It was revealed that 35-year-old women have a rash on her face during the past one week. She has never experienced such problems before. Mary noticed the rush after spending one week in the Appalachians. However, she states that no new food, medication, or lotions were used. Speaking of her previous diseases, it should be stressed that Mary had tonsillectomy in childhood. No other diseases or hospitalization cases were detected. The patient has no children. From the genetic point, her mother suffers from rheumatoid arthritis, while her father is healthy. Mary avoids smoking and illicit drug use yet drinks a glass of wine almost every evening. According to her social history, the patient has a master’s degree in engineering and lives with her boyfriend. During the examination, she was quiet and focused.
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The physical examination of the patient detected that she has a number of alarming symptoms that are as follows: itchy and painful lesions, increased fatigue, fever, weight loss, mouth soreness, and increased muscle aches. At the same time, she denies the following symptoms: headache, ear pain, sore throat, nasal or sinus congestion, shortness of breath, chest pain, cough, abdominal pain, and diarrhea. The examination discovered some erythematous plaques scattered over the cheeks and the nasolabial folds. Taking into account both the history of this patient as well as her physical examination, it is possible to come up with a conjectural nursing diagnosis.
Presumptive Nursing Diagnosis
Considering the above analysis, it can be suggested that the patient has perioral dermatitis that is caused by climate change, excessive exposure to ultraviolet radiation, and increased susceptibility to bacterial allergens. Perioral dermatitis manifests itself in the form of a rash that is concentrated in the area around the mouth, nose, and sometimes eyes or forehead in the form of characteristic nodules (Mahmoudi, 2010). Most often this type of dermatitis is diagnosed in young women from 20 to 30. This type of rash looks like acne due to redness and roughness that is provided by the appearance of small but multiple tubercles along the surface of the face. Traditionally, the patients with perioral dermatitis experience no acute symptoms yet they are concerned about a cosmetic defect, sense of itching, burning, and skin tightening as well as intolerance to humidifiers and some cosmetics.
Considering the disease as a whole, one can notice that perioral dermatitis is not dangerous to health, although it leads to some inconvenience and discomfort related to the appearance of the patient in the form of a defect in varying degrees of intensity (Lyons & Ousley, 2015). Thus, it is likely that the patient’s rash is caused by inflammation of the skin due to perioral dermatitis. However, in order to clarify the diagnosis, the patient should consult with a dermatologist as the appearance of rash on the face may also occur for a number of other reasons. In addition, the patient has fatigue and weight loss that cause stress and affects her overall well-being. In its turn, stress can result in various complications including insularity and depression.
Teaching and Nursing Care Plan
It is obvious that the identified disease requires some medical treatment. However, nursing care plan related to skin issues assumes the provision of appropriate measures to re-establish impaired tissue integrity and improve psychological condition of a patient. Primarily, it is of great importance to stop the effects of the factor which is regarded as contributing to the emergence of the disease. The patient should also refrain from the use of certain additional cosmetics for the skin including tonics, lotions, soaps, and others (Mahmoudi, 2010).
It should be noted that face washing until complete recovery is to be carried out only with the use of running water. Even after the rash disappears, the patient should be advised to exclude those aggravating factors that caused the disease as there is no possibility to exclude the recurrence of the rash in the future. In particular, the patient should understand that the risk of dermatitis infection lies in the fact that it has the ability to accumulate in the body, gradually expanding the list of allergic diseases and adding new reactions. Therefore, only timely and comprehensive treatment is the key to a successful struggle against this illness.
The paramount role of a nurse in this situation is to teach the patient to use self-care measures and explain the reasons of the disease. Establishing trustful relationships, a nurse should note any changes both in physical and psychological changes of the patient reporting them to a doctor. The implementation of nursing care plan should be based on the full confidence in the attending nurse explaining the significance to stop using cosmetic means and following a hypoallergenic diet (Peate, Wild, & Nair, 2014). A nurse can recommend using mostly plant-based diet that helps integuments to cope with inflammation and irritation.
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In the acute phase, it is useful to exclude consumption of fat foods, sweets, and alcohol. According to the topical treatment, it is permissible to use only herbal lotions and sunscreen agents to relieve itching and pain (4 Dermatitis nursing care plans, 2015). It is also possible to recommend to wash her face “twice daily with a mild soap, avoid picking at the papules, and to apply an over-the-counter benzoyl peroxide cream nightly to the affected area” (Smith, 2015, p. 302). Taking into account that a large part of health care is given to the prevention of diseases, the role of a nurse is to provide the patient with complete and relevant information related to the corresponding field. The patients with dermatitis should timely prevent centers of infection by effective natural measures such as air baths, massage, hydrotherapy, physiotherapy, and walking outdoors.
Considering that except the main disease, the patient suffers from fatigue, weight loss, and fever, it is important to initiate a range of measures to improve her quality of life. In particular, fatigue prevention and elimination strategies focus on positive thinking and self-esteem that act as great defenders from stress as they help the patient to view stress as the situation instead of regarding it as the problem (Carpenito-Moyet, 2009). In order to prevent fatigue, it is beneficial to try to move more, especially in case the patient has a sedentary job. Finally, walking in a park and communication with friends are important ways to improve the overall health of the patient.
In conclusion, it should be emphasized that the analysis of this patient’s history and her physical examination revealed such presumptive nursing diagnosis as perioral dermatitis and fatigue. It was also identified that the patient needs comprehensive treatment based on healthy eating habits, stress prevention, and the establishment of trustful relationships with a nurse.
4 Dermatitis nursing care plans. (2015). Web.
Carpenito-Moyet, L. (2009). Nursing diagnosis: Application to clinical practice. Philadelphia, PA: Wolters Kluwer.
Lyons, F., & Ousley, L. E. (2015). Dermatology for the advanced practice nurse. New York, NY: Springer.
Mahmoudi, M. (2010). Challenging cases in allergic and Immunologic diseases of the skin. New York, NY: Springer.
Peate, I., Wild, K., & Nair, M. (2014). Nursing practice: Knowledge and care. New York, NY: Wiley.
Smith, T.S. (2015). Rash, rash, go away. Pediatric Nursing, 41(6), 301-302.