Sarah is a 4 – day – old infant in the office with her mother for an initial visit and weight check. Her mother states that Sarah has a rash on her chest and arms that has been intermittent for the past 2 days. There do not seem to be any triggers for the rash. Sarah’ s mother has washed all the baby’ s clothes in a hypoallergenic cleanser only and has not used any moisturizers on the skin since the baby was discharged from the hospital. The rash also appears when Sarah is clad in only a diaper. The rash does not appear to cause discomfort for Sarah. Sarah’ s mother has not found anything that makes the rash better or worse.
Birth history: Sarah is the product of a 40 – week gestation. Her birth weight was 3600 g. Further questioning about Sarah’ s birth history reveals that the mother’ s pregnancy was normal. She had no infections, falls, nor known exposures to environmental hazards. She did not use alcohol, take prescription medication (other than prenatal vitamins), use tobacco products, or use illicit drugs. During labor