Integumentary Advanced Nursing Practice Assignment

Integumentary Advanced Nursing Practice Assignment

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Complete Integumentary assignment.
The student must generate a digital clinical experience score of 90% or greater on every assignment.
A SOAP note is required for this activity. Please see instructions below.

INSTRUCTIONS TO WRITER:::::::
GO HERE ON MY BLACKBOARD SHADOW HEALTH:::
Advanced Nursing Practice I – Primary Care – Adult – March 2023, 202310nur6111master Integumentary Advanced Nursing Practice Assignment

ORDER A PLAGIARISM-FREE PAPER HERE

Sick Visit: IntegumentaryAdvanced Nursing Practice I – Primary Care – Adult – March 2023, 202310nur6111master

Patient Exam : This assignment provides the opportunity to conduct a sick visit in a primary care setting, with a patient experiencing integumentary concerns. You will interview and examine the patient, document your findings, and complete post-exam activities. On average, this assignment should take 75 minutes to complete.

1. Assignment Description: This assignment provides the opportunity to conduct a sick visit in a primary care setting, with a patient experiencing integumentary concerns. You will interview and examine the patient, document your findings, and complete post-exam activities. On average, this assignment should take 75 minutes to complete

2. Please log on to my shadow health from my institution page. Its on BlackBoard. My log in credentials are: username – virmanip
Password – Chinoo@1000 Please use these credentials to log in the webpage mentioned in next point. Integumentary Advanced Nursing Practice Assignment Paper

3. instituition is William Paterson University. webpage to get in : https://bb.wpunj.edu/ultra/courses/_30999_1/cl/outline. Log on to my university log in through this page. Go to Module 1 and then scroll all the way to the bottom to find shadow health tab.

4. Interview is being conducted by NP – Puneet Virmani, so intorduce yourself as Ms. Puneet while conducting an assessment on Gastrointestinal

5. Deadline is 2 days please. Must remember.

6. Follow SOAP NOTE RUBRIC v v strictly in all excellent section Boxes. I am Attaching the soap note rubric along Writer will Submit the Shadow health .A Score of 95-100% is a must.

7. working diagnosis/es including ICD 10 code and brief evidence-based rationale to support diagnosis:::::::: MUST8. A score of 100% is must

Patient particular’s

Name: Felipe

Age: 48years

Gender: male

Ethnicity: American

Subjective Data

Chief complaint: skin rash and lower back pain

History of presenting illness: Felipe is a 48years old male at the outpatient clinic due to lower back pain and skin rash. The pain is at the spinal region, of acute onset, and radiates towards the right hip joint and to the right inner thigh to the leg. The pain is constant, sharp, and so severe that ibuprofen does not relieve the pain. The patient denies a history of trauma-associated back pain. The patient reports a skin rash of acute onset following a dermatome on the right thoracic region. The rash was slight, red, blistering, and burning. It worsens sweating and is relieved by the use of an ice pack Integumentary Advanced Nursing Practice Assignment.

Past medical history: the patient has a positive history of chicken pox infection during childhood. He denies previous hospitalization, current conditions, and back injuries. His immunization schedule is up to date.

Past surgical history: he denies major and minor surgical procedures.

Current medication: He takes ibuprofen 200mg capsules 1-4 every 8 hours for pain.

Allergies: the patient denies known drug, food, latex, and environmental allergies.

Social history: Felipe lives in a condo with his husband. He works as a firefighter. He takes three meals a day and performs weight training exercises every day. He enjoys taking coke soda, deep fried chicken, and potatoes for lunch and takes vegetable and bread for dinner. He drinks 1-2 bottles of alcohol in a sitting at least twice a week. The patient reports that he recently lost a friend and a coworker, and he receives strong support from friends, husband, colleagues, family, and professional therapy.

Family history: he is the only child in his family. The mother and father are alive. There is a paternal history of hypertension and dyslipidemia and maternal history of type 2 diabetes mellitus. he denies family history of mental state disorders and cancer.

Review of systems

General: the patient affirms that he has fatigue. He denies fever, malaise, and chills.

Respiratory system: the patient denies coughing, shortness of breath, chest pain, and wheezing.

Gastrointestinal system: the patient denies abdominal pain, nausea, vomiting, and changes in bowel movement.

Musculoskeletal: The patient denies injuries and joint pain.

Neurological system: the patient denies change in coordination of memory, dizziness, weakness, and tremors.

Integumentary: he affirms that he has a rash.

Genitourinary system: he denies kidney stones, polyuria, dysuria, hematuria, and incontinence.

