourage good personal hygiene practices, including daily baths or showers.Recommended using a mild, antibacterial soap to clean the affected areas gently.Advise against sharing towels, clothing, or personal items to prevent the spread of theinfection.Washing hands, linens, and affected areas will lower the likelihood of contact with infectedfluids.Scratching can spread the sores; keeping nails short will reduce the chances of spreading.Infected people should avoid contact with others and eliminate sharing of clothing or linens.Children with impetigo can return to school 24 hours after starting antibiotic therapy as long astheir draining lesions are covered.Infection Control Measures at Home: Disinfect surfaces, toys, and clothing that may havecome into contact with the child’s skin.Wash and change bed linens, towels, and clothing regularly to prevent reinfection.Monitoring and Follow-Up:Follow-up in 1 week. Schedule follow-up appointments to monitor the progress of treatmentand ensure that the infection is resolving. Assess for any complications or the development ofnew lesions.Referral: No.References:Hartman-Adams H, Banvard C, Juckett G. (2021), Impetigo: diagnosis and treatment. AmFam Physician.; 90 (4):229-35.Bowen AC, Mahé A, Hay RJ, et al. (2020), The global epidemiology of impetigo: a systematicreview of the population prevalence of impetigo and pyoderma.; 10 (8): 0136789.Elliot AJ, Cross KW, Smith GE, et al. (2021), The association between impetigo, insect bitesand air temperature: a retrospective 5-year study (1999-2019) using morbidity data collectedfrom a sentinel general practice network database. (5): 490-6.week6PPP.peds.docxInstructionsPediatricsPlease upload a case scenario from your typhon log that pertains to Pediatric health.Please submit a power point presentation with a cover slide and content slide.Your paper should cover the points presented below.Subjective Data:ROS:HPI: Describe the course of the patient’s illness:Onset, Location, Duration, Characteristics, Aggravating and Relieving Factors:Current Medications (if any):PMH:Allergies:Objective:CNS:HEENT:Resp:CVS:GI:GU:Extremities:Other assessments (if applicable like neuro, CMS, etc)Differential Diagnoses:Plan/Intervention:Patient Education (minimum of three top patient education entries provided to patient):Rx: (complete prescription name, dose, quantity, refills, etc.):Labs:Diagnostic: (i.e x-rays, endoscopy, CT scan, etc.)Preventative measures based on age and US Task Force Preventative Guidelines of Family Medicine: (pap smear, screening guidelines appropriate to age):Referrals: (endo, cardiologist, endocrine: provide justification):RTC: (Follow-up):casestudyPPP.pdfPatient Initials: AB. Student: Lianet Aroche.Date: 11/22/2023. Age: 10 y/o. Sex: FemaleAllergies: NKDA Race: Hispanic.SUBJECTIVE DATACC:“My daughter has Skin rash ”.HPI:A 10 -year-old female teenager, Hispanic, is brought to the office by her mother, who statedthat her has a rash near the mouth, on the right side, which began as a mosquito bite that nowextends to several centimeters of the face and around the curve of the lip, The mother says thatthe eruption began 4 days ago, and denies fever or other reported symptoms. Also deniedcontact with a friends or relatives with similar lesions, no allergies were reported.Current Medications:Patient is not taking any regular medications or over-the-counter drugs. Also does not take anysupplements or any herbal supplements.PMH: Negative for Chronic Disease. Unremarkable. Delivered at 39.2 W2D. Spontaneousvaginal delivery was uneventful. Normal birth weight, Apgar score 8/9. DC two days afterdeliveryMedication Intolerances: NoneChronic Illnesses/Major traumas: NoneScreening Hx/Immunizations Hx: Vaccines reactivations updated. (Flu Vaccine, TT Reat;Hib; Hep B, Covid).Hospitalizations/Surgeries: NoneFamily HistoryMother Alive: 36 y/o / HealthyFather Alive: 40 y/o/ Healthy1Sister Alive 16 HealthyNegative Hx for Cancer, Dead