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Skin Condition Number 2

 

Patient Initials: EG        Age: 69            Gender: F

 

SUBJECTIVE DATA

Chief Complaint (CC): Small reddish growths on the skin.

History of Present Illness (HPI): Erica Georges is a 60-year-old African American woman with complaints of lesions that have appeared on her torso. She has had them for the past week, and they have suddenly developed. The growths are raised off the skin with the presence of red blood cells, which is responsible for the reddish appearance. The patient notes that the growths are not itchy nor painful, but the reddish looks scare her, hence the reason she has resorted to seeking medical attention. She has been using hydrocortisone ointment for the past three days without any significant change. The patient reports occasional headaches, dizziness, and insomnia, which are related to other medical conditions, which is hypertension. She is currently taking medicine for hypertension.

Medication:

• Hydrocortisone 3x daily

• Bisoprolol 2.5mg tab 1x daily

Allergy:

Isosorbide mononitrate-hives

 

Past Medical History (PMH):

Apart from the skin rash, the patient reports being in her usual state of health apart from the mild complications related to age and the hypertensive condition. She was diagnosed with hypertension five years ago and has been taking prescription medicine to manage the disease. She adheres to her medication schedule.

Past Surgical History (PSH):

• Hip replacement surgery 2001

Sexual/Reproductive history:

• ​

• ​

Personal Social History:

Used to drink alcohol occasionally while on social occasions but stopped ten years ago. No history of illicit drug use. Has never smoked. 

Immunization History:

Up to date with immunization. Influenza vaccine last November and Pneumococcal 2 years ago

Significant family history:

Has a brother who had eczema since childhood. Has a sister 50 years old who was diagnosed with diabetes two years ago. The mother died of hypertension-related complications, was diagnosed at age 40 and died at age 78. Father diagnosed with diabetes at age 46.

Lifestyle:

The patient is retired and lives with a 21-year-old granddaughter who works and studies at the same time; hence she is alone in the house most of the time. The husband is deceased, and children have families and live some distance from her home. She does gardening when she has strength. No safety issues reported. No recent travel. She has a homecare nurse who comes twice a week to check her vital signs to ensure that her high blood pressure is not out of control.

She does not observe a nutritional diet. She is overweight and recognizes that this put her at risk of developing several health complications including diabetes. There is a community center nearby that have resources for the elderly. She has insurance, which caters for her prescription medication and other health costs.

Review of Systems:

General: the patient denies any recent fever or body changes. She, however, reports occasional difficulty in sleeping

HEENT: No rash noted near the eyes. No history of eye problem. No reported ear infections. No discharge observed in the ear. No complaints of mouth pain, no sore throat issues, absence of any mucosa swelling. Patient denies nasal stuffiness, no recent history of sinus infection.

Neck: No injury, pain, or history of compression

Breasts: The patient reports no current abnormal mammograms, no report of changes in the breasts.

Respiratory: The patient reports no night sweats, coughs, or dyspenia

Cardiovascular/Peripheral Vascular: No reported chest discomfort, palpitations or history of murmur, no chest pains, denies edema

Gastrointestinal: The patient denies any nausea or vomiting, absence of abdominal pain, no changes in bladder pattern.

Genitourinary: The patient is heterosexual, no change in urinary tract pattern, no history of STD or HPV, the patient is currently not sexually active.

Musculoskeletal: The patient reports no joint inflammation or pain. No history of fractures

Psychiatric: No history of mental illness, suicidal history, or anxiety/depression issues, present occasional sleep disturbance but denies experience of any delusions.

Neurological: No issues with memory or change in thinking patterns, no dizziness, but occasional headaches   

Integumentary/Heme/Lymph: Presence of rashes, but do not itch, no bruising, no history of transfusions, no history of skin cancer

Endocrine: No hormone therapies or presence of endocrine issues

Allergic/Immunologic: Has hx of allergy to Isosorbide mononitrate.

 

OBJECTIVE DATA

 

Physical Exam:

Vital signs: BP -137/72 and regular, BMI 33.9, Weight 106.kg (16st 11IB), Height 1.72 (5’8)

General: A&O x3, NAD, comfortable, neatly dressed, alert and conscious

HEENT: PERRLA, EOMI, oronasopharynx is clear, pupils reactive to light and equal

Neck: trachea midline

Chest/Lungs: lungs clear on  auscultation, regular respirations

Heart: RRR without murmur, rub, or gallop; pulses+2 bilat pedal

Peripheral Vascular: Abdomen: Not assessed

Genital/Rectal: Absence of cervical motion tenderness, external genitalia intact

Musculoskeletal: Age-related atrophy, normal muscle movement, 

Neurological: CN II-XII grossly intact, DTR’s intact

Skin: Reddish lesions raised off the skin surface on the trunk of the body. In other parts of the body, the skin has no palpable nodes, no presence of edema.

 

ASSESSMENT

Lab Results: Blood test for antinuclear antibody

Presence of lupus

CBC – WBC 7,500 cells/mcL

Hemoglobin 12.6 grams/dL

Diagnostics

Lab: positive outcomes with biopsy

Cherry angiomas

Skin biopsy : punch biopsy analyzed under a microscope

• sharply bounded vascular proliferation

• adnexal structures and collarette of the epithelium

Priority Diagnosis:

Cherry angiomas

Also known as the Campbell De Morgan spots are cherry red bumps that occur on the skin. They occur either as a single spot on the skin or a group of spots. Most common spot for occurrence is the trunk of the body and the arm. However, they can also occur in other parts of the body; for instance, in rare cases, they occur on the scalp (Kim, Park, & Ahn, 2009). The exact reason why they occur is not known, but they commonly manifest in people from age 30 years onwards. They could be due to broken blood vessels, which bleed under the skin causing the red spots. Other associated causes of cherry angiomas include allergic reactions, aging skin, sun damage, bruise, or certain drugs (Dains, Baumann, & Scheibel, 2016). The aging factor may be the best explanation to account for the occurrence of cherry angiomas since they tend to increase in number as one becomes old. In this diagnosis, age could be the likely cause of cherry angiomas in the patient. The red spots, unlike most skin rashes, are not itchy and even though they appear as though they can burst any time, the spots do not bleed (Watkins, 2013). In addition, they are not dangerous and thus, it is not a necessity to treat them. However, they can be removed using electrocautery, shaving, or using lasers.

Normally, the condition is diagnosed clinically, but for doubts, it can be confirmed using skin biopsy. In this case, scanning the punch of spot reveals a sharply bounded vascular proliferation. In addition, it is characterized by adnexal structures and collarette of the epithelium. It is also important to note that the skin benign changes or growths that occur in the case of cherry angioma do not have cancer cells.   

Diagnosis /Client problem

1. Cherry angiomas

2. ​

3. Occasional headaches

4. ​

5. Dizziness

Differential diagnoses (DDx):

• Acute Urticaria

• Angiokeratoma of the Scrotum

• Bacillary Angiomatosis

• Cutaneous Melanoma

 

 

References

Dains, J. E., Baumann, L., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care. St. Louis, MO: Elsevier Mosby.

Kim, J.-H., Park, H.-y., & Ahn, S. (2009). Cherry Angiomas on the Scalp. Case Rep Dermatol, 1(1): 82–86.

Watkins, J. (2013). Skin rashes, part 2: Distribution and different types of rashes. Practice Nursing, 24(3):124–127. Retrieved from http://www.practicenursing.com/.