ASSESSMENT

History

Problem may have started as a small break in the skin.
Patient may feel sick, have fever and chills.

Exam

Patient may look sick or have a fever.
Skin has one of the following:

• Red streak up arm or leg
  
  • Inflamed area (tender, warm, by strep bacteria) red, swollen), without clear edges.
    
  • Enlarged, tender lymph nodes.
    

Plan (Red Streak/Cellulitis)

INFECTED WOUND (caused by bacteria)

History
Wound, cut, or break in skin seems to be getting worse instead of better.
If wound is from a sea mammal (seal, walrus, etc.) it may start to hurt more after 4-5 days.

Exam
Patient may look sick or have a fever.

Plan (Infected Wound)

ABSCESS (boil, furuncle; infection caused by bacteria)

History
Problem may have started around the base of a hair.

Exam
Patient may feel sick, have fever and chills.

Skin problem:

• Inflamed lump (very tender; warm, red, swollen)
• Has edges that are firm, from swelling
• Later, in center, becomes soft, white or yellow (from pus inside) ; may drain pus.
• Enlarged, tender lymph nodes.
  

Plan (Abcess)

IMPETIGO (infection mainly caused by strep bacteria)

History
Often the patient has not taken good care of the skin problem.
May have enlarged, tender lymph nodes.
Usually itches.

Exam
Sores:

• May be pinhead-sized blisters, filled with a thin yellow fluid like honey.
• May have started from a small insect bite, a scratch, or other break in the skin that has spread.
• Dry yellow crusts; scabs. flat, red area. Some pus present.
• NOT very inflamed, swollen, red, warm, or tender to touch.
  

Plan (Impetigo)

ALLERGIC REACTION

• History
  Itches excessively.
  Patient may complain of rash.
  May have low-grade fever.
  May have started quickly, in reaction to something such as food, medicine, something breathed in, an insect bite, heat, or cold.
  Past or family history of allergies.
  Exam
  Rash may include:
  
• Red, raised spots.
  
• Swelling in area of rash, face, or eyes.
  
• Hives (urticaria); welts usually 1 cm or larger, raised and red.
  
  • May have pink "halo" around edges, or swelling white centers due to swelling.
    Exam may also show:
    Shock (weakness, fast pulse, low BP), If so, go to pg. 8.
    Severe swelling, wheezing, or shortness of breath.
    Patient may also have watery eyes.
    Plan
    

• CHICKEN POX (infection caused by virus)
  

• History
• Low-grade fever.
  
• Rash: Began on second day of illness. started on trunk; later on face, neck, arms and legs.
  
  • Itches.
    Exam
• Started 11-20 days after exposure.
  
• All types seen at the same time; starts as small, flat area, becomes a pinhead-size blister with red edges, then breaks and forms crust.
  
  • Lasts 1-2 weeks.
    Plan 4.8
    

• DERMATITIS [includes eczema, atopic dermatitis and contact dermatitis]
  

• History
• Usually a recurrent rash.
  Exam
• Rash ( often on the face and neck, hands and wrists, inside of elbows, or behind knees ; caused by an irritant )
  May start after:
  
• touching something that may cause allergic reaction.
  
• eating something patient is allergic to.
  
• allergy or by contact with an irritating chemical (chemical soap, hot water).
  
• emotional upset.
  In infant, may cover most of body.
  In areas exposed to irritation:
  
• Skin may have more or less color than normal.
  
• May start as inflamed skin (tender, warm, red, swollen).
  
• Itches; may burn.
  
• As described under "exam" develops pinhead-size blisters that break, ooze, and form crusts as they dry.
  
• Often small scabs form from excessive scratching.
  
  • If chronic, skin becomes dry, thick, and has more obvious skin lines (markings).
    Plan 4.8
    

• FUNGUS (tinea, ringworm, athlete's foot; skin infection caused by fungus)
  

• History
• Rash spreading slowly as described under "exam".
  
  • Itches.
    Exam
    If on feet, may have:
    
• Moist, cracked skin in-between toes.
  
• Tiny flakes of skin on much of the foot.
  Rash on other areas of the skin:
  
• Pinhead-sized blisters on fingers (allergic reaction).
  
• If in hair: loss of hair, hair broken off, dull color.
  
• Spreads out from edges; red, flat; sharp edges which may be raised.
  
  • May have a few pinhead-sized blisters at edges.
    Areas infected first clear up and look fine.
    Plan(Plan 4.11)
    

• LICE (pediculosis, crabs; caused by small insects living around body hair)
  

• History
• Skin problem, as described under "exam".
  
• May be similar problem in family member or close contact.
  
  • Itching: Starts about 30 days after exposure.
    Exam
    Skin problem ("rash"):
    
• May be so severe that patient has bleeding from excessive scratching.
  
• Hair: Nits (tiny white eggs) seen attached to hair.
  
• May see lice on hair, body, clothes, or next to body.
  
• May have small bite marks or hives.
  
  • Often small scabs from excessive scratching.
    Plan(Plan 4.13)
    

• SCABIES [caused by small insects (mites) living in the skin]
  

• History
  Skin problem:
  
• Started about 30 days after exposure; as described under "exam".
  
• Itching, usually worse at night.
  
  • May be similar problem in family member or close contact.
    Exam
    Skin problem ("rash"):
    
• Location may include in-between fingers, wrists, elbows breasts, belt-line, genital area.
  
• A few pinhead-size, round blisters or lumps.
  
• May see burrows from the insect: small, wavy, pink or-red lines.
  
• Often small scabs from excessive scratching.
  
  • Patient may also have hives.
    Plan(Plan 4.14)
    

• SCARLET FEVER (infection caused by strep bacteria)
  

• History
• Patient feels sick, may have fever and/or chills.
  
• May also have headache.
  
• Possible runny nose, if patient is less than 3 years old.
  
• Sore throat; hurts to swallow.
  
• Rash: Started on second day of illness. As described under "exam".
  
  • If a child: may have abdominal pain.
    Exam
• Looks sick.
  
• Fever of 101+ degrees.
  
• Throat: red, swollen, may have white patches.
  
• Neck: enlarged, tender lymph nodes at angle of jaw.
  Rash:
  
• On neck, upper chest, abdomen, possibly whole body.
  
• Red, may resemble a sunburn.
  
• Pinpoint, raised bumps; feels like sandpaper.
  
  • Lasts about a week; then skin may peel. (Plan: pg. 301, "Strep Throat")
    Plan 3.3
    

• Include in your assessment that the problem is one of the following skin infections caused by bacteria:
• Red streak, or cellulitis (Plan 4.1)
  
• Infected wound (Plan 4.2)
  
• Abscess (plan 4.3)
  
• Impetigo (Plan 4.4)
  Rashes and other skin problems:
  
• Acne (Plan 4.5)
  
• Allergic reaction (Plan 4.6)
  
• Chicken pox (Plan 4.7)
  
• Dandruff (Plan 4.8)
  
• Dermatitis (Plan 4.9)
  
• Diaper rash (Plan 4.10)
  
• Fungus (Plan 4.11)
  
• Insect bites, other than scabies or lice (Plan 4.12)
  
• Lice (Plan 4.13)
  
• Scabies (Plan 4.14)
  
• Scarlet fever (Plan: p. 301, "Strep throat")
  
• Swelling of skin (edema) from unknown cause (See p. 27)
  
• Warts (plan 4.15)
  
• Other or unknown skin problem (Plan 4.16)