for CV event, Genetical diseaseSocial HistoryPatient lives with his married parents in an apartment. Normal, familiar dynamic, he has ahealthy sister 14 y/o. He is a middle school student with good/normal development and socialinteraction Denied smoke, alcohol intake and use or recreational drugs., No second-handsmoking exposure. Denies being sexually active.REVIEW OF SYSTEMS:GeneralPatient denied change in appetite; tired,weakness or sleep disorder.CardiovascularDenies chest pain, palpitations, or edema onthe lower extremities. Deny varicosities orhistory of DVT.SkinRefer her daugther has itching, and red rashnear lip right, no secretions, no burns, nokeloids.RespiratoryDenies shortness of breath, hemoptysis,wheezing, pleuritic pain or coughing.EyesDenies any changes in vision. Denies anytrouble seeing clearly, pain, itching, or drainingof eyes. Does not use glasses. Last eye exam 1year agoGIDenied appetite problems. No dysphagia.Denies heartburn or bleeding. Nocomplaints of flatulence. Denies nausea orvomiting. Denies hematochezia. Nodiarrhea or constipation. Last bowelmovement: (today); Denies abdominal pain,nausea, vomiting, diarrhea, constipation,bowel habit changes, jaundice, vomitingblood, blood in stool, tarry stools.EarsPatient denies pain or drainage from the ear,hearing loss or tinnitus.GUDenies changes in urinary habits, normalurinary frequency. Denies history of kidneystones, flank pain, cloudy urine or badsmell, denies being sexually active.Nose/ Mouth/ Throat/Neck:Denies sinus problems, dysphagia, nose bleedsor discharge, loss of sense of smell, dry sinuses,sinusitis, postnasal drip, sore tongue, bleedinggums, sores in the mouth, loss of sense of taste,dry mouth, frequent sore throats, hoarseness,waking up with acid or bitter fluid in the mouthor throat, food sticking in throat when swallowsor painful swallowing. Deny masses or pain onneck or thyroid diseases.MusculoskeletalPatient refers no has history of fallsreported, denies weakness, muscular pain,swollen or any other inflammatorysymptoms in the joints. Denies joint pain,limited ROM, difficulty walking or troublereaching above head.PsychiatricPatients deny no changes in mood, deniesanxiety, depression, or insomnia.Denies low self-esteem, feeling sad, socialisolation or attention deficit, no change inthought patterns. Deny associated suicidalideas, nor mental illness in past.NeurologicalDenies loss of memory, seizures, seizures orfainting lightheadedness, facial pain, gaitimbalance or changes in LOC. Deniestremors, muscle weakness, numbness,tingling or sleeping disturbances.OBJECTIVE DATA:Weight:156 pns.Height:5`7”BMI:21.4 m2.Temp:97.2 oFBP:108/66 mmhg.Pulse: 92 bmp Resp: 18 x min Pulse Ox: 99 % Pain scale 0/10.PHYSICAL EXAMINATION:General AppearancePatient normal percentile according height and weight, properly dressed, speech clear andappropriate, cooperative to the interview, alert, oriented in place, person, time. Discomfort dueto the pain is reflected in his face and posture. Well hydrated, well nourishedSkinin the physical exam is presents small, red, itchy sores and blisters on the skin, especiallyaround the face (nose and mouth) and some low in extremities. The child experiences itchingand discomfort around the affected areas. The surrounding skin is red and slightly swollen.HEENTHead: Normocephalic, symmetric head, no signs of trauma. Normal sinuses, maxillary andfrontal palpation.Eyes: No strabismus observed during exploration, normal extraocular muscle function, nodischarge from the eyes, sclera is white, conjunctiva pink. PERRLA.Ears: Normal tragus and external canal. Meatus are normal. Not swollen or reddened. Bilateraltympanic membranes were intact and pearly gray with light reflex. No erythematous, scarredor hemorrhage. No pus or serous exudate. No hearing loss on bilateral whisper test.Nose: No external deformities of the nose. Nasal mucosa moist and pink with clear drainage,septum midline. Nasal turbinate