DERMATOLOGY CASE STUDY
Chief disease: “ My direct immense toe has been hurting for about 2 months and now it’s itchy, grandiloquent and yellow. I can’t excavate barred shoes and I was superior until I inaugurated going to the gym”.
HPI: E.D a 38 -year-old Caucasian effeminate presents to the clinic delay disease of self-denial, hankering, inflammation, and “yellow” direct immense toe. She noticed that the toe was tolerably hankering succeeding she took a steep at the gym. She did not pay noblely consideration. About two weeks succeeding the hankering became fervent and she applied Benadryl pith delay simply some exemption. She continued going to the gym and noticed that the hankering got worse and her toe nail inaugurated to modify falsification. She to-boot involved that the toe got grandiloquent, self-denialful and austere thoroughly yellow 2 weeks ago. She applied lotrimin AF pith and it did not acceleration exemption her symptoms. She has not trained other remedies.
Denies associated symptoms of fervor and chills.
PMH: Diabetes Mellitus, likeness 2.
Medication: Metformin 500mg PO BID.
Vaccination History: Immunization is up to determination and she current her flu shot this year.
Social truth: College graduate married and no progeny. She drinks 1 glass of red wine integral obscurity delay dinner. She is a foregoing smoker and abandon 6 years ago.
Family truth:Both parents are inhalationing. Father has truth of DM likeness 2, Tinea Pedis. dowager inhalationing and has truth of atopic dermatitis, HTN.
Constitutional: Negative for fervor. Negative for chills.
Respiratory: No Shortness of inhalation. No Orthopnea
Cardiovascular: Regular rhythm.
Skin: Direct immense toe grandiloquent, itchy, self-denialful and discolored.
Psychiatric: No solicitude. No dip.
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 corpulence, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth mislaying seen. Gums no redness.
NECK: Neck compliant, no gross masses, no lymphadenopathy, no thyroid extension.
LUNGS: No Crackles. Lungs unclouded bilaterally. Equal inhalation sounds. Symmetrical respiration. No respiratory embarrass.
HEART: Normal S1 delay S2 during spiritlessness. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No gross masses.
GENITOURINARY: No CVA kindness bilaterally. GU exam plentiful.
MUSCULOSKELETAL: Slow walk but equable. No Kyphosis.
SKIN: Direct immense toe delay yellow-brown disfigurement in the proximal nail plate. Marked periungual inflammation. + parching. No pus. No neuro failure.
PSYCH: Normal pretend. Cooperative.
Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
Primary Diagnosis: Proximal subungual onychomycosis
Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Fungal refinement confirms fungal poison.
As an NP learner, you deficiency to individualize the medications for onychomycosis.
1. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this resigned be prescribed, and for how hanker? Write her thorough arranges using the arrange congeniality format in your textbook.
2. What labs for baseline and prosper up of therapy would you arrange for this resigned? Give rationale.
You deficiency 1 primal shaft and 1 answer for this DB. Total of 2 shafts attended by peer-reviewed references, and in APA 6th ed format.