iHuman Case Study

‘‘Rash’’ 2023
NR 602 IHuman -CASE- RASH QUESTION TO ASK

How can I help her today?

Does she have any other symptoms you would like to discuss?
What treatment has she had for the cough? Is she coughing any sputum?
What treatment has she had for the rash?
On what part of her body did the rash start and where did it spread?
Is her rash painful or itchy?
What treatment has she had for the rash?
Has she been having fevers?
When did the fever start?
How high is the fever?
Is she taking any over the counter medication?
How is her appetite any recent change?
Did she have any other problems two to four days ........ ?
How many wet diapers does your child have per day?
How many stools diaper does your child have per day?
Does she have any allergies?
DIAGNOSIS
Exanthema subitum HHV 6/ roseola
Human parvovirus 19 Rubella (German measles)
Measles
URI

NO TEST REQUIRED

History
Reason for encounter: rash on abdomen, b/l UEs and b/l Les
History of present illness: fever started 3 days ago, stopped last evening
Cough and rhinorrhea started 3 days ago
ROS
General
(-) fever
(-) significant weight change
(-) significant appetite change
HEENT/neck
(+) rhinorrhea
(+) cough
CARD
(-)CP/pressure/discomfort
(-) decrease in activity
(-) SOB
RESP
(-) SOB
(-) wheezing
(-) difficulty catching a breath
(-) chronic cough
(-) sputum production
GI
diaper stools about 2 per day
GU
Diaper urine 4-5 per day
MSK….
NEUR
No history of seizures
INTEGUMENTARY/breast
(+) rash on abdomen, b/l UEs and b/l LEs
Psychiatric….
Endocrine
No history of diabetes, endocrine/thyroid problems
Hemolytic/lymp
No history of anemia
Allergic/Immunologic
No history of allergies, immunizations up to date

PMH
None
Hospitalizations/surgeries:
Born full term 38 wees GA. Born via NSVD. No complications during delivery or after birth
Preventative health
Growing and developing well. Meeting all developmental milestones.
Medications
none
Allergies
NKDA
Immunizations
all up to date
Social Hx
Lives in an apartment with both parents
Family Hx
Mother 32: healthy
Father 35: healthy
PHYSICAL ASSESMENT

Skin/hair/nails
Inspection of skin:
Skin is warm and dry. There is a maculopapular pink rash on abdomen and extremities. Normal skin
turgor
HEENT/neck:
Inspect eyes:
Eyelids: no ptosis, erythema or swelling:
Conjunctivae: pink, no discharge
Sclerae: anicteric
Orbital area: no edema, redness, tenderness or lesion noted.
Inspect pupils:
R pupil: normal reactive
L pupil: normal reactive
Inspect ears:
Normal appearing external structures; no deformities or edema. No discharge noted
Otoscopic examination of ears:
Normal-appearing external auditory canals. Tympanic membrane translucent, non-injected and
pinkish-gray in color. No scaring, discharge or purulence noted. Normal landmarks. Normal mobility
wit insufflation.
Nose inspection
No discharge/polyps. No edema/tenderness over the frontal or maxillary sinuses.
Look up nostrils:
Normal exam
Inspect mouth/pharynx:
No hoarseness; oropharynx not injected, clear mucosa, tonsils without exudate. Tongue normal color,
symmetrical, no swelling or ulcerations. Normal gag reflex.
Neck inspection:
No visible scars, deformities or other lesions. Trachea midline and freely mobile. No asymmetry or
accessory respiratory muscle use with quiet breathing.
CHEST WALL & LUNGS
Visual inspection of AP chest:
The chest is symmetrical and the AP diameter is normal. The excursion with respiration is symmetrical
and there are no abnormal retractors or use of accessory muscles. No distension, scars, masses or
rashes.
Lungs auscultation
Right clear (normal)
Left clear (normal)
CARDIO
Heart auscultation:
Normal S1 S2
Lymphatic:
No pathologically enlarged lymph nodes in the cervical, supraclavicular, axillary and inguinal chains
ABDOMAN:
Abdomen inspection: Flat symmetric with no scars, deformities, striae or lesions.
Abdomen palpation: No pain, tenderness, masses or pulsation abdomen palpation. No guarding,
rebound tenderness. No hepatosplenomegaly. Liver span normal. The spleen is not palpable.
Abdomen auscultation: normoactive bowel sounds in all 4 quadrants
EXTREMETIES:
Visual inspection: no swelling or deformity. There is no cyanosis, clubbing or edema.