no erythematous, no swollen. No sinus tenderness.Oral Cavity: Oral mucosa moist and pink. No lesions suggestive of malignancy or infections.Normal gums and palate, no bleeding or hypertrophy. Good hygiene, no caries or abscessdetectable to single inspection, normal dentition.Pharynx: Moist and pink, no presence of plaques or exudate. No petechias, no strawberrytongue. Normal pharynx and uvula to inspection, gag reflex presents and unaltered.Neck: No visible mass. No lymphadenopathy noted. Thyroid in the middle, no palpable. Nopalpable masses or tenderness, trachea is midline. No JVD.CardiovascularNormal chest wall, absence of orthopnea, collateral circulation or edema on lower extremities,no clubbing or cyanosis observed. No pericardial friction rub heard. Regular rate and rhythm,heart sounds of S1 and S2, no bruits, murmurs found to auscultation, no extra heart sounds,PMI at 5th intercostal space, midclavicular line. No pericardial friction rub heard. No gallops,murmurs, or opening snaps. Carotid, apical, radial femoral and pedal pulses present andstrong, capillary refill 2 seconds.RespiratoryOn inspection, the chest is symmetrical and moves with respiration, No osseous abnormality,scars, hematomas, or edema. Normal thoracic breathing, no use of accessory muscle, no tripodposition. On palpation, no masses or crepitus, tactile fremitus equal bilaterally. On percussion,resonance. On auscultation, clear lung without adventitious sounds.GastrointestinalAbdomen: Inspection: Symmetric, is watched flat, nondistended, no visible masses. No scarsAuscultation: Bowel sound active in all 4 quadrants. No bruits. Palpation: soft, no pain whenpalpating the abdomen, no involuntary guarding or rebound tenderness observed, no signs ofperitoneal irritation, no palpable masses. No hepatomegaly or splenomegaly. Percussion:Normal.GenitourinaryBimanual palpation does not reveal signs of enlarged kidneys. Costovertebral angles do notreveal tenderness. No palpable or percussed bladder.MusculoskeletalNormal gait. No muscular atrophies observed, no evident deformities, no stiffness observed,range of motion within normal limited, normal joints. Fingers, feet, and toes are normal. Spinewithout deformity.NeurologicalAAOx3. Keeps adequate communication ability, no concentration or attention deficit notedduring the exploration. Normal gait and balance observed. Sensation intact. Normal motoractivity. Deep tendon reflexes symmetrical and equal bilaterally. Normal function of all cranialnerves (from I to XII). Bilateral UE/LE strength 5/5.Psychiatric:Patient is euthymic, with normal level of mood, language and communication. The affect wasnormal. No past medical condition previous, no depression signs, no suicidal ideas presented.Main Diagnosis:ICD 10: L01.00: Impetigo, is a bacterial infection that involves the superficial skin. The mostcommon presentation is yellowish crusts on the face, arms, or legs. Less commonly there maybe large blisters which affect the groin or armpits. The lesions may be painful or itchy. Feveris uncommon. This most common form of impetigo, also called nonbullies impetigo, mostoften begins as a red sore near the nose or mouth which soon breaks, leaking pus or fluid, andforms a honey-colored scab, followed by a red mark which heals without leaving a scar. Soresare not painful, but they may be itchy. Lymph nodes in the affected area may be swollen, butfever is rare. Touching or scratching the sores may easily spread the infection to other parts ofthe body. (Hartman-Adams H, Banvard C, Juckett G.).Differential DiagnosisB00.9; Herpes viral infection, unspecified. Herpes viral infections in children refer to a groupof viral infections caused by the herpes simplex viruses (HSV). There are two main types ofherpes simplex viruses: HSV-1 and HSV-2. These viruses can cause a range of clinicalmanifestations, including oral herpes (HSV-1), genital herpes (usually caused by HSV-2 butcan also be caused by HSV-1), and