NR 602 IHuman -CASE- RASH QUESTION TO ASK
How can I help her today?
Does she have any other symptoms you would like to discuss?
What treatment has she
... [Show More] had for the cough? Is she coughing any sputum?
What treatment has she had for the rash?
On what part of her body did the rash start and where did it spread?
Is her rash painful or itchy?
What treatment hasshe had for the rash?
Has she been having fevers?
When did the feverstart?
How high is the fever?
Is she taking any over the counter medication?
How is her appetite any recent change?
Did she have any other problems two to four days........ ?
How many wet diapers does your child have per day?
How many stools diaper does your child have per day?
Does she have any allergies?
DIAGNOSIS
Exanthema subitum HHV 6/ roseola
Human parvovirus 19 Rubella (German measles)
Measles
URI
NO TEST REQUIRED
History
Reason for encounter: rash on abdomen, b/l UEs and b/l Les
History of present illness: feverstarted 3 days ago,stopped last evening
Cough and rhinorrhea started 3 days ago
ROS
General
(-) fever
(-) significant weight change
(-) significant appetite change
HEENT/neck
(+) rhinorrhea
(+) cough
CARD
(-)CP/pressure/discomfort
(-) decrease in activity
(-) SOB
RESP
(-) SOB
(-) wheezing
(-) difficulty catching a breath
(-) chronic cough
(-) sputum production
GI
diaper stools about 2 per day
GU
Diaper urine 4-5 per day
MSK….
NEUR
No history of seizures
INTEGUMENTARY/breast
(+) rash on abdomen, b/l UEs and b/l LEs
Psychiatric….
Endocrine
No history of diabetes, endocrine/thyroid problems
Hemolytic/lymp
No history of anemia
Allergic/Immunologic
No history of allergies, immunizations up to date
PMH
None
Hospitalizations/surgeries:
Born full term 38 wees GA. Born via NSVD. No complications during delivery or after birth
Preventative health
Growing and developing well. Meeting all developmental milestones.
Medications
none
Allergies
NKDA
Immunizations
all up to date
Social Hx
Lives in an apartment with both parents
Family Hx
Mother 32: healthy
Father 35: healthy
PHYSICAL ASSESMENT
Skin/hair/nails
Inspection of skin:
Skin is warm and dry. There is a maculopapular pink rash on abdomen and extremities. Normalskin
turgor
HEENT/neck:
Inspect eyes:
Eyelids: no ptosis, erythema orswelling:
Conjunctivae: pink, no discharge
Sclerae: anicteric
Orbital area: no edema, redness, tenderness or lesion noted.
Inspect pupils:
R pupil: normal reactive
L pupil: normal reactive
Inspect ears:
Normal appearing externalstructures; no deformities or edema. No discharge noted
Otoscopic examination of ears:
Normal-appearing external auditory canals. Tympanic membrane translucent, non-injected and
pinkish-gray in color. No scaring, discharge or purulence noted. Normal landmarks. Normal mobility
wit insufflation.
Nose inspection
No discharge/polyps. No edema/tenderness over the frontal or maxillary sinuses.
Look up nostrils:
Normal exam
Inspect mouth/pharynx:
No hoarseness; oropharynx not injected, clear mucosa, tonsils without exudate. Tongue normal color,
symmetrical, no swelling or ulcerations. Normal gag reflex.
Neck inspection:
No visible scars, deformities or other lesions. Trachea midline and freely mobile. No asymmetry or
accessory respiratory muscle use with quiet breathing.
CHEST WALL & LUNGS
Visual inspection of AP chest:
The chest is symmetrical and the AP diameter is normal. The excursion with respiration issymmetrical
and there are no abnormal retractors or use of accessory muscles. No distension, scars, masses or
rashes.
Lungs auscultation
Right clear (normal)
Left clear (normal)
CARDIO
Heart auscultation:
Normal S1 S2
Lymphatic:
No pathologically enlarged lymph nodesin the cervical, supraclavicular, axillary and inguinal chains
ABDOMAN:
Abdomen inspection: Flat symmetric with no scars, deformities, striae or lesions.
Abdomen palpation: No pain, tenderness, masses or pulsation abdomen palpation. No guarding,
rebound tenderness. No hepatosplenomegaly. Liver span normal. The spleen is not palpable.
Abdomen auscultation: normoactive bowel sounds in all 4 quadrants
EXTREMETIES:
Visual inspection: no swelling or deformity. There is no cyanosis, clubbing or edema.
Problem statement:
Gemma Jones is a 2-year-old girl, accompanied by her mother. The mother reports a rash that started
today on her abdomen this morning but it spread to her extremities. Additionally, the mother reports
cough, rhinorrhea, and fever that hasstarted 3 days ago (fever hasresolved). Patient is up to date with
all immunizations.
Or
Gemma Jones is a 2 years old girl that came in with CC of a nonpruritic rush that has started on her
abdomen today but progressed to her upper and lower extremities. Three days prior she developed a
cough, runny nose, and fever (last fever yesterday-resolved). The mother reports no change in [Show Less]