DERMATOLOGY CASE STUDY

Chief complaint:  “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin  AF cream and it did not help relief her symptoms. She has not tried other remedies.

Denies associated symptoms of fever and chills. 

PMH: Diabetes Mellitus, type 2.

Surgeries: None

Allergies: Augmentin

Medication: Metformin 500mg PO BID.

Vaccination History:  Immunization is up to date and she received her flu shot this year.

Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.

Family history:Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: Regular rhythm.

Skin: Right great toe swollen, itchy, painful and discolored.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.

PSYCH: Normal affect. Cooperative.

Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

Assessment:

Primary Diagnosis: Proximal subungual onychomycosis

Differential Diagnosis:  Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis

Special Lab:

Fungal culture confirms fungal infection.

As an NP student, you need to determine the medications for onychomycosis.

1. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.

2.  What labs for baseline and follow up of therapy would you order for this patient? Give rationale.

references, and in APA 6th ed format. 

The Clinical Issue and Research Questions Developed Using PICOT

PICOT is an acronym used to help develop clinical research questions and guide you in your search for evidence:P = Patient populationI = Intervention or issue of interestC = Comparison of interventions or comparison of interestsO = OutcomeT = Time frameFor example, you may wish to research the effects of interrupted sleep on cognition of ICU patients 65 or older.Using this PICOT model,In _________(P), how does __________ (I) compared to _________ (C) influence _________ (O) over ________ (T)?In ICU patients who are 65 or older, how does interrupted sleep (awakened one time or more in four hours) as compared to uninterrupted sleep influence the patient’s cognitive ability over 5 days? Assignment DirectionsBegin by selecting a topic in nursing or medicine that is of interest to you. Next, use PICOT to format possible research questions about that topic. Provide 3 possible PICOT research questions.
Include the following:

• Title page
• Provide a brief description of the topic and background information.
• Explain the significance of the topic to nursing practice.
• Provide 3 clearly stated PICOT questions.

Your paper should: 

• Be 2–3 pages (not including the title page and reference page)
• Use the current APA format to style your paper and to cite your sources. 

 
Topic 5 DQ 1 reply to Katlin

CAM stands for complementary or alternative medicine and is usually used to describe diverse products or practices that are outside of mainstream Western medical practice for promoting health and preventing or treating disease (Falvo, 2011). This can include treatments such as cupping, acupuncture, and chiropractic medicine. According to the NIH (2018), more than 30% of adults and about 12% of children use CAM—or health care approaches that are not typically part of conventional medical care or that may have origins outside of usual Western practice. Most people who use CAM also use conventional health care. There are 10 most common complementary health approaches among adults. These include natural products; deep breathing; yoga, tai chi, or qi gong; chiropractic or osteopathic manipulation; meditation; massage; special diets; homeopathy; progressive relaxation; and guided imagery (NIH, 2018).

References

Falvo, D.R. (2011). Effective Patient Education: A Guide to Increased Adherence. (4th ed.). http://gcumedia.com/digital-resources/jonesandbartlett/2010/effective-patient-education_-a-guide-to-increased-adherence_ebook_4e.php

NIH. (2018). Complementary, Alternative, or Integrative Health: What’s In a Name? https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name

  Topic 5 DQ 2 Reply to Olabisi

Complementary or alternative therapies were once viewed by conventional health professionals as countercultural. Their study indicated that patients’ use of complementary and alternative therapies was much higher than previously believed. In a follow-up study, Eisenberg and colleagues (1998) found that 42% of adults were found to have used at least 277 one alternative therapy during the previous year, with a significantly higher proportion of patients who saw an alternative medicine practitioner in 1997 than in 1990. There are some indications that the rate of use of CAM is actually greater than most studies indicate (Lazar & O’Connor, 1997). As a generally increasing pattern of CAM use has been seen across a range of conditions, recognition of its impact on conventional, mainstream health care has generated significant interest from the conventional healthcare community (Falvo,2011). However, ‘Patients more likely to use complementary or alternative therapies have been found to be women, Caucasian, between the ages of 35 and 49, highly educated, and affluent’ ( Eisenberg, 2005).The assumption that use of CAM was more common in immigrants has also been dispelled, especially when known to be financially okay or educated. Although CAM use is prevalent in this group, use appears to be more preva-lent in immigrants who are better educated and in a higher socioeconomic status, not just in groups with limited financial means or limited healthcare access (Miller, 1990).

On the other hand, according to Robles et al, 67% uses CAM  with prayers (Robles et al., 2017), while the number of people who do not use CAM with prayers are 36% (NCAAM, n.d.). 

Reference

Eisenberg, D. M., Davis, R. B., Ettner, S. L., Appel, S., Wilkey, S., & Van Rompay, M. (1998). Trends in alternative medicine use in the United States, 1990–1997. Journal of the American Medical Association, 28, 1569–1575.

Falvo, D. (2011). Effective Patient Education: A Guide To Increased Adherence. Retrieved from https://viewer.gcu.edu/RQBKXW

Lazar, J. S., & O’Connor, B. B. (1997). Talking with patients about their use of alternative thera-pies. Complementary and Alternative Therapies in Primary Care, 24, 699–714.

  Topic 5 DQ 2  Reply to Candi

In today’s society CAM has gotten very popular in regards to going a different route when it comes to medical treatment. This altrnative treatment has been on the rise in last couple of years. It has been incorporated with individuals culture, beliefs, and religion ( Favlo, 2011). CAM therapy represented one of the highly common form of prayer that was being used by well over 60 percent of the individuals involved in the survey. On this issue, it has also been pointed out that the use of complementary and alternative medicine has increased in a dramatic fashion over the past few years. It is also observed that “Several studies of CAM utilization reveal that reported use increases dramatically and may even double when prayer is included in the definition of CAM” (Ernst, 2015). Among the 60 percent of people who use the complementary and alternative medicine with prayer, the prayer has been categorized based on such aspects like yoga as well as the spiritual healingfor many individuals.

Ernst, E. (2015). Complementary medicine: Common misconceptions. Journal of the Royal Society of Medicine, 244-247.

Falvo, D. (2011). Effective Patient Education: A Guide To Increased Adherence. Retrieved from https://viewer.gcu.edu/RQBKXW

 Topic 5 DQ 2 Reply to Nicole

According to a survey that included questions on various types of Complementary and Alternative Medicine (CAM), prayer specifically for health reasons was the most used CAM therapy. 43% uses prayer for their own health.24% uses prayer for others health and 10% participates in a prayer group for their own health. Most people who use CAM use it to treat themselves, as only about 12% sought care from a licensed CAM practitioner (CDC, 2009). In the United States, according to the government survey, 36% of adults are using some form of CAM (CDC, 2009). When megavitamin therapy and prayer specifically for health reasons are included in CAM, that number rises to 64% compared to 57% when prayers are excluded. It was also noted that overall, blacks and women had a significantly higher odds of using CAM with prayer (Robles et al., 2017).

Centers for Disease Control and Prevention. (2009). NCHS Pressroom – 2004 News Release – Complementary and Alternative Medicine. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/pressroom/04news/adultsmedicine.htm.

Robles, B., Upchurch, D. M., & Kuo, T. (2017, March 3). Comparing Complementary and Alternative Medicine Use with or without Including Prayer as a Modality in a Local and Diverse United States Jurisdiction. Frontiers. https://www.frontiersin.org/articles/10.3389/fpubh.2017.00056/full.