other less common infections. Oral Herpes (HSV-1): Oralherpes is commonly known as “cold sores” or “fever blisters.” It typically presents as painful,fluid-filled blisters or sores on or around the lips, mouth, or gums. And Genital Herpes (HSV-2 or HSV-1): Genital herpes in children is less common than in adults but can occur, usuallydue to sexual abuse. It presents as painful sores or blisters in the genital or anal area.Treatment with antiviral medications is typically necessary to manage symptoms and reducethe risk of complications. Herpes Gladiatorum (HSV-1): Also known as “mat herpes,” thiscondition can affect children participating in contact sports like wrestling. It presents asclusters of painful blisters on the face, neck, or other exposed areas of the body. (Hartman-Adams H, Banvard C, Juckett G.)ICD 10: B01.9; Varicella without complication. Varicella, commonly known as chickenpox, isa contagious viral infection that primarily affects children. It is caused by the varicella-zostervirus (VZV), which belongs to the herpesvirus family. Chickenpox is characterized by adistinctive rash of itchy, fluid-filled blisters and is typically a mild childhood illness. Here’s adescription of varicella in children: Initial Symptoms: Chickenpox typically begins with a fewdays of mild, flu-like symptoms, including: Fever, Fatigue, Loss of appetite, Headache andRash development: After the initial symptoms, a rash appears. This rash is a hallmark ofchickenpox and progresses through several stages: Red Spots: Small, red, itchy spots developon the skin. These can appear anywhere on the body. (Bowen AC, Mahé A, Hay RJ, et al.).ICD 10: L73.9; Follicular disorder, unspecified. Follicular disorders in children refer to agroup of skin conditions that affect hair follicles. These disorders can result in a variety ofsymptoms and can be caused by various factors. Here are a few examples of folliculardisorders that can occur in children: Folliculitis: Folliculitis is a common condition in whichhair follicles become inflamed. It can occur in children and is often caused by bacterial orfungal infections. It presents small red or pimple-like bumps around hair follicles and can beitchy or painful. Keratosis Pilaris: This is a common and usually harmless skin condition thatcan affect children. It results in small, raised bumps on the skin, often on the arms, thighs, orbuttocks. These bumps are caused by the buildup of keratin, a protein that can block hairfollicles. And others disease. (Elliot AJ, Cross KW, Smith GE, et al.).Plan:Lab exams: no at this time.Medications:Amoxicillin 250 mg 1 tab PO every 6 hours x 7 days(Considered oral antibiotics (e.g., cephalexin, dicloxacillin) for more extensive or severe casesof impetigo or if multiple family members are affected. And Prescribed antibiotics as needed,and provide clear instructions on dosage and duration of treatment.)Mupirocin 2% topical ointment apply in lesions 3 x times per day.Ibuprofen 400 mg1 tab each 8 hrs orally.Preventions:Emphasize the importance of handwashing with soap and water before and after touching theaffected areas.Encourage good personal hygiene practices, including daily baths or showers.Recommended using a mild, antibacterial soap to clean the affected areas gently.Advise against sharing towels, clothing, or personal items to prevent the spread of theinfection.Washing hands, linens, and affected areas will lower the likelihood of contact with infectedfluids.Scratching can spread the sores; keeping nails short will reduce the chances of spreading.Infected people should avoid contact with others and eliminate sharing of clothing or linens.Children with impetigo can return to school 24 hours after starting antibiotic therapy as long astheir draining lesions are covered.Infection Control Measures at Home: Disinfect surfaces, toys, and clothing that may havecome into contact with the child’s skin.Wash and change bed linens, towels, and clothing regularly to prevent reinfection.Monitoring and Follow-Up:Follow-up in 1 week. Schedule follow-up appointments to monitor the progress of treatmentand ensure that the infection is resolving. Assess for any complications or the development ofnew lesions.Referral: No.References:Hartman-Adams H, Banvard C, Juckett G. (2021), Impetigo: diagnosis and treatment. AmFam Physician.; 90 (4):229-35.Bowen AC, Mahé A, Hay RJ, et al. (2020), The global epidemiology of impetigo: a systematicreview of the population prevalence of impetigo and pyoderma.; 10 (8): 0136789.Elliot AJ, Cross KW, Smith GE, et al. (2021), The association between impetigo, insect bitesand air temperature: a retrospective 5-year study (1999-2019) using morbidity data collectedfrom a sentinel general practice network database. (5): 490-6.week6PPP.peds.docxInstructionsPediatricsPlease upload a case scenario from your typhon log that pertains to Pediatric health.Please submit a power point presentation with a cover slide and content slide.Your paper should cover the points presented below.Subjective Data:ROS:HPI: Describe the course of the patient’s illness:Onset, Location, Duration, Characteristics, Aggravating and Relieving Factors:Current Medications (if any):PMH:Allergies:Objective:CNS:HEENT:Resp:CVS:GI:GU:Extremities:Other assessments (if applicable like neuro, CMS, etc)Differential Diagnoses:Plan/Intervention:Patient Education (minimum of three top patient education entries provided to patient):Rx: (complete prescription name, dose, quantity, refills, etc.):Labs:Diagnostic: (i.e x-rays, endoscopy, CT scan, etc.)Preventative measures based on age and US Task Force Preventative Guidelines of Family Medicine: (pap smear, screening guidelines appropriate to age):Referrals: (endo, cardiologist, endocrine: provide justification):RTC: (Follow-up):casestudyPPP.pdfPatient Initials: AB. Student: Lianet Aroche.Date: 11/22/2023. Age: 10 y/o. Sex: FemaleAllergies: NKDA Race: Hispanic.SUBJECTIVE DATACC:“My daughter has Skin rash ”.HPI:A 10 -year-old female teenager, Hispanic, is brought to the office by her mother, who statedthat her has a rash near the mouth, on the right side, which began as a mosquito bite that nowextends to several centimeters of the face and around the curve of the lip, The mother says thatthe eruption began 4 days ago, and denies fever or other reported symptoms. Also deniedcontact with a friends or relatives with similar lesions, no allergies were reported.Current Medications:Patient is not taking any regular medications or over-the-counter drugs. Also does not take anysupplements or any herbal supplements.PMH: Negative for Chronic Disease. Unremarkable. Delivered at 39.2 W2D. Spontaneousvaginal delivery was uneventful. Normal birth weight, Apgar score 8/9. DC two days afterdeliveryMedication Intolerances: NoneChronic Illnesses/Major traumas: NoneScreening Hx/Immunizations Hx: Vaccines reactivations updated. (Flu Vaccine, TT Reat;Hib; Hep B, Covid).Hospitalizations/Surgeries: NoneFamily HistoryMother Alive: 36 y/o / HealthyFather Alive: 40 y/o/ Healthy1Sister Alive 16 HealthyNegative Hx for Cancer, Dead for CV event, Genetical diseaseSocial HistoryPatient lives with his married parents in an apartment. Normal, familiar dynamic, he has ahealthy sister 14 y/o. He is a middle school student with good/normal development and socialinteraction Denied smoke, alcohol intake and use or recreational drugs., No second-handsmoking exposure. Denies being sexually active.REVIEW OF SYSTEMS:GeneralPatient denied change in appetite; tired,weakness or sleep disorder.CardiovascularDenies chest pain, palpitations, or edema onthe lower extremities. Deny varicosities orhistory of DVT.SkinRefer her daugther has itching, and red rashnear lip right, no secretions, no burns, nokeloids.RespiratoryDenies shortness of breath, hemoptysis,wheezing, pleuritic pain or coughing.EyesDenies any changes in vision. Denies anytrouble seeing clearly, pain, itching, or drainingof eyes. Does not use glasses. Last eye exam 1year agoGIDenied appetite problems. No dysphagia.Denies heartburn or bleeding. Nocomplaints of flatulence. Denies nausea orvomiting. Denies hematochezia. Nodiarrhea or constipation. Last bowelmovement: (today); Denies abdominal pain,nausea, vomiting, diarrhea, constipation,bowel habit changes, jaundice, vomitingblood, blood in stool, tarry stools.EarsPatient denies pain or drainage from the ear,hearing loss or tinnitus.GUDenies changes in urinary habits, normalurinary frequency. Denies history of kidneystones, flank pain, cloudy urine or badsmell, denies being sexually active.Nose/ Mouth/ Throat/Neck:Denies sinus problems, dysphagia, nose bleedsor discharge, loss of sense of smell, dry sinuses,sinusitis, postnasal drip, sore tongue, bleedinggums, sores in the mouth, loss of sense of taste,dry mouth, frequent sore throats, hoarseness,waking up with acid or bitter fluid in the mouthor throat, food sticking in throat when swallowsor painful swallowing. Deny masses or pain onneck or thyroid diseases.MusculoskeletalPatient refers no has history of fallsreported, denies weakness, muscular pain,swollen or any other inflammatorysymptoms in the joints. Denies joint pain,limited ROM, difficulty walking or troublereaching above head.PsychiatricPatients deny no changes in mood, deniesanxiety, depression, or insomnia.Denies low self-esteem, feeling sad, socialisolation or attention deficit, no change inthought patterns. Deny associated suicidalideas, nor mental illness in past.NeurologicalDenies loss of memory, seizures, seizures orfainting lightheadedness, facial pain, gaitimbalance or changes in LOC. Deniestremors, muscle weakness, numbness,tingling or sleeping disturbances.OBJECTIVE DATA:Weight:156 pns.Height:5`7”BMI:21.4 m2.Temp:97.2 oFBP:108/66 mmhg.Pulse: 92 bmp Resp: 18 x min Pulse Ox: 99 % Pain scale 0/10.PHYSICAL EXAMINATION:General AppearancePatient normal percentile according height and weight, properly dressed, speech clear andappropriate, cooperative to the interview, alert, oriented in place, person, time. Discomfort dueto the pain is reflected in his face and posture. Well hydrated, well nourishedSkinin the physical exam is presents small, red, itchy sores and blisters on the skin, especiallyaround the face (nose and mouth) and some low in extremities. The child experiences itchingand discomfort around the affected areas. The surrounding skin is red and slightly swollen.HEENTHead: Normocephalic, symmetric head, no signs of trauma. Normal sinuses, maxillary andfrontal palpation.Eyes: No strabismus observed during exploration, normal extraocular muscle function, nodischarge from the eyes, sclera is white, conjunctiva pink. PERRLA.Ears: Normal tragus and external canal. Meatus are normal. Not swollen or reddened. Bilateraltympanic membranes were intact and pearly gray with light reflex. No erythematous, scarredor hemorrhage. No pus or serous exudate. No hearing loss on bilateral whisper test.Nose: No external deformities of the nose. Nasal mucosa moist and pink with clear drainage,septum midline. Nasal turbinate no erythematous, no swollen. No sinus tenderness.Oral Cavity: Oral mucosa moist and pink. No lesions suggestive of malignancy or infections.Normal gums and palate, no bleeding or hypertrophy. Good hygiene, no caries or abscessdetectable to single inspection, normal dentition.Pharynx: Moist and pink, no presence of plaques or exudate. No petechias, no strawberrytongue. Normal pharynx and uvula to inspection, gag reflex presents and unaltered.Neck: No visible mass. No lymphadenopathy noted. Thyroid in the middle, no palpable. Nopalpable masses or tenderness, trachea is midline. No JVD.CardiovascularNormal chest wall, absence of orthopnea, collateral circulation or edema on lower extremities,no clubbing or cyanosis observed. No pericardial friction rub heard. Regular rate and rhythm,heart sounds of S1 and S2, no bruits, murmurs found to