Diagnosing Integumentary Disorders and Treatment

Advanced practice nurses face different kinds of patient issues and needs as they carry out their work in healthcare settings. To address patient issues and needs, these professionals conduct patient assessments by looking for external abnormalities like cloudy eyes and skin irritations. An example of a patient issue faced by advanced practice nurses is the case of a 46-year-old male complaining of pruritic skin rash, which has been present for a few weeks. The skin rash started on his feet and has spread to other parts of the body i.e. fingers, wrist, and waist. The problem began after the patient came home from a trip in Florida where he had stayed in several hotels. The results of a physical examination shows that the man has several tiny vesicles and scales between his fingers, on ankles and feet, around the belt line and his wrist.

Buttaro et al. (2013) states that physical examination when diagnosing integumentary disorders entail the use of a contact dermatoscope or a non-contact microscope that utilizes cross-polarized light for objective examination of skin lesions. This process enables the clinician to visualize the epidermis and superficial dermis, which in turn help to identify changes in pigmentation throughout the lesion. The diagnosis involves a close examination of the distribution and location of the lesion as well as surface characteristics or appearance, which includes configuration, shape, borders, color and size. However, the determination of an appropriate diagnosis of a patient with integumentary disorders requires evaluation of his/her history and physical exams.
In relation to the 46-year-old case, the skin rash problem can be attributable to his recent trips in Florida. As shown in the patient’s history, he started having skin rashes after staying in multiple hotels in Florida during a recent trip. This implies that the patient could have used hotel amenities that contributed to the skin rash. He could have shared a towel, bed sheets, blankets or any other items that had been used by other people with skin problems. Based on the physical exam, the patient’s condition is attributable to the living conditions and amenities in the hotels he stayed in while on the trip. Since he occasionally takes ibuprofen for knee pain, has no other health problems and has no drug allergies, staying in multiple hotels is the genesis of this skin problem. This implies that he probably developed a skin allergy after using the facilities in the multiple hotels in Florida.
Given his history and physical exam, the most probable differential diagnosis for this 46-year-old is scabies. This is a suitable differential diagnosis since the skin is susceptible to cutaneous diseases like rashes, malignant tumors, benign, and lesions, which represent a huge portion of skin complaints (Buttaro et al., 2013). Scabies most often develop on waist, wrists, elbows, between the fingers, and armpits (Brannon, 2018). Scabies are mostly contacted when an individual is in the same house as someone who has scabies or through sharing a bed or clothing with them. Scabies is a skin rash that is intensely itchy and tends to be worse at night. The 46-year-old could be suffering from scabies because of irritation and allergic reactions to soaps, wool, chemicals, and other substances in the hotels that irritate the skin and cause itching.
The potential treatment option for this 46-year-old male patient is eliminating the skin infestation or rash using medications. There are numerous creams and lotions available in the health sector that can be applied to the entire body to help prevent and/or eliminate skin rashes. Brannon (2018) states that treatment of scabies involve the use of 5% permethrin lotion or cream. These lotions or creams are often used in tandem with topical steroids or oral histamines to treat the skin rash. The other available medications that can be used to treat this patient include invermectin, lindane lotion, and crotamiton. However, the determination of the most suitable diagnosis and treatment requires further physical and/or microscopic examination.
References
Brannon, H. (2018, September 26). How to Identify 9 Common Skin Rashes. Retrieved March 6, 2019, from https://www.verywellhealth.com/rash-pictures-4020312
Buttaro, T.M., Trybulski, J., Polgar-Bailey, P. & Sandberg-Cook, J. (2013). Primary care: a collaborative practice (5th ed.). St Louis, MO: Elsevier.