Psychiatry: the patient has had a recent loss of a loved one. He has little energy and feels down, hopeless, and depressed. He denies suicidal ideation Integumentary Advanced Nursing Practice Assignment

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Objective Data

General: the patient is calm and oriented. He has no pallor, jaundice, cyanosis, edema, dehydration, or lymphadenopathy.

Vitals: blood pressure 120/78mmhg, pulse rate at 88 beats per minute, the temperature at 36.0 degrees Celsius, and BMI at 22kg/m².

Integumentary: the skin is intact. A clustered vesicular erythematous rash is noted across a dermatome on the right side of the back thoracic region. The rash is tender with palpation.

Musculoskeletal system: the spin expected range of motion is intact on extension at 30 degrees, flexion at 80 degrees, and lateral bending at 35 degrees bilaterally. The movement is made without discomfort. The accessory muscles and the spinous process is non-tender to palpation.

Neurological system: sensation on bilateral legs and feet are intact.

Gastrointestinal: the bowel sounds are present in the four quadrants. The abdomen is non-tender to palpation.

Cardiovascular system: the heart sounds s1 s2 are heard with regular rhythm and no extra sounds on auscultation.

Assessment

Differential diagnoses

Herpes zoster B02. 8

Herpes zoster or shingle is a viral infection resulting from the varicella-zoster virus’s reactivation. The varicella-zoster virus remains dormant within the dorsal ganglia decades after exposure or infection in the form of chickenpox. When the varicella virus is reactivated, it replicates in the neuronal cell bodies that carry it along the nerve area of the innervated skin ganglion. The triggers for herpes zoster are emotional stress, acute or chronic diseases, exposure to viruses, the presence of medications, and immunosuppressants (Marra et al., 2022)Integumentary Advanced Nursing Practice Assignment. The proliferation of varicella-zoster virus-specific t-cells causes the production of specific antibodies that appear in higher numbers than the initial infections. The infection follows a dermatome, especially of the lumbar and cervical roots. The mode of transmission is through direct skin contact or air droplets. The characteristic symptoms are fever, malaise, and a burning sensation following the outbreak of the blisters.

Herpes zoster occurs in three phases pre-eruptive stage, acute eruptive stage, and chronic infection. The pre-eruptive phase occurs within 48 hours after the initial infection, and it presents with headache, malaise, and itchiness. The acute eruptive phase presents with an erythematous vesicular lesion that raptures and causes ulceration (Patil et al., 2022)Integumentary Advanced Nursing Practice Assignment Paper. The pain is so severe and unresponsive to traditional medication. The chronic infective stage presents with recurrent pain, paresthesia, and shock. This is the patient’s actual diagnosis because he presents with similar symptoms. Additionally, he has emotional stress after his friend’s demise and has a positive history of chicken pox. However, laboratory tests such as varicella-zoster-specific antibodies IgM determine the active infection.

Erysipelas A46

Erysipelas is a bacterial skin infection of the upper dermis and extends to the cutaneous lesion of the lymphatics. It is characterized by an area of erythema that is well-demarcated. The disease is caused by beta-hemolytic streptococcus invading the lymphatic system, causing erysipelas. It starts with a skin rash or breakout that leads to injecting of the eliciting bacteria. The risk factors are recent trauma, pharyngitis, lymphatic obstruction, nephrotic syndrome, and immunocompromised state. The presenting symptoms are malaise, fever, chills, and rigors days before the eruption of skin erythema. The patients often report burning and tenderness that progress to vesicles and bullae (Michael, & Shaukat, 2022)Integumentary Advanced Nursing Practice Assignment Paper. The presenting symptoms are muscle and joint pain, nausea, headache, and compassion. Erysipelas is not the patient diagnosis because it is common in the lower limbs and the face. However, the elevated c reactive proteins and leukocytosis determines the infection.

Herpes simplex B00.9

Herpes simplex is a viral infection caused by the herpes simplex virus HSV-1 and HSV-2, which is typically affect any part of the body. Herpes simplex is highly contagious and can be transmitted through close contact with an infected person, such as kissing, sexual contact, or sharing personal items like towels or razors. The most common dermatologic manifestation of herpes simplex is a group of fluid-filled blisters or vesicles that can occur on the skin associated with Itching, burning, or tingling around the affected area (Möckel et al., 2022). These blisters may be painful, itchy, or tender, and can break open and form scabs. These lesions may be localized or widespread, and can occur in various locations on the body. The patient presents with similar symptoms, however, it is not the actual diagnosis because it does not present with back pain.

Plan

The patient’s primary or working diagnosis is herpes zoster because has positive history of varicella zoster infection. Acute stress activates the varicella zoster to manifest the symptoms. Therefore, laboratory investigations are important to confirm the diagnosis.