auscultation, no extra heart sounds,PMI at 5th intercostal space, midclavicular line. No pericardial friction rub heard. No gallops,murmurs, or opening snaps. Carotid, apical, radial femoral and pedal pulses present andstrong, capillary refill 2 seconds.RespiratoryOn inspection, the chest is symmetrical and moves with respiration, No osseous abnormality,scars, hematomas, or edema. Normal thoracic breathing, no use of accessory muscle, no tripodposition. On palpation, no masses or crepitus, tactile fremitus equal bilaterally. On percussion,resonance. On auscultation, clear lung without adventitious sounds.GastrointestinalAbdomen: Inspection: Symmetric, is watched flat, nondistended, no visible masses. No scarsAuscultation: Bowel sound active in all 4 quadrants. No bruits. Palpation: soft, no pain whenpalpating the abdomen, no involuntary guarding or rebound tenderness observed, no signs ofperitoneal irritation, no palpable masses. No hepatomegaly or splenomegaly. Percussion:Normal.GenitourinaryBimanual palpation does not reveal signs of enlarged kidneys. Costovertebral angles do notreveal tenderness. No palpable or percussed bladder.MusculoskeletalNormal gait. No muscular atrophies observed, no evident deformities, no stiffness observed,range of motion within normal limited, normal joints. Fingers, feet, and toes are normal. Spinewithout deformity.NeurologicalAAOx3. Keeps adequate communication ability, no concentration or attention deficit notedduring the exploration. Normal gait and balance observed. Sensation intact. Normal motoractivity. Deep tendon reflexes symmetrical and equal bilaterally. Normal function of all cranialnerves (from I to XII). Bilateral UE/LE strength 5/5.Psychiatric:Patient is euthymic, with normal level of mood, language and communication. The affect wasnormal. No past medical condition previous, no depression signs, no suicidal ideas presented.Main Diagnosis:ICD 10: L01.00: Impetigo, is a bacterial infection that involves the superficial skin. The mostcommon presentation is yellowish crusts on the face, arms, or legs. Less commonly there maybe large blisters which affect the groin or armpits. The lesions may be painful or itchy. Feveris uncommon. This most common form of impetigo, also called nonbullies impetigo, mostoften begins as a red sore near the nose or mouth which soon breaks, leaking pus or fluid, andforms a honey-colored scab, followed by a red mark which heals without leaving a scar. Soresare not painful, but they may be itchy. Lymph nodes in the affected area may be swollen, butfever is rare. Touching or scratching the sores may easily spread the infection to other parts ofthe body. (Hartman-Adams H, Banvard C, Juckett G.).Differential DiagnosisB00.9; Herpes viral infection, unspecified. Herpes viral infections in children refer to a groupof viral infections caused by the herpes simplex viruses (HSV). There are two main types ofherpes simplex viruses: HSV-1 and HSV-2. These viruses can cause a range of clinicalmanifestations, including oral herpes (HSV-1), genital herpes (usually caused by HSV-2 butcan also be caused by HSV-1), and other less common infections. Oral Herpes (HSV-1): Oralherpes is commonly known as “cold sores” or “fever blisters.” It typically presents as painful,fluid-filled blisters or sores on or around the lips, mouth, or gums. And Genital Herpes (HSV-2 or HSV-1): Genital herpes in children is less common than in adults but can occur, usuallydue to sexual abuse. It presents as painful sores or blisters in the genital or anal area.Treatment with antiviral medications is typically necessary to manage symptoms and reducethe risk of complications. Herpes Gladiatorum (HSV-1): Also known as “mat herpes,” thiscondition can affect children participating in contact sports like wrestling. It presents asclusters of painful blisters on the face, neck, or other exposed areas of the body. (Hartman-Adams H, Banvard C, Juckett G.)ICD 10: B01.9; Varicella