Pertinent positive and negative information.
PART A:
A 28-year old male complains of a scaly lesion over his left groin area and a painful “cut” between his “big” and second toe x 3 weeks.
For the case you have chosen, post to the discussion:
Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.Pertinent positive and negative information.Pertinent positive and negative information.
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In SOAP format, list:
Pertinent positive and negative information
Differential and working diagnosis
Treatment plan, including: Pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.Pertinent positive and negative information.
PART B:
Describe at least one policy shift in access to, or the cost of, personal health services that has an effect on the health of families. How can understanding family involvement really make a difference for individuals’ health and illness?Pertinent positive and negative information.
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. This is required. In addition, you may also provide an example case, either from personal experience or from the media, which illustrates and supports your ideas. All sources must be referenced and cited using correct APA (including a link to the source).Pertinent positive and negative information.Pertinent positive and negative information.
Questions
1. When did the lesion develop?
2. Has the lesion spread to other parts of the body?
3. Is the lesion itchy?
4. Have you ever developed such lesions before?
5. Have you had direct contact with any chemicals at the groin area?
6. When is the last time you had unprotected sexual intercourse?
7. How did you get the cut between your toes?
8. Have you taken any medications?
The physical examination elements I would include for the patient are the appearances of the lesion. This entails the color, shape and texture as well as the contents together with the distribution pattern. I would also have wanted to conduct further testinginvolving blood tests, allergy testing, skin biopsy, skin swabs and skin scraping (Dako& Ali, 2017). Allery testing is associated with testing the lesions with suspected substances to determine which could have been the causative agent. Blood tests test the probable infections on the cut and the lesion and other underlying diseases. Skin swabs allow culturing for bacteria while ski scraping identifies fungus in cultures. The skin biopsy on the other hand would have provided evidence of infections on the cuts and the groin area through entailed examination of small skin sections under the microscope.Pertinent positive and negative information.
Pertinent positive and negative information
Positive for scaly groin lesions and a contaminated cut on between the toes
Negative for abdominal pain
Differential and working diagnosis
1. Tinea cruris: associated with palpable, scaly edge lesions on the groin. They are erythematous, well-demarcated, asymmetrical lesions and could have a central clearing.
2. Pityriasisrosea: scaly, oval-shaped lesions on the groin area.
3. Erythema annularecentrifugum: internally scaly lesions on the groin area.
4. Nummular eczema: Well-demarcated, erythematous or hyperpigmented scaly or crusty coin-shaped lesions.
Treatment plan:
Pharmacotherapy: Topical corticosteroids, Topical or systemic antifungal agents, Oral corticosteroids if significant pruritus is present.
Diagnostics: Microscopic examination of a potassium hydroxide (KOH)
Health Education and lifestyle changes; engage in responsible sexual behaviors; wear closed shoes to prevent cuts and avoid injuries
Age-appropriate preventive care: engage in protected sex; avoid allergens, avoid sharp objects
Follow-up to this visit; hospital visits after two weeks. Patient can visit anytime when symptoms worsen.Pertinent positive and negative information.
Part B
The cost shifting policy is associated with the charging of more cost for the insured patients by the hospitals while charging the uninsured less for the same services (Morrisey, 1994). Theuncompensated care are shifted to the private insures following the development of the Medicare by the Affordable care Act. This makes the access of care by the uninsured citizens much easier considering that most of them are economically challenged. On the other hand, it improves personal health services and the general wellbeing of the family due to the relief of the financial burden by the cost shifting policy. Consequently, understanding the family involvement in the illness improves their wellbeing. Apart from covering the economic cost of the illness through hospital bills and medication, they also provide social support essential for the recovery of the client. The family also offers home care to the patient and also promotes prevention practices to avoid disease spread. The cost shifting policy also plays significant role in ensuring that the minority poor families are able to receive healthcare access and health education as well as moral support for the whole family.Pertinent positive and negative information.