NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS SUBJECTIVE DATA: Chief Complaint (CC): Graphic 5. Painful vesicles in the back and lower surface of the right arm for 5 days.

History of Present Illness (HPI): Calvin Harris is a 49-year-old Caucasian male who presents to the dermatology clinic complaining of multiple painful vesicles on his skin around his right side of the back, lower surface of the shoulder and upper right arm for 5 days that were preceded by a burning sensation. He describes the lesions as small fluid filled vesicles with an erythematous base, that first appeared as raised bumps. He reports that the eruptions began with a burning sensation and discomfort around the same area a few days prior to the appearance of the vesicles. He is HIV positive for 4 years and is on Tenofovir disoproxil fumarate 300 mg and Dolutegravir 50 mg, and Lamivudine 100 mg. He is also on cotrimoxazole 960 mg twice daily. The pain and the rash have affected his sleep and quality of life.

Medications:

1. Tenofovir disoproxil fumarate 300 mg once daily.
2. Dolutegravir 50 mg once daily
3. Lamivudine 100 mg once daily
4. Cotrimoxazole 960 mg twice daily.

Allergies:

Peanuts

Past Medical History (PMH):

1. HIV/AIDS
2. Tuberculosis- 2021
3. Pneumonia – 2020

Past Surgical History (PSH):

1. Appendicectomy- 2005
2. Adenotonsillectomy- 1980

Sexual/Reproductive History

Identifies as a heterosexual male

Personal/Social History:

He is a track driver.

Quit methamphetamine use 10 years ago.

No history of tobacco use.

Health Maintenance:

Colonoscopy- No polyps seen

Immunization History:

Tdap 10 years ago.

Covid19 Vaccination- 1st dose 5/4/2021, 2nd dose 6/5/2021, booster dose, 8/8/2023

Influenza vaccine-3/5/2018

Pneumococcal Conjugate Vaccine- 16/5/2022

Significant Family History:

Father died 4 years ago due to colorectal carcinoma.

Mother- diabetes mellitus diagnosed at age 68 years

One brother with schizophrenia diagnosed at age 49.

Review of Systems:

General: Mr. C.H is a middle-aged man, appears to be in a fair general condition, he is not in obvious pain or respiratory distress, is of good nutritional status.

HEENT: He denies headaches, blurring of vision, photophobia, double vision. He has no tinnitus, ear ache, or discharge. He has no nasal congestion, sore throat or difficulty swallowing.

            Respiratory: He denies cough, shortness of breath and wheezing.

Cardiovascular/Peripheral Vascular: He has no palpitations, no chest pain, no lower limb edema.

Gastrointestinal: He reports no constipation, no change of bowel habits, and no diarrhea.

Genitourinary: He denies, hesitancy, increased frequency, urethral discharge, dysuria and burning sensation on urination.

Musculoskeletal: He is negative for joint pains, muscle aches, stiffness of joints and reduced range of movements.

Neurological: Aside from the discomfort associated with the skin condition, Mr. C.H. does not report any neurological symptoms such as headache, dizziness, numbness, tingling, weakness, or changes in coordination.

Psychiatric: He denies any symptoms of depression, anxiety, mood changes, or sleep disturbances. He has no history of psychiatric disorders.

Skin/hair/nails:  Apart from the vesicles on the back and right arm, he has no discoloration of nails. He reports no easy falling off of the hair, no brittle hair.

 OBJECTIVE DATA:

            Physical Exam

Vital signs: BP-109/68 mm Hg left arm, sitting, Temp-98.4 axillary, RR- 15 b/min. Weight- 173 lbs. Height- 6’0. BMI- 23.5

General: Appears comfortable. Is oriented to time place and person, and is alert.

HEENT: Pupils bilaterally reactive to light, EOMI, nasopharynx is clear.

Neck: Has no distended neck veins, no scars, obvious masses.

Chest/Lungs: He has vesicular breath sounds, no wheezes, no crepitation, equal chest wall expansion.

Heart/Periphe