The first potential diagnosis that can be noted is systematic lupus erythematosus. The patients, as a rule, are concerned about weakness, weight loss, fever without any apparent cause, and pain in the joints as in case of the given patient (Kuhn et al., 2015). There are also other symptoms of systematic lupus erythematosus, including skin lesions in the form of reddening of skin of cheeks and nose and the increased sensitiveness of the area below the neck, aggravated by stress as well as exposure to sun and wind. Lupus that is also known as systemic erythematous skin tuberculosis is not completely understandable, yet it may be specified as a state in which an incorrectly directed body immune system attacks its own health, causing tissue pains, fatigue, and damage to vital organs (Kuhn et al., 2015). In this connection, the most of the mentioned symptoms correspond to this disease, making it the most likely diagnosis.
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Taking into account the above examination, it is possible to assume that the patient may have 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 rash that may be concentrated in the area around one’s nose, mouth, eyes, or forehead in the form of characteristic congestion (Lipozenčić & Hadžavdić, 2014). Most often, this disease is diagnosed in young women aged between 20 and 35 years. The patient’s rash looks like acne due to its soreness and redness that caused by the appearance of small yet numerous tubercles along the surface of the face. Conventionally, the patients with perioral dermatitis feel no acute symptoms, yet they are concerned with the cosmetic defect, sense of itching, flaming, and skin tightening as well as intolerance to going outdoors (Lipozenčić & Hadžavdić, 2014). The fact that the patient never experienced rash before also serves as an indicator that she may have perioral dermatitis.
Plan for Systemic Lupus Erythematosus
It is possible to prescribe Plaquenil 200 mg for one month after the consultation with a physician as the mentioned intervention is the evidence-based measure.
Additional Diagnostic Tests: Blood and urine tests should be made in order to either support or reject the suggested diagnoseis.
Education: The key role of a nurse is to explain the patient possible outcomes of the disease, increasing her awareness of potential complications and recovery as well. It is essential to ensure that she understands impact of the disease and is ready to cope with it as some patients tend to experience psychological pressure from other people because of their appearance (Lyons & Ousley, 2015). In this case, it may be useful to recommend considering this situation as temporary and focus on health instead of others’ perceptions.
Referrals: It is possible to recommend to consult with the psychologist in case of depression or the need for other psychological issues.
Follow up: The patient should visit a physician in a timely manner to control the progress of the disease and suggest future interventions.
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Plan for Perioral Dermatitis
Erythromycin 200 mg can be recommended to take orally within three weeks.
Additional Diagnostic Tests: Usually, no tests are required. However, culture for bacteria test may be taken to exclude bacterial inflammation.
Education: The patient should be notified of the need for protection of her face from sun as it may cause complications. The patient should be advised to eliminate the aggravating factors that caused the disease as there is no possibility to exclude the reappearance of rash in the future (Lyons & Ousley, 2015). In this regard, the patient should comprehend that the risk of dermatitis infection lays in the fact that it has the tendency to accumulate in the body of a person, steadily increasing the list of allergic symptoms. Consequently, timely treatment and awareness compose the key to successful treatment of this disease. Taking into account that nursing health care focuses not only on treatment but also prevention of diseases, the role of a nurse is to provide the patient with comprehensive and appropriate information related to this area. In particular, the patient should be recommended to prevent centers of infection by effective natural measures such as air baths, hydrotherapy, and physiotherapy.
Kuhn, A., Bonsmann, G., Anders, H., Herzer, P., Tenbrock, K., & Schneider, M. (2015). The diagnosis and treatment of systemic lupus erythematosus. Deutsches Ärzteblatt International, 112(25), 423-432.
Lipozenčić, J., & Hadžavdić, S. L. (2014). Perioral dermatitis. Clinics in Dermatology, 32(1), 125-130.
Lyons, F., & Ousley, L. E. (2015). Dermatology for the advanced practice nurse. New York, NY: Springer.