Please Work Carefully; This Grade Is Very Important

Please Work Carefully This Grade Is Very Important And Is Going Throug

Please work carefully this grade is very important and is going through Turniting Final Case Study #1 Case Study I Mary is a 35 years old electrical engineer who presents to the office for evaluation of a rash on her face that has been present for 1 week. She denies new soaps, detergents, lotions, environmental exposures, medications, and foods. The rash is across her face and the bridge of her nose. She states that she first noticed it after spending a week hiking and camping in the Appalachians. The lesions itch and are painful.

She has not tried anything to make it better, but she has noticed that going outdoors makes it worse. She denies any spread of the rash to other areas. She has never had this rash before. She has noticed some increased fatigue, fever, and weight loss. She denies headache, sore throat, ear pain, nasal or sinus congestion, chest pain, shortness of breath, cough, abdominal pain, and pain with urination, constipation, or diarrhea.

She does have mouth soreness. She has noticed some increased muscle aches and pains, which are worse in the hand and wrist. She denies early morning joint stiffness or difficulty with being able to move in the morning. She denies temperature intolerance, polyuria, polydipsia, or polyphagia. She had a tonsillectomy at age 9 for chronic strep throat infections.

She has been healthy as an adult. She has never had children. She has never been hospitalized for any reason. Her family history is significant for a mother with rheumatoid arthritis. Her father is healthy.

She does not smoke; she drinks a glass of wine nearly every night with her dinner; she denies illicit drug use. She completed a master’s degree in engineering. She has lived with her boyfriend for the past 5 years. Patient is an alert young woman, sitting comfortably on the examination table. BP 112/66 mm Hg; HR 62 BPM and regular; respiratory rate 12 breaths/min; temperature 100.3°F.

Several erythematous plaques scattered over the cheeks and the bridge of nose, sparing the nasolabial folds. Normocephalic, atraumatic. Sclera white, conjunctivae clear; pupils constrict from 4 mm to 2 mm and are equal, round, and reactive to light and accommodation. Oropharynx moist with erythema in the posterior pharyngeal wall; no exudates; shallow ulcers in the buccal mucosa bilaterally. Neck supple without cervical lymphadenopathy or thyromegaly.

Full range of motion; no swelling or deformity; muscles with normal bulk and tone.

Paper For Above instruction

Comprehensive History and Physical Examination

Chief Complaint (CC):

The patient presents with a facial rash that has been present for one week, accompanied by fatigue, fever, weight loss, mouth soreness, and muscle aches.

History of Present Illness (HPI):

• Onset: One week ago, following hiking and camping in the Appalachians.
• Character: Erythematous plaques on cheeks and nasal bridge; rash is itchy and painful.
• Location: Face, specifically cheeks and bridge of nose; sparing nasolabial folds.
• Aggravating factors: Outdoor exposure worsens the rash.
• Relieving factors: None tried.
• Associated symptoms: Fatigue, low-grade fever, weight loss, mouth soreness, muscle aches, especially in hands and wrists.
• Absence of symptoms: No headache, sore throat, sinus congestion, chest symptoms, gastrointestinal symptoms, or urinary symptoms.

Past Medical History (PMH):

• Healthy as an adult, no prior hospitalizations.
• History of tonsillectomy at age 9 for recurrent strep throat.

Family History (FH):

• Mother with rheumatoid arthritis.
• Father healthy.

Social History (SH):

• Non-smoker.
• Consumes alcohol—about one glass of wine nightly.
• No illicit drug use.
• Lives with boyfriend for 5 years.
• Highest education: Master’s degree in engineering.

Medications:

None currently reported.

Allergies:

None known.

Review of Systems (ROS):

General:

• Fatigue, fever, weight loss

Skin:

• Facial rash, erythematous plaques

Mouth:

• Soreness, shallow ulcers in buccal mucosa

Musculoskeletal:

• Muscle aches, especially in hands and wrists

Other systems:

• No reports of headache, sore throat, cough, gastrointestinal, urinary, or other systemic symptoms.

Physical Examination:

• Vital Signs: BP 112/66 mm Hg, HR 62 bpm, RR 12/min, Temperature 100.3°F.
• General Appearance: Alert, comfortable young woman.
• Skin: Multiple erythematous plaques on cheeks and nasal bridge, sparing nasolabial folds.
• Head/Neck: Normocephalic, atraumatic; no lymphadenopathy or thyromegaly.
• Eyes: Sclera white, conjunctiva clear; pupils constrict normally.
• Oropharynx: Moist, erythematous posterior wall, no exudates, shallow oral ulcers bilaterally.
• Neck: Supple, no cervical lymphadenopathy.
• Musculoskeletal: Full range of motion, no swelling or deformities, muscles of normal bulk and tone.

Presumptive Nursing Diagnoses:

1. Risk for Imbalanced Fluid Volume related to fever and decreased oral intake evidence by fever (100.3°F).
2. Impaired Skin Integrity related to rash and skin lesions evidence by erythematous plaques on face.
3. Acute Pain related to skin lesions and oral ulcers evidence by facial rash and buccal ulcers.
4. Fatigue related to systemic illness evidence by reports of tiredness and decreased activity.
5. Risk for Activity Intolerance related to fatigue and muscular aches evidence by muscle soreness affecting daily activities.

Teaching Plan and Nursing Care

1. Risk for Imbalanced Fluid Volume

• Monitor vital signs, especially temperature and hydration status.
• Encourage oral fluid intake; ensure adequate hydration.
• Educate about signs of dehydration, such as dizziness, dry mouth, and decreased urination.
• Administer antipyretics as prescribed to reduce fever and comfort.
• Assess skin turgor and mucous membranes regularly.

2. Impaired Skin Integrity

• Maintain skin hygiene, gentle cleansing to avoid aggravating lesions.
• Apply prescribed topical treatments to lesions to promote healing.
• Educate patient on avoiding irritants and sun exposure.
• Protect facial skin from further trauma or irritation.
• Monitor for signs of secondary infection such as increased redness, warmth, or discharge.

3. Acute Pain

• Provide comfort measures, such as topical anesthetics if prescribed.
• Teach relaxation techniques and distraction methods.
• Assess pain levels regularly using appropriate scales.
• Administer analgesics as ordered, monitor for effectiveness and side effects.
• Advise patient to avoid touching or irritating the skin lesions and oral ulcers.

4. Fatigue Management and Educative Support

• Encourage adequate rest and activity balance.
• Discuss energy conservation strategies with the patient.
• Advise on nutritious diet to support immune function.
• Educate about symptom monitoring and maintaining activity levels within tolerance.
• Support emotional well-being, and provide reassurance about illness management and prognosis.

Conclusion

This patient's presentation suggests an autoimmune or inflammatory dermatologic condition possibly linked to systemic lupus erythematosus (SLE), given the characteristic facial rash, oral ulcers, fatigue, and systemic symptoms, and her family history of autoimmune disease. The nursing assessment should focus on holistic care, symptom management, patient education, and monitoring for disease progression. A multidisciplinary approach, including laboratory workup and specialist referral, is essential for accurate diagnosis and appropriate treatment. Nursing interventions aim to promote comfort, prevent complications, and support the patient’s understanding of her condition.

References

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