Custom Writing Help For You!

Special Discounts Offers! 20-30% Off!

Posted: January 29th, 2015

Nursing Assignment: I need help writing a research paper. DERMATOLOGY CASE STUDY

Nursing Assignment: I need help writing a research paper.

DERMATOLOGY CASE STUDY

Chief complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies.

Denies associated symptoms of fever and chills.

PMH: Diabetes Mellitus, type 2.

Surgeries: None

Allergies: Augmentin

Medication: Metformin 500mg PO BID.

Vaccination History: Immunization is up to date and she received her flu shot this year.

Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.

Family history:Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: Regular rhythm.

Skin: Right great toe swollen, itchy, painful and discolored.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.

PSYCH: Normal affect. Cooperative.

Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

Assessment:

Primary Diagnosis: Proximal subungual onychomycosis

Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis

Special Lab:

Fungal culture confirms fungal infection.

As an NP student, you need to determine the medications for onychomycosis.

1. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.

2. What labs for baseline and follow up of therapy would you order for this patient? Give rationale.

___________________________
According to the AAFP/CDC Guidelines, the recommended treatment for proximal subungual onychomycosis is oral terbinafine or itraconazole for 12 weeks. Given the patient’s comorbidities, terbinafine would be the preferred option. Therefore, the patient should be prescribed Terbinafine 250mg PO once daily for 12 weeks.
Prescription:
Terbinafine 250mg PO daily for 12 weeks
Dispense #84
Refills: 0

For baseline and follow-up of therapy, the following labs should be ordered:
Baseline:

Comprehensive metabolic panel (CMP) to monitor liver function, since terbinafine can cause liver damage.
Complete blood count (CBC) to monitor for anemia and leukopenia, which are potential side effects of terbinafine.
Fungal culture of the affected nail to confirm the diagnosis and identify the specific type of fungus causing the infection.
Follow-up:

CMP at 4-6 weeks after starting therapy to monitor liver function and detect any potential hepatotoxicity.
CBC at 4-6 weeks after starting therapy to monitor for anemia and leukopenia.
Fungal culture of the affected nail at the end of therapy to confirm eradication of the fungus and ensure successful treatment.
Rationale: The baseline labs are important to establish a baseline for liver function and rule out any underlying anemia or leukopenia. Fungal culture will confirm the diagnosis and identify the specific type of fungus causing the infection, which can guide the choice of antifungal agent. The follow-up labs are essential to monitor for potential side effects of terbinafine and assess the efficacy of therapy. The liver function tests are particularly important since terbinafine can cause liver damage. The fungal culture at the end of therapy will confirm the successful eradication of the fungus and ensure a complete cure.

Tags: , , , , , , , , , , , , ,

Order for this Paper or similar Answer/Assignment Writing Service

Place your order by filling a guided instructions form in 3 easy steps.

Why choose our Study Bay Services?

Like every student, Focusing on achieving the best grades is our main goal

Top Essay Writers

We have carefully cultivated a team of exceptional academic writers, each with specialized expertise in particular subject areas and a proven track record of research writing excellence. Our writers undergo rigorous screening and evaluation to ensure they hold relevant advanced degrees and demonstrate mastery of English grammar, citation style, and research methodology. Recent projects completed by our writers include research papers on topics such as sustainable energy policy, cognitive behavioral therapy, and molecular genetics.

Student-Based Prices

We prioritize attracting highly skilled writers through competitive pay and strive to offer the most cost-effective services for students. References from recent years include surveys of customer satisfaction with online writing services conducted by the American Customer Satisfaction Index between 2018 to 2022, demonstrating our commitment to balancing affordable costs with high standards of work through positive reviews and retention of expert writers.

100% Plagiarism-Free

We guarantee 100% original and plagiarism-free final work through a thorough scanning of every draft copy using advanced plagiarism detection software before release, ensuring authentic and high-quality content for our valued customers. To note, we also do not generate assignment content with AI tool, thus you a guaranteed 0% similarity index for your final research paper.

How it works

When you decide to place an order with Study Pro Essay, here is what happens:

Complete the Order Form

You will complete our order form, filling in all of the fields and giving us as much detail as possible.

Assignment of Writer

We analyze your order and match it with a writer who has the unique qualifications to complete it, and he begins from scratch.

Order in Production and Delivered

You and,the support and your writer communicate directly during the process, and, once you receive the final draft, you either approve it or ask for revisions.

Giving us Feedback (and other options)

We want to know how your experience went. You can read other clients’ testimonials too. And among many options, you can choose a favorite writer.