Advanced FNP Clinical I. Reply to peer discussion week 6

You should respond to your peers by extending, refuting/correcting, or adding additional nuance to their posts.
All replies must be constructive and include at least two references.

Weekly Clinical Experience 6

Elizabeth Varona-Martin

My week started well with a few patients suffering from the common cold. I had an easy time with most patients. The highlight of my week was when I got to dress a burn. It was the most challenging part as the child was in much pain. I felt so helpless as there was no other way to deal with the situation.

Another patient was a two-year-old Asian girl with flare and redness around the neck, brought by her parents. The area looked very dry. The mother described how it started and how the girl behaved. The little girl has continually scratched the affected area. The parents told us that it gets worse at night. The infant would lose sleep due to scratching, and it was the fourth day since the rashes appeared. These rashes looked like flare-ups. I enquired whether it had ever happened before. Since it had never happened, I asked what remedy they had used at home. They explained that they had just washed with saltwater. The parents stated they had not introduced any new meal unless she took something new in daycare.

We initiated the assessment by checking the temperature that was higher than 101°F. I checked her eyelids and realized they were darker. A few rough bumps on the face were eczema in the first stages. Due to the symptoms displayed, the patient’s most likely diagnosis is atopic dermatitis or eczema.

Differential diagnosis include:

Psoriasis: In comparison to atopic dermatitis, psoriasis frequently affects the diaper region in newborns and young children, with well-differentiated erythema patches with minimal scaling (Weston & Howe, 2022).
Scabies: can appear as a generalized eruption similar to atopic dermatitis. The involvement of the skin folds and diaper region and the development of vesico pustules on the palms and soles point to scabies. The presence of mites or eggs can be confirmed by skin sampling, dermoscopy, or an adhesive tape test (Weston & Howe, 2022).
Contact dermatitis: allergens, or irritants cause contact dermatitis; however, it can be challenging to distinguish from atopic dermatitis, and both conditions may coexist (Weston & Howe, 2022).

My preceptor prescribed desonide 0.5% to apply to the affected areas two times daily. I also advised the parents to avoid harsh soaps and reduce bath time. I insisted on moisturizing the skin at least twice a day.

This week’s lesson was on doing my tests thoroughly to come up with comprehensive information. I also learned the virtue of patience as I would learn something new as we continued to have conversations with the parents. The parents would give information they had left out as we continued talking.

Atopic dermatitis treatment aims to alleviate symptoms such as pruritus and dermatitis, avoid exacerbations, and decrease therapeutic risks. The recommendations are for a low-potency corticosteroid cream or ointment for patients with mild atopic dermatitis, such as desonide 0.05 percent or hydrocortisone 2.5 percent (Howe, 2022). Moisturizing would help in reducing and preventing flaking of skin. Anti-itch cream was to help in reducing the itchiness of the affected areas (Ribet et al., 2018). Constant itching would lead to severe conditions of the skin. Avoiding harsh soaps would help in reducing the effect of rashes worsening.

References

Howe, W. (2022, December 8). Treatment of atopic dermatitis (eczema). UpToDate. Retrieved from https://www.uptodate.com/contents/treatment-of-ato…

Ribet, V., Mielewczyk, E., Sirvent, A., Georgescu, V., & Rossi, A. B. (2018). A novel dermo-cosmetic product containing thermal spring water, sucralfate, copper sulfate, and zinc sulfate in the management of hand eczema. Clinical, Cosmetic and Investigational Dermatology, 11, 373.

Weston, W. L., & Howe, W. (2022, January 2). Atopic dermatitis (eczema): Pathogenesis, clinical manifestations, and diagnosis. UpToDate. Retrieved from https://www.uptodate.com/contents/atopic-dermatiti…

Zhao, M., Liang, Y., Song, F., Ma, L., Wang, Y., Gao, W., … & Ma, X. (2022). Protocol: Preventive Antenatal Educational Program on Allergic Diseases (PAEPAD) versus standard antenatal care to prevent atopic dermatitis: study protocol for a single-center, investigator-blinded randomized controlled trial. BMJ Open, 12(1).