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Fever and Rash

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A clinical syndrome characterized by fever, malaise, ... Dermatology Textbook. On-line Resources. Diagnosis. Diagnosis. Disease. Differential. Probability ' ... – PowerPoint PPT presentation

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Title: Fever and Rash


1
Fever and Rash
  • A Sick College Student

Lisa B. Goben Domain Terminology Project N409
Spring Duke University School of Nursing
2
Fever and Rash
  • Measles (rubeola) in the 21st century
  • A clinical syndrome characterized by fever,
    malaise, coryza, cough, and rash. Death is rare,
    usually from pneumonia or encephalopathy.
  • It is highly contagious and was once considered
    as inevitable as death and taxes.
  • Because of aggressive vaccination programs in the
    U.S. starting in the late 1980s, case reports
    have fallen from 250,000 in 1990 to a provisional
    105 cases in 2003.

So a college kid walks into the ER
3
Fever and Rash
4
Demographic Data
5
Living Situation
Age
College Student
  • Dormitory
  • Apartment

Family Support
  • Relative
  • Mother

6
Biophysical Attributes
7
Medical History
  • Symptoms
  • Past Medical History

8
Symptoms
  • Sick
  • Achy
  • Arthralgias
  • Felt bad
  • Headache
  • Itching

9
Past Medical History
  • Medical Problems
  • Immunization History
  • Medication Use
  • Tobacco Use

10
Medication Use
  • Alternative Medications
  • Tetracycline
  • Doxycycline
  • Side effects
  • Photosensitivity
  • Illegal Drugs

11
Vital Signs
  • Temperature
  • 39.0 Centigrade
  • Fever
  • Blood pressure
  • Heart Rate
  • Postural (links to Dehydration)
  • Respiration Rate
  • Oxygen Saturation

12
Physical Exam
  • Physical Signs
  • Neck
  • Nucal Rigidity
  • Lymphadenopathy
  • Skin
  • Rash
  • Face
  • Acne
  • Chest
  • Stomach
  • Thighs

13
Physical Exam
  • Psychosocial Exam
  • Reexamining

14
Laboratory Tests
  • Blood Tests
  • Complete Blood Count
  • Mono Spot
  • Antibodies
  • Rubeola IgM (links to Public Health Concerns)
  • Rubeola IgG
  • Results
  • Positive
  • Negative
  • Levels

15
Medical Knowledge
16
Medical Knowledge
  • Medical Provider
  • Nurse Practitioner
  • Doctor
  • Consultant
  • Literature
  • Dermatology Textbook
  • On-line Resources

17
Diagnosis
18
Diagnosis
  • Disease
  • Differential
  • Probability

The terrors of disease are always with
us. Thomas A. Dooley (1927-1961)
19
Differential
  • Allergic reaction
  • or
  • Infectious Disease

20
Infectious Disease
  • Measles
  • Rubeola
  • Atypical Measles
  • Mononucleosis
  • Meningitis
  • Meningococcal rash

21
Drug Allergic Reaction
22
Measles Rash
23
Mononucleosis Rash
24
Infectious Disease
  • Non-specific Viral Illness
  • Viral Syndrome
  • Influenza A
  • Influenza B
  • Garbage Pail Diagnosis
  • Viral Exanthem
  • Contagious
  • Public health concerns

25
Disease
  • Secondary Diagnosis
  • Dehydration

26
Treatment
27
Intravenous Fluids
  • Normal Saline

Medications
  • Antipyretic
  • -Tylenol

28
Patient Teaching
  • Explanation
  • Patient Education
  • Self Help
  • Reassurance

Comfort measures
  • Warm Blanket

29
Outcome
30
Discharged
  • Called
  • Resolved
  • Sequelae
  • Public Health Reporting

31
Public Health Concerns
32
Immunization
  • MMR
  • Immunity
  • Wanes

Community Health
  • Officials
  • Outbreak
  • Epidemic

33
Take Home Message
  • Common things are common
  • Think horses not zebras
  • Analysis improves patient care

34
Bibliography
  • Barinaga, J. L., Skolnik, P. R. (2005).
    Clinical presentation and diagnosis of measles,
    from http//uptodateonline.com.
  • Charters, K. G. (2003). Nursing informatics,
    outcomes, and quality improvement. AACN Clinical
    Issues Advanced Practice in Acute Critical
    Care., 14(3), 282-294.
  • Cohen, B. A., Lehmann, C. U. (2005).
    Dermatlas.Org, from http//dermatlas.med.jhmi.edu/
    derm/.
  • Mengert, T., Eisenberg, M. S., Copass, M. K.
    (1996). Emergency medical therapy (4th ed.).
    Philadelphia W.B.Saunders.
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