N522PE Module 2 Discussion 2

N522PE Module 2 Discussion 2

Discussion 2

This week you have studied advanced physical assessment of the eyes, ears, nose, throat, head, neck and skin (HEENT). Describe the classification of rashes. What additional resources for HEENT advanced health assessment skills have you found beneficial in developing your knowledge and psychomotor skills this week? Post a concept to the discussion board that you have had difficulty with and note where you are with resolution of your difficulties. N522PE Module 2 Discussion 2. Please describe the issue completely, citing your sources so that your classmates can reference the information and provide additional “clinical pearls”. In other words, please include primary sources and/or reliable electronic sources to support your arguments.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.

Example Approaches

Describe the classification of rashes

Fever

Fever is normal in viral rashes. It is not deadly. However, meningococcemia rash presents a macular or petechial with fever, irritability, hypotension, and immediate attention to be lifesaving. (Dains, Baumann, & Scheibel, 2016, p.331)

Allergic Reaction

The warning sign ( rashes ) occurs right after the exposure to the allergen, which associates with swelling of the extremities, face, lips, tongue, or airway. Allergic reactions may cause cough, short of breath, wheezing, and heart palpitations. Hospitalization immediately is necessary. (Dains, Baumann, & Scheibel, 2016, p.331)

Rash with mucosal involvement

Toxic epidermal necrolysis (TEN) and Steven Johnson syndrome is brutal mucocutaneous responses. These conditions are described by massive necrosis and skin layer disconnection. The percentage of body surface involvement will determine the variant of the disease. However, TEN takes 30% of the body surface, and it is considered more dangerous. Erythematous and the morbilliform rash usually goes with fever, oral ulcers, diarrhea, and conjunctivitis are terrible reactions. They need to admit to the hospital to remove dead cells from the surface of the skin. (Dains, Baumann, & Scheibel, 2016, p.331 )

Additional Resources for HEENT Advanced Health Assessment Skills

This week, I learned from Shadow health assessment for head, eyes, ear, nose, and throat examination. They include inspected head and face for feature symmetry, appearance: reviewed eye and orbital area for any abnormal visual findings. Regarding nasal cavities, I am looking for turbinate patency and discharge. As inspected ears, tympanic membrane color and auditory canal color should include. Mouth and throat inspected for oral mucosa, tonsils, and posterior oropharynx color and texture. Neck examination includes appearance and symmetry. Then, I was instructed to palpate the scalp for any tenderness. Sinuses assessments include palpate frontal, maxillary, temporal arteries are bilateral. For carotid arteries feel for thrill and intensity. Having the patient open and close the mouth observe for temporomandibular joint (TMJ). In addition, I was instructed to palpate for lymph nodes and thyroid gland. To examine the eyes, extraocular eye movements include cardinal fields, convergence, visual acuity. For the ear exam, I am also be taught to do the Weber test, Rinne test, and whisper test. Finally, a throat exam includes gag reflex tested. (Shadow Health, 2017) N522PE Module 2 Discussion 2

Difficulty and resolution of the difficulty

I encountered some difficulty understanding as performing a physical assessment with the virtual patient in Shadow Health. I was spending so much time asking all questions, but I was not sufficient points. I have not given up and kept practicing again and again. I also started taking notes during my practice in Shadow Health.

References

American Psychological Association. (2019). Publication manual of the American Psychological

Association (7th ed.). Washington, DC. ISBN-13: 978-1433832154

Bickley, L. S. (2017). Bate’s guide to physical examination and history taking (12th ed.).

Philadelphia, PA: Wolters Kluwer. ISBN-13: 978-1-4698-9341-9

Dains, J., Baumann, L., & Scheibel, P. (2016). Advanced health assessment & clinical diagnosis

in primary care (5th ed.). St. Louis, MO: Elsevier. ISBN-13: 978-0323266253, ISBN-10:

0323266258

Shadow Health ( 2017). Advanced_Health_Assessment_Student_Handbook_v2.pdf

Discussion Responses

Interesting discussion! I had never heard of Steven Johnson syndrome and luckily I have never seen it during my time in the Emergency Department. I researched this condition and learned that it is a medical emergency that usually requires hospitalization. Treatment focuses on removing the cause, caring for wounds, controlling pain and minimizing complications as the skin regrows. It can take weeks to months to recover. Both Steven Johnson syndrome and toxic epidermal necrolysis are severe cutaneous adverse reactions. They are cause for concern because they both have high mortality rates. The mortality rate is 23% at 6 weeks and 34% at 1 year. The largest risk factor for death being the severity of the reaction rather than comorbidities (Sekula et al., 2013).
Treatment usually begins by stopping any current non-essential medications. Then patients receive fluid replacement, topical steroids, antibiotics if warranted and the cylosporien drugs (Neoral, Sandimmune) and etanercept (Enbrel). If the latent cause for the syndrome can be eliminated and the skin reaction stopped, a patient’s skin may begin to grow within several Days (Barvaliya et al, 2011).
Skin is such a complex organ of the body. I will need lots of repetition and experience to become a skilled practitioner for skin complaints. I find looking at many photographs helps me as I learn all the various definitions.
Barvaliya, M., Sanmukhani, J., Patel, T., Paliwal, N., Shah, H., & Tripathi, C. (2011). Drug-induced Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS-TEN overlap: A multicentric retrospective study. Journal of Postgraduate Medicine, 57(2), 115-9. http://dx.doi.org.americansentinel.idm.oclc.org/10.4103/0022-3859.81865

Sekula, P., Dunant, A., Mockenhaupt, M., Naldi, L., Bouwes Bavinck, J. N., Halevy, S., Kardaun, S., Sidoroff, A., Liss, Y., Schumacher, M., & Roujeau, J. (2013). Comprehensive Survival Analysis of a Cohort of Patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. The Journal of Investigative Dermatology, 133(5), 1197-204. http://dx.doi.org.americansentinel.idm.oclc.org/10.1038/jid.2012.510

324 words

Anh, thank you for your post. In addition to determining a rash’s underlying etiology, it is important to describe the rash using its morphological features. For example, acute allergic contact dermatitis lesions are associated with erythematous, indurated, scaly plaques with vesiculation and bullae seen in severe cases (Yiannias, 2019). Chronic allergic contact dermatitis can present with dry, scaly, and thicker lesions with possible eventual development of lichenification and fissuring (Yiannias, 2019).

In contrast, acute urticaria associated with angioedema often presents as circumscribed, raised, erythematous plaques, with central pallor (Asero, 2020). Lesion shape varies from round, oval, to serpiginous and lesions can coalesce as they enlarge (Asero, 2020).

Distribution of affected areas is also important to note. Rashes attributed to allergic contact dermatitis are typically localized to the area that came in contact with the allergen (Yiannias, 2019). In contrast, distribution of urticaria lesions associated with corresponding angioedema varies and any area of the body may be affected (Asero, 2020).

References

Asero, R. (2020). New-onset urticaria (S. Saini, J. Callen, & A. M. Feldweg, Eds.). UpToDate. Retrieved January 26, 2021, from https://www.uptodate.com/contents/new-onset-urticaria

Yiannias, J. (2019). Clinical features and diagnosis of allergic contact dermatitis (J. Fowler & R. Corona, Eds.). UpToDate. Retrieved January 26, 2021, from https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-allergic-contact-dermatitis

213 words N522PE Module 2 Discussion 2

N522PE Module 2 Discussion 2