Fever and Rash

A Sick College Student

Lisa B. Goben

Domain Terminology Project

N409 Spring

Duke University School of Nursing

Fever and RashMeasles (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 1980’s, case reports have fallen from 250,000 in 1990 to a provisional 105 cases in 2003.

So a college kid walks into the ER……

Fever and Rash

Demographic Data

Living Situation• Dormitory• Apartment

Family Support•Relative

–Mother

Age

College Student

Biophysical Attributes

Medical History

• Symptoms• Past Medical History

Symptoms

• Sick• Achy

– Arthralgias

• Felt bad• Headache• Itching

Past Medical History

• Medical Problems• Immunization History• Medication Use

• Tobacco Use

Medication Use

• Alternative Medications• Tetracycline

– Doxycycline

– Side effects• Photosensitivity

• Illegal Drugs

Vital Signs• Temperature

– 39.0 Centigrade– Fever

• Blood pressure• Heart Rate

– Postural (links to Dehydration)• Respiration Rate• Oxygen Saturation

Physical Exam• Physical Signs

– Neck• Nucal Rigidity

• Lymphadenopathy

– Skin • Rash

– Face» Acne

– Chest– Stomach– Thighs

Physical Exam

• Psychosocial Exam

• Reexamining

Laboratory Tests• Blood Tests

– Complete Blood Count– Mono Spot– Antibodies

• Rubeola IgM (links to Public Health Concerns)

• Rubeola IgG

• Results – Positive – Negative

– Levels

Medical Knowledge

Medical Knowledge• Medical Provider

– Nurse Practitioner– Doctor– Consultant

• Literature– Dermatology Textbook– On-line Resources

Diagnosis

Diagnosis

• Disease– Differential– Probability

“The terrors of disease are always with us.”

Thomas A. Dooley (1927-1961)

Differential

• Allergic reactionor

• Infectious Disease

Infectious Disease

• Measles– Rubeola

– Atypical Measles

• Mononucleosis

• Meningitis– Meningococcal rash

Drug Allergic Reaction

Measles Rash

Mononucleosis Rash

Infectious Disease• Non-specific Viral Illness

– Viral Syndrome• Influenza A• Influenza B• Garbage Pail Diagnosis

– Viral Exanthem

• Contagious– Public health concerns

Disease

• Secondary Diagnosis– Dehydration

Treatment

Intravenous Fluids• Normal Saline

Medications• Antipyretic

-Tylenol

Patient Teaching• Explanation• Patient Education

– Self Help

• Reassurance

Comfort measures•Warm Blanket

Outcome

Discharged

• Called– Resolved– Sequelae

•Public Health Reporting

Public Health Concerns

Immunization• MMR• Immunity

– Wanes

Community Health•Officials•Outbreak

–Epidemic

Take Home Message

• “Common things are common”

• Think “horses” not “zebras”• Analysis improves patient care

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.