WK6AssignmtMoutouLDerm

Episodic Visit: Dermatology Focused Note PRAC 6541: Primary Care of Adolescents and Children Practicum Lucia Mariolina Moutoux October 3, 2022 Patient Information: NY, 13 y/o Female, African American. CC: “I have an itchy rash on my arms” HPI: The patient is an African American 13 y/o female who presents to the clinic accompanied by her mother for evaluation and treatment a progressively getting worse pruritic rash/patches around both elbows, and forearms. Patient reports she has noticed the itchy scaly rash about three weeks ago, beginning in her elbows and migrating progressively in both forearms. Also the small round lesions have increased in sizing since the onset of symptoms. Associated symptoms include intense moderate pruritus. Precipitants factors include clothing over the rash/patches. Patient denies any drainage or pain. Reports no relieving factors. Parent has not tried any treatment. Severity of symptoms 0/10. Denies history of current rash. Denies fevers. Current Medications: None Allergies: NKDA PMH: History of normal childhood illnesses of cough, congestions, and colds. No other hospitalizations, surgeries, ER visits, or specialist provider visits since last well visit. Developmental: patient cognitive and psychological stage appropriate to patient’s age Immunizations administered as of today include:  Hep B: Birth, 06/15/2009, 08/14/2009  RV1: 08/14/2009, 10/16/2009  DTap: 08/14/2009, 10/16/2009, 12/18/2009, 12/14/2010, 02/18/2015  Hib: 08/28/2009, 10/23/2009, 09/23/2010  PCV13: 08/14/2009, 10/16/2009, 12/18/2009, 09/23/2010  IPV: 08/28/2009, 10/23/2009, 06/15/2010, 02/18/2015  Influenza A: 09/23/2010, 09/26/2011, 09/05/2012, 09/28/2013, 08/31/2014, 09/05/2015, 09/17/2016, 09/21/2017, 08/25/2018/, 08/18/2019, 08/20/2020, 09/18/2021, 08/21/2022.  MMR: 12/14/2010, 02/18/2015  VAR: 12/14/2010, 02/18/2015  Hep A: 09/15/2012, 06/18/2011  Meningococcal: 08/20/2020  TdaP: 08/20/2020  HPV 08/20/2020, 02/18/2021 Surgical History: None FMH: Mother: 35 y/o, alive and healthy Father: 38 y/o, alive and healthy Maternal Grandmother: 68 y/o, alive, HTN Maternal Grandfather: 70 y/o, alive and healthy Paternal Grandmother: Unknown Paternal Grandfather: 65 y/o, alive and healthy SH: Patient lives in a townhouse home with her mother and father. Patient is the only child. Mother is high school bus driver, and the father works in realty. Patient attends 7th grade in public school. The patient participates in gymnastics 3 days a week for 1-2 hours each session. Enjoys interacting with peer’s activity in school. Reports doing well academically. The residence contains a small dog and an indoor/outdoor cat in the household. No one in the home smokes. No second hand smoke exposure reported. No alcohol use. Wear the seatbelt when in the car and wear helmet when riding the bicycle. Uses sunscreen when in the sun. Mental Hx: No pertinent mental Hx reported. Negative for anxiety, depression, or psychological disorders. Violence Hx: No pertinent violence Hx reported. No concern or issues about safety in the home, community, extracurricular activities, or at school. ROS: SUBJECTIVE General/ Constitutional: No recent changes in weight or clothing size, no change in appetite, no fever, chills, or night sweats. Skin: Reports multiple patches on her elbows and forearms x 3 weeks. Reports patches being round, scaly, and itchy with raised borders and “clearer in the center”. Mother reports occasional “pustules on and off” HEENT: Reports no HA, changes in vision or hearing, no cough, or sore throat. Cardiovascular: No new findings reported. No history of murmur, no shortness of breath. No history of fainting or excessive sweating. Respiratory: Reports non-productive cough. Denies wheezing, dyspnea, SOB, or hemoptysis. Abdomen/GI: Reports no nausea, vomiting, diarrhea, or abdominal pain. Neurological: No headache, dizziness, syncope. Allergic/Immunologic: Reports no allergies, no history of asthma, hives, or eczema