Nursing Rash Patient Discussion

Scabies Chief Complaint The patient's chief complaint is a rash and scathes that appear as tunnels. There are small, grey-white linear lesions with a minute black speck at the closed end. The rash is persistently itchy. Precipitating/Alleviating Factors/Past Medical History There are no obvious precipitating factors. The patient is young and otherwise healthy. The patient has a normal diet, and reports no surgeries, history of illness, medications (except OTC Tylenol) or allergies.

The patient works in an oil field, however, and in the course of that work may have been exposed to hazardous chemicals, which are common in that industry. The patient's family does not have any medical history that appears related to the rash. The patient is sexually active with one partner. The patient's financial and living situation is stable. It is not known if the partner has a similar rash, but this would be important information because scabies is often sexually transmitted (Monsel & Chosidow, 2012).

Associated Symptoms The rash is persistently itchy. Otherwise there are no associated symptoms reported. Quality of Reported Symptoms The itchiness is an impediment to comfort at this point. The patient is otherwise able to live as normal. Temporal Factors The patient has not indicated date of onset. Rash is currently active. The rash is persistent. Location It is not known whether the rash is generalized or localized. It is not known if the rash radiates or not. Sequelae The nature of the rash is unknown at present.

Aside from the itching, there are no active complications. Persistent itching, however, can result in scratching that further damages the skin. Thus, there is risk of secondary infection if the rash persists further. Severity of Symptoms The patient is reporting a rash, but has not indicated the severity of the itching, or of the rash itself. Assessment The patient believes that he may have scabies. There are no details provided as to why he feels this way.

The symptoms of the rash do not align with scabies, in terms of the appearance of the rash. Scabies is typically a sexually-transmitted disease, and the patient's family situation does not align with sexual transmission of scabies, unless there is something the patient is not admitting to. However, given that the rash is not manifesting like a scabies rash, it is unlikely that the patient has scabies. Potential Differential Diagnoses Scabies is an option, because the patient is presenting with an itchy rash.

More information would be required to obtain a scabies diagnosis, as there are a few reasons noted above to suggest that the patient does not have scabies. One potential diagnosis for this patient is lichenoid keratosis. This is a benign skin lesion that can become itchy. It predominantly affects adults, is more common in UV-exposed areas (the patient works on an oil field).

The timeline is that there is an inflammatory phase at which the lesion is itchy, but then it fades to the pigmented phase where it becomes grey-brown in color (PCDS, 2016). Another differential diagnosis contact dermatitis. Due to the patient's vocation, there is the possibility that the patient has come into contact with a chemical agent that has caused a skin irritation. More information from the patient will be required to determine what, if any, chemicals he has come into contact with in the oil field.

Consultation with a dermatologist is required to arrive at a diagnosis for this patient. The patient will be referred to a dermatologist. This patient was not appropriate for a nurse practitioner, as the nurse practitioner lacks the appropriate training in dermatology and the patient has not yet received a diagnosis. After the patient has been diagnosed, he would be appropriate for a nurse practitioner, but not before. Plan Once the cause of the rash is identified, a plan for the patient can be developed.

The plan will include appropriate treatment for the rash. The patient may need to be coached on how to avoid exposure.