DISCUSSION RESPONSE(NUR630)

PLEASE RESPOND TO THE TWO PEOPLE DISCUSSIONS (KENYA AND Goldie) 

NOTHING LESS THAN A PARAGRAPH. 

Kenya Mcclendon 

Based on this 35 y.o. female with symptoms of a “very painful” vesicular rash along the left lateral rib, under the breast and has fatigue. Additionally, the woman has a 6-month-old infant who is breastfeeding and three other children over 3 years of age, all of whom were not vaccinated. Vesicular rashes can appear on almost any region of the skin and vesicular rash that appear on the trunk area are filled with red blisters. (Mayo Clinic, 2018).  Based on the information provided, chickenpox or shingles, herpes are possible diagnoses, however, chickenpox appears to be the probable diagnosis.

Chickenpox is an infection caused by the varicella-zoster virus. It causes an itchy rash with small, fluid-filled blisters, which is non-painful. Chickenpox is highly contagious to people who haven't had the disease or been vaccinated against it. The chickenpox vaccine protects children and the initial dose if given between 12-15 months of age. Due to the woman declining the vaccine for her children, there is a high risk and the likelihood that her children may have also been exposed to the virus. I would ask if the children had an itchy rash, fever, poor appetite, or had gone to a daycare. Based the woman’s rash being painful, chickenpox is ruled out. The most probable diagnosis is shingles.

Shingles is an infection caused by the varicella-zoster virus, which is the same virus that causes chickenpox. (Mayo Clinic, 2018).  Even after the chickenpox infection is over, the virus may live in your nervous system for years before reactivating as shingles. This type of viral infection is characterized by a red skin rash that can cause pain and burning. Shingles usually appears as a stripe of blisters on one side of the body, typically on the torso, neck, or face. (Mayo Clinic, 2018). The woman is experiencing symptoms of fatigue  due to recent stress related to providing 24-hour care in her home to her mother, who is seriously ill.

 I would gather more information by asking the woman if her mom currently has a rash, did her mom have a history of chickenpox and was she vaccinated. Shingles could spread through direct contact with fluid from the rash blisters. (CDC, 2019). Treatment includes antiviral medications such as Acyclovir (Zovirax),: 800 mg PO q4hr while awake (5 times daily) for 7-10 days, Valacyclovir (Valtrex)  1000 milligrams (mg) three times a day for seven days and Famciclovir 500 milligrams (mg) every eight hours for seven days. (CDC, 2019). These medications are the most effective to treat shingles, shorten the length and severity of the illness and should be taken as soon as possible after the rash appears. (CDC, 2019). Pain medicine, would include Acetaminophen 325-650 mg every four hours as needed. The woman requires a two week follow-up care with medical provider.

Reference

Centers of Disease Control and Prevention (2019). Shingles. Retrieved from https://www.cdc.gov/shingles/about/index.html

Mayo Clinic Staff. (2018). Shingles.

mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054

2 Goldie Nwachuku 

1. Which conditions should be considered as possible diagnoses?

Ans: It is possible the 35 year old woman has Shingles or herpes zoster, which is a viral infection caused by chicken pus virus known as varicellar-zoster virus

1. What additional information should be gathered to make the diagnosis?

Ans:Taking medical history, looking at the rash and scraping the tissue from the rash or swab some fluid from the blisters and send to lab for testing

1. Which condition is the woman likely experiencing?

Ans:The woman is experiencing herpes zoster or shingles virus due to the symptoms of severe pain and rash on the left lateral rib area.

1. What other information should you obtain from the patient?

Ans: Taking Medical history including history of chicken pox and chicken pox vaccine (Hollier, 2016).

1. What treatment plan should you prescribe?

Ans: Research study shows that shingle vaccine is a preventative therapy and not a treatment for those who already have shingles.

No treatment for shingles

Antiviral medications taken 3 days after rash appears to help reduce severity of shingle attack

Cool wash cloth, pain reliever, calamine lotion, oatmeal bath to help relieve itching.

1. What follow-up care should you recommend?

Ans:According to Centers for Disease control and prevention (CDC), it is recommended that the patient with shingles stay away from anyone who has not had chicken pox or the chicken pox vaccine or any one with weak immune system.

After recovering, to get RZV, shingrix a preferred shingles vaccine given in 2 doses separated by 2 to 6 months apart.

1. Based on the likely diagnosis, what are your concerns about the other members of the family?

Ans: Shingles are not contagious but one can catch chicken pox from someone with shingles if one never have chicken pox or vaccine as in the case of the three children over 3 years whom parents have chosen not to vaccinate against common childhood illnesses. Stress can increase risk of shingles. Immune system may be weaker when one have infection.

The new born baby of mother with shingle may be given Zoster immune globulin due to baby immature of immune system to fight off the attack.

The main objective of medical research on shingles are to develop drugs to fight the disease and prevent or treat its complications and also to study and understand the disease well to prevent it especially in people at high risk (National Center for Immunization and Respiratory Disease).