Problem statement:
Gemma Jones is a 2-year-old girl, accompanied by her mother. The mother reports a rash that started
today on her abdomen this morning but it spread to her extremities. Additionally, the mother reports
cough, rhinorrhea, and fever that has started 3 days ago (fever has resolved). Patient is up to date with
all immunizations.
Or
Gemma Jones is a 2 years old girl that came in with CC of a nonpruritic rush that has started on her
abdomen today but progressed to her upper and lower extremities. Three days prior she developed a
cough, runny nose, and fever (last fever yesterday-resolved). The mother reports no change in
appetites. Wet and stool diapers are unchanged and adequate. She does not have any medical or
allergy history, and she lives home with both parents

Assessment/management plan
Exanthem subitum (Roseola) B08.20
Roseola is a generally mild infection caused by two strains of herpes virus. It's common, usually
affecting children by age two. It occasionally affects adults.
Symptoms include several days of high fever, followed by a rash that may appear as many small
pink spots. Other symptoms may include loss of appetite, irritability, swollen lymph nodes, red
spots on the soft palate, runny nose, or sore throat.

There is no specific treatment for roseola infantum. The majority of cases of roseola infantum are
mild and self-limited.
Treatment is supportive with rest, maintaining fluid intake and antipyretics such as
acetaminophen or ibuprofen to control the fever. Due to the rash likely being nonpruritic,
treatment is unnecessary. There is currently no vaccination or antiviral therapy for the acute
phase of this virus. Adequate hand washing is very important to prevent the spread of the disease.

Tylenol oral suspension OTC

SIG: take 5ml PO every 4 hours as needed
Max dose 25ml/24 hours, do not exceed do not exceed 75 mg/kg/day from all sources

Children's Advil oral suspension OTC

SIG: take 5ml PO every 6-8 hours as needed,
max 20ml in 24 hours give with food to avoid GI upset

Education: The rash should resolve within 24 hours. You can alternate Tylenol and Ibuprofen for
fever reduction. You should increase the child fluid intake and allow for plenty of rest. Take all
medications as directed and do not exceed the recommended dosage. Do not give any other
medications that have combined acetaminophen or ibuprofen in medication.

Tylenol/acetaminophen is an over-the-counter medicine taken to relieve fever and pain. It's a safe
drug when used correctly for a wide variety of problems. The dosage is based on the child’s
weight/age. But too high a dose can make a child very sick, so it's important to know how to
properly give acetaminophen. When administering the medication, make sure you a dropper,
syringe, or cup that came with the product to prevent overmedicating/overdose.
Side effects of Tylenol can include:
• Headache
• Nausea
• Rash

Advil/Ibuprofen/Motrin is a medicine used to reduce fever and pain as well. It is considered as

nonsteroidal ant-inflammatory drug. It also OTC medication and just like Tylenol dosage is
determined by weight/age of the child. Just like Tylenol, this medication must be administered
with a dropper, syringe, or cap that came with the product to avoid overdosing.
Side effects that may occur with taking Advil:
 • Upset stomach
• nausea,
• vomiting,
• headache,
• diarrhea,
• constipation,
• dizziness
• drowsiness
Allergy alert: Ibuprofen may cause a severe allergic reaction, especially in people allergic to
aspirin. Symptoms may include hives, facia swelling, asthma, shock, etc.

Roseola infantum is a clinically diagnosed, self-limited illness that can be treated

symptomatically. It does not warrant a referral at this time.