Diagnostic investigations

1. Tzanck smear for vesicular fluid shows multinucleated giant cells in the case of herpes zoster (Marra et al., 2022)Integumentary Advanced Nursing Practice Assignment Paper.
2. Varicella zoster-specific antibodies IgM is positive in the presence of active chickenpox infection.
3. Polymerase chain reaction of the vesicular fluid or blood to confirm herpes zoster
4. Human immunodeficiency virus serology test
5. Direct fluorescent antibody test of the vesicular fluid to confirm herpes zoster
6. Complete blood count to rule out superimposed bacterial infection

Pharmacological treatment

1. Acyclovir 800mg po six hourly for five days (Marra et al., 2022)
2. Gabapentin 300mg po once a day
3. Topical lidocaine to reduce nerve pain
4. Prednisolone 40mg po once daily to relieve acute pain

Non-pharmacological

1. Cleaning and dressing of the ulcer
2. Use of a wet dressing with 5% aluminum acetate six hourly
3. Use calamine lotion to moisten the skin

Patient Education

Enlightening the patient is an important component in healthcare to allow the patient make informed decision. Patient education includes the causes of disease, symptoms, and treatment methods. Explain to the patient about the treatment methods, procedures, risks, benefits, and the side effects. Include lifestyle education such as diet, physical, exercise, and preventing the contact of the disease. The appropriate patient education strategy are providing graphic and brochures educational materials for easier understanding.

Reflection

Assessing a patient with a neurological disorder was a learning experience. The interview and examination were easy because the patient was cooperative. I learned how varicella zoster spreads through a dermatome to cause pain to the surrounding organs.

References

Marra, F., Parhar, K., Huang, B., & Vadlamudi, N. (2020, January). Risk factors for herpes zoster infection: a meta-analysis. In Open forum infectious diseases (Vol. 7, No. 1, p. ofaa005). US: Oxford University Press. https://doi.org/10.1093/ofid/ofaa005

Michael, Y., & Shaukat, N. M. (2022). Erysipelas. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532247/

Möckel, M., De La Cruz, N. C., Rübsam, M., Wirtz, L., Tantcheva-Poor, I., Malter, W., … & Knebel-Mörsdorf, D. (2022). Herpes Simplex Virus 1 Can Bypass Impaired Epidermal Barriers upon Ex Vivo Infection of Skin from Atopic Dermatitis Patients. Journal of Virology, 96(17), e00864-22. https://doi.org/10.1128/jvi.00864-22

Patil, A., Goldust, M., & Wollina, U. (2022). Herpes zoster: a review of clinical manifestations and management. Viruses, 14(2), 192.  https://doi.org/10.3390/v14020192 Integumentary Advanced Nursing Practice Assignment Paper

INSTRUCTIONS TO WRITER:::::::

GO HERE ON MY BLACKBOARD SHADOW HEALTH:::

Advanced Nursing Practice I – Primary Care – Adult – March 2023, 202310nur6111master

Sick Visit: Integumentary Advanced Nursing Practice I – Primary Care – Adult – March 2023, 202310nur6111master

Patient Exam : This assignment provides the opportunity to conduct a sick visit in a primary care setting, with a patient experiencing integumentary concerns. You will interview and examine the patient, document your findings, and complete post-exam activities. On average, this assignment should take 75 minutes to complete.

1. Assignment Description: This assignment provides the opportunity to conduct a sick visit in a primary care setting, with a patient experiencing integumentary concerns. You will interview and examine the patient, document your findings, and complete post-exam activities. On average, this assignment should take 75 minutes to complete

2. Please log on to my shadow health from my institution page. Its on BlackBoard. My log in credentials are: username – virmanip

Password – Chinoo@1000     Please use these credentials to log in the webpage mentioned in next point.

3. instituition is William Paterson University. webpage to get in : https://bb.wpunj.edu/ultra/courses/_30999_1/cl/outline. Log on to my university log n through this page. Go to Module 1 and then scroll all the way to the bottom to find shadow health tab.

ORDER NOW

4. Interview is being conducted by NP – Puneet Virmani, so intorduce yourself as Ms. Puneet while conducting an assessment on Gastrointestinal

5. 5. Deadline is 2 days Must remember.

6. Follow SOAP NOTE RUBRIC v v strictly in all excellent section Boxes. I am Attaching the soap note rubric along Writer will Submit the Shadow health .A Score of 95-100% is a must.
7. working diagnosis/es including ICD 10 code and brief evidence-based rationale to support diagnosis:::::::: MUST
8. A score of 100% is must Integumentary Advanced Nursing Practice Assignment