Gladys P. is an 89 year old African American female who complains of a red painful rash on her “stomach” for 2 days. It is important to note that Gladys could be describing several illnesses, so it is necessary to interview her using several questions to receive subjective data regarding her condition. Firstly, it’s important to ask the patient when she first started noticing these symptoms; it may be useful to treat the appearance of the presence of the rash and the onset of pain as separate time points. This is necessary because different illnesses that manifest as rashes have different durations; this is an important first step in determining whether the rash is viral, bacterial, or fungal. Next, it is important to ask the patient whether she tried self-medicating by applying any lotions or creams to the rash area; it is possible that the rash started out as a minor skin irritation, but increase in intensity due to an allergy or some other kind of irritation. In addition, Gladys should be asked whether or not she’s experienced this kind of skin irritation before; if she has, it will be useful to look through her medical records and determine what medical professionals believed the cause and diagnosis to be as a starting point for the examination (Jarvis, 2007).
The first step of the physical examination (and therefore acquisition of objective data) will be the examination/observation of the rash itself. Size and color will be taken to account, and the body will be searched to determine whether it has spread to a location other than the stomach; this will provide clues as to whether the rash is fungal, bacterial or viral. Next, a viral test will be conducted to determine the patient’s immunity to diseases like chicken pox. A useful next step would be to conduct a herpes test on the cells taken from the rash if rash has the appearance of having blisters.
While there are many different kinds of rashes, most are not considered to be painful (Seller, 2000). Therefore, Gladys’s rash is unlikely due to an allergic reaction, psoriasis, or rosacea, although these possibilities should be visited if the patient used lotions or creams she does not usually use. If there are blisters present, this rash is likely caused by either the chicken pox virus or the herpes virus.
An interesting test question for this case study would be how to distinguish the difference between viral blisters such as the ones caused by the herpes virus and blisters caused by immune reactions like contact dermatitis. In the case of contact dermatitis, blisters, welts, and hives typically form in a pattern surrounding the area in which the skin was directly exposed by the allergen; there also may be a rash in the surrounding area. Blisters caused by the herpes virus are more sporadically located. In addition, herpes blisters are more likely to go away and return without any intervention, whereas treatment for contact dermatitis should cause the blisters to go away until the next exposure.
Seller, R (2000). Differential Diagnosis of Common Complaints, Philadelphia, W.B. Saunders
Jarvis, C (2007). Physical examination and health assessment, (5th ed.). Saunders: St. Louis
Bickley, L. (2005). Bates Guide to Physical Exam and History Taking. (9th ed). Lippincott