without complication. Varicella, commonly known as chickenpox, isa contagious viral infection that primarily affects children. It is caused by the varicella-zostervirus (VZV), which belongs to the herpesvirus family. Chickenpox is characterized by adistinctive rash of itchy, fluid-filled blisters and is typically a mild childhood illness. Here’s adescription of varicella in children: Initial Symptoms: Chickenpox typically begins with a fewdays of mild, flu-like symptoms, including: Fever, Fatigue, Loss of appetite, Headache andRash development: After the initial symptoms, a rash appears. This rash is a hallmark ofchickenpox and progresses through several stages: Red Spots: Small, red, itchy spots developon the skin. These can appear anywhere on the body. (Bowen AC, Mahé A, Hay RJ, et al.).ICD 10: L73.9; Follicular disorder, unspecified. Follicular disorders in children refer to agroup of skin conditions that affect hair follicles. These disorders can result in a variety ofsymptoms and can be caused by various factors. Here are a few examples of folliculardisorders that can occur in children: Folliculitis: Folliculitis is a common condition in whichhair follicles become inflamed. It can occur in children and is often caused by bacterial orfungal infections. It presents small red or pimple-like bumps around hair follicles and can beitchy or painful. Keratosis Pilaris: This is a common and usually harmless skin condition thatcan affect children. It results in small, raised bumps on the skin, often on the arms, thighs, orbuttocks. These bumps are caused by the buildup of keratin, a protein that can block hairfollicles. And others disease. (Elliot AJ, Cross KW, Smith GE, et al.).Plan:Lab exams: no at this time.Medications:Amoxicillin 250 mg 1 tab PO every 6 hours x 7 days(Considered oral antibiotics (e.g., cephalexin, dicloxacillin) for more extensive or severe casesof impetigo or if multiple family members are affected. And Prescribed antibiotics as needed,and provide clear instructions on dosage and duration of treatment.)Mupirocin 2% topical ointment apply in lesions 3 x times per day.Ibuprofen 400 mg1 tab each 8 hrs orally.Preventions:Emphasize the importance of handwashing with soap and water before and after touching theaffected areas.Encourage good personal hygiene practices, including daily baths or showers.Recommended using a mild, antibacterial soap to clean the affected areas gently.Advise against sharing towels, clothing, or personal items to prevent the spread of theinfection.Washing hands, linens, and affected areas will lower the likelihood of contact with infectedfluids.Scratching can spread the sores; keeping nails short will reduce the chances of spreading.Infected people should avoid contact with others and eliminate sharing of clothing or linens.Children with impetigo can return to school 24 hours after starting antibiotic therapy as long astheir draining lesions are covered.Infection Control Measures at Home: Disinfect surfaces, toys, and clothing that may havecome into contact with the child’s skin.Wash and change bed linens, towels, and clothing regularly to prevent reinfection.Monitoring and Follow-Up:Follow-up in 1 week. Schedule follow-up appointments to monitor the progress of treatmentand ensure that the infection is resolving. Assess for any complications or the development ofnew lesions.Referral: No.References:Hartman-Adams H, Banvard C, Juckett G. (2021), Impetigo: diagnosis and treatment. AmFam Physician.; 90 (4):229-35.Bowen AC, Mahé A, Hay RJ, et al. (2020), The global epidemiology of impetigo: a systematicreview of the population prevalence of impetigo and pyoderma.; 10 (8): 0136789.Elliot AJ, Cross KW, Smith GE, et al. (2021), The association between impetigo, insect bitesand air temperature: a retrospective 5-year study (1999-2019) using morbidity data collectedfrom a sentinel general practice network database. 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