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NR602 IHuman-week6 notes and questions to ask
Primary Care Of The Childbearing (NR-602)
Chamberlain University
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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 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 has she had for the rash? Has she been having fevers? When did the fever start? 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: fever started 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. Normal skin turgor HEENT/neck: Inspect eyes: Eyelids: no ptosis, erythema or swelling: Conjunctivae: pink, no discharge Sclerae: anicteric Orbital area: no edema, redness, tenderness or lesion noted. Inspect pupils: R pupil: normal reactive
appetites. Wet and stool diapers are unchanged and adequate. She does not have any medical or allergy history, and she lives home with both parents
Assessment/management plan
Exanthem subitum (Roseola) B08.
Roseola is a generally mild infection caused by two strains of herpes virus. It's common, usually
affecting children by age two. It occasionally affects adults.
Symptoms include several days of high fever, followed by a rash that may appear as many small
pink spots. Other symptoms may include loss of appetite, irritability, swollen lymph nodes, red
spots on the soft palate, runny nose, or sore throat.
There is no specific treatment for roseola infantum. The majority of cases of roseola infantum are
mild and self-limited.
Treatment is supportive with rest, maintaining fluid intake and antipyretics such as
acetaminophen or ibuprofen to control the fever. Due to the rash likely being nonpruritic,
treatment is unnecessary. There is currently no vaccination or antiviral therapy for the acute
phase of this virus. Adequate hand washing is very important to prevent the spread of the disease.
Tylenol oral suspension OTC
SIG: take 5ml PO every 4 hours as needed
Max dose 25ml/24 hours, do not exceed do not exceed 75 mg/kg/day from all sources
Children's Advil oral suspension OTC
SIG: take 5ml PO every 6-8 hours as needed,
max 20ml in 24 hours give with food to avoid GI upset
Education: The rash should resolve within 24 hours. You can alternate Tylenol and Ibuprofen for
fever reduction. You should increase the child fluid intake and allow for plenty of rest. Take all
medications as directed and do not exceed the recommended dosage. Do not give any other
medications that have combined acetaminophen or ibuprofen in medication.
Tylenol/acetaminophen is an over-the-counter medicine taken to relieve fever and pain. It's a safe
drug when used correctly for a wide variety of problems. The dosage is based on the child’s
weight/age. But too high a dose can make a child very sick, so it's important to know how to
properly give acetaminophen. When administering the medication, make sure you a dropper,
syringe, or cup that came with the product to prevent overmedicating/overdose.
Side effects of Tylenol can include:
Headache
Nausea
Rash
Advil/Ibuprofen/Motrin is a medicine used to reduce fever and pain as well. It is considered as
nonsteroidal ant-inflammatory drug. It also OTC medication and just like Tylenol dosage is
determined by weight/age of the child. Just like Tylenol, this medication must be administered
with a dropper, syringe, or cap that came with the product to avoid overdosing.
Side effects that may occur with taking Advil:
Upset stomach
nausea,
vomiting,
headache,
diarrhea,
constipation,
dizziness
drowsiness
Allergy alert: Ibuprofen may cause a severe allergic reaction, especially in people allergic to
aspirin. Symptoms may include hives, facia swelling, asthma, shock, etc.
Roseola infantum is a clinically diagnosed, self-limited illness that can be treated
symptomatically. It does not warrant a referral at this time.
NR602 IHuman-week6 notes and questions to ask
Course: Primary Care Of The Childbearing (NR-602)
University: Chamberlain University
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