nitial Discussion Question/Prompt Due Wednesday by 11:59 pm
Instructions:
You have been reviewing SOAP or partial SOAP notes in prior units.
Review the Subjective and Objective elements of the attached document to determine the appropriate diagnoses to assign (‘A’) and construct an Evidence-based ‘Plan”.
Use your ‘model’ thinking as you assign the diagnoses including in parentheses behind each diagnosis the pertinent positives and pertinent negatives that you are using to support the diagnoses you assigned
Elements of the ‘plan’ need to reflect current EBP and CPGs. Be sure to include appropriately constructed in-text citations.
Assignment file
Week 9 SOAP Note download
Discussion Peer/Participation Prompt Due Sunday by 11:59 pm
Instructions:
Construct a response to at least 2 of your peers commenting on the adequacy and accuracy of the elements of their SOAP note. For example, if you note the presence of objective data in the ‘S’ or subjective data in the ‘O’ discuss this with your peers.
For each colleague that you respond to list at least one subjective piece of data and/or one objective piece of data that support the ‘A’ demonstrated in the note – or comment if there is no data/insufficient data to support the ‘A’.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
Please review the rubric to ensure that your response meets the criteria.
please respond to each peer below i will provide their post:
peer#1
Porsha Collins
Jul 7, 2021Jul 7 at 10:14am
Week 9 Discussion: Clinical Practice
Ezema, also known as atopic dermatitis, causes itchy and inflamed skin condition in young children and teens. Eczema can occur anywhere but mostly affects the arms, inner elbows, back of knees, and head. Symptoms are itchiness, flakiness, and inflamed, irritated skin. Eczema is not fully understood, but it is believed that it is caused by allergic reaction to a irritant. Some common irritants are rough scratchy material (wool), raised or changed temperature, sweating, stress, food allergy, or upper respiratory infection (Healthline, 2019).
Diagnosis: Mild Ezema “pt has been using Hydrocortisone topical cream 2.5% applied twice a day to affected area.” “Loves chips and eats a lot of fast food.” “brother has controlled eczema” “No history of asthma”
Plan:
Diagnostic Study: Patch test to figure out allergen (Healthline, 2019).
Treatment/Therapeutic: OTC antihistamine (Benadryl), Cortisone cream, high potency hydrocortisone (Healthline, 2019).
Educational:
Parent should help children to prevent eczema from flaring up by avoiding triggers.
In addition, kids should take shorter baths or showers, and use mild unscented soaps and body products.
Ask the pediatrician if it is okay to use oatmeal baths to help soothe itchiness.
Kids should wear comfortable clothes that do not irritate the skin, such as soft, breathable cotton fabrics; and kids should avoid wearing wool clothing or using a wool blanket.
Parents should discourage scratching, because it can make the eczema worse, and dirty fingernails can cause skin infections.
Kids should avoid extreme temperatures, and stay hydrated.
Use of moisturizes [ointment, mild lotions] can help control eczema, as well as reducing the amount of stress a child may experience (Healthline, 2019).
Consultation/Collaboration: Pediatrician, dermatologist, dietician (Healthline, 2019).
Reference
Healthline. (2019). Eczema: Symptoms, Causes, and Treatment. https://www.healthline.com/health/eczema
peer#2
Kayla McClaren
Jul 8, 2021Jul 8 at 7:56am
Week 9 Discussion
Atopic dermatitis (AD) is a common, chronic skin disorder that can significantly impact the quality of life of affected individuals as well as their families. AD is a highly pruritic (itchy) inflammatory skin disease and is also one of the most common skin disorders in children (Kapur et al., 2018). Although the pathogenesis of the disorder is not completely understood, it appears to result from the complex interplay between defects in skin barrier function, environmental and infectious agents, and immune dysregulation. The disorder results in significant morbidity and adversely affects quality of life. Not only are patients affected by the social stigma of a visible skin condition, but the intense itching characteristic of the disease often leads to skin trauma and significant sleep disturbances (Kapur et al., 2018).
Diagnosis:
Atopic Dermatitis
Worsening rash on bilateral arms without improvement after using hydrocortisone topical cream.
History of eczema
Reporting the area of her arms is very itchy and painful. Rating pain a 7/10, describes as a “burning feeling.”
Reports that nothing makes the pain better, but it helps when she itches.
States that right after she itches, it will start to burn worse and itch more.
Noted signs of excoriations on bilateral antecubital region, scaling on bilateral antecubital regions with erythema about 3 inches in diameter.
Fever, unspecified
Temperature 100.7
Seborrheic dermatitis
Reports increased itching and flakiness on her scalp
Diagnostics:
There are no diagnostic tests for AD; therefore, the diagnosis is based on specific clinical criteria that consider the patient’s history and clinical manifestations (Kapur et al., 2018). Current management involves treatment combinations to suppress inflammation, restore skin barrier function, and prevent superinfection. Systemic immunosuppressants are reserved typically for treatment of moderate-to-severe AD but are associated with adverse events (AEs) and not suitable for long-term use. Therefore, more effective, and well-tolerated therapies are required that target the etiologic mechanisms of AD pathophysiology rather than simply providing symptom relief (Wollenberg et al., 2019).
Allergy testing: Children with moderate to severe eczema have a high incidence of associated allergy. The results of these tests in combination with the clinical history provide a more accurate assessment of the child’s allergy status.
Lab: CBC-checking WBC count due to fever.
Therapeutics:
Children’s Motrin 300mg PO q 6-8 hours for fever and inflammation
Assists with pain control and treatment of fever.
OTC Children’s Diphenhydramine 25mg PO Q 4-6 hours PRN
Helps with itching.
Triamcinolone Acetonide 0.025% topical application to affected areas 2-4 times a day.
Assists with itching, swelling and irritation of AD.
Aquaphor
Probiotics
Studies have shown that probiotics lower Bacteroidescounts in the fecal microflora of children with atopic eczema than in healthy infants and suggested that probiotics can be used to treat AD in children (Huang et al., 2017).
Tea Tree oil shampoo and conditioner
Aveeno soothing bath treatment colloidal oatmeal skin protectant
Relieves dry, itchy, irritated skin due to poison ivy, insect bites, eczema, sunburn, hives & rashes.
Education:
Wear cotton clothing
Avoid known allergens.
Bath daily (do not use extremely hot water).
Avoid extreme temperatures.
Medication application as suggested.
Apply moisturizers immediately after bathing.
Handwashing
Use mild, fragrance-free laundry detergents, and avoid fabric softeners.
Follow up in 1 week.
Consultation/Collaboration:
Dermatologist: This physician specializes in conditions involving the skin, hair, and nails.
Allergist: specializes in the diagnosis and treatment of asthma and other allergic diseases.
References:
Huang, R., Ning, H., Shen, M., Li, J., Zhang, J., & Chen, X. (2017). Probiotics for the Treatment of Atopic Dermatitis in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Cellular and Infection Microbiology, 7. https://doi.org/10.3389/fcimb.2017.00392
Kapur, S., Watson, W., & Carr, S. (2018). Atopic dermatitis. Allergy, Asthma & Clinical Immunology, 14(S2). https://doi.org/10.1186/s13223-018-0281-6
Wollenberg, A., Howell, M. D., Guttman-Yassky, E., Silverberg, J. I., Kell, C., Ranade, K., Moate, R., & van der Merwe, R. (2019). Treatment of atopic dermatitis with tralokinumab, an anti–IL-13 mAb. Journal of Allergy and Clinical Immunology, 143(1), 135–141. https://doi.org/10.1016/j.jaci.2018.05.029
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