WALDEN UNIVERSITY MSN FNP LATEST EDITION 2026-2027
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, 1. Patient Overview
o Sarah Mitchell is an adult female presenting to primary care with a new-onset
pruritic skin rash. Dermatologic complaints are among the most common
outpatient presentations, and the key clinical task is to determine whether the
rash is:
o Allergic (contact or drug-induced)
o Infectious (viral, bacterial, fungal, parasitic)
o Inflammatory (eczema, psoriasis)
o Autoimmune
o Systemic disease manifestation
o This case evaluates the learner’s ability to:
o Perform a focused dermatologic history
o Accurately describe rash morphology
o Identify red flags requiring escalation
o Construct a differential diagnosis
o Develop evidence-based pharmacologic and non-pharmacologic management
o 2. Chief Complaint (CC)
o “I developed a red, itchy rash a few days ago that seems to be spreading.”
o 3. History of Present Illness (HPI)
, o Sarah Mitchell reports an acute onset rash that began approximately 3–5 days
ago. The rash is described as pruritic (itchy) and has gradually expanded since
onset.
o Key characteristics:
o Onset: Sudden
o Duration: Several days
o Progression: Mild spreading
o Symptoms: Intense itching, mild burning sensation in some areas
o Location: Often starts on arms, neck, trunk, or areas of exposure
o Triggers: Possible exposure to new detergent, soap, lotion, plants, animals,
medications, or environmental irritants
o She denies:
o Fever or chills (important to rule out infection)
o Painful lesions (rules out herpes zoster in many cases)
o Shortness of breath or facial swelling (rules out anaphylaxis)
o Systemic symptoms such as weight loss or fatigue
o The presentation strongly suggests a localized or systemic hypersensitivity
reaction, most commonly allergic contact dermatitis.
o 4. Past Medical History (PMH)
o Possible history of atopic conditions:
o Allergic rhinitis
o Eczema (atopic dermatitis)
o Otherwise generally healthy in most case versions
o 5. Medications
o Important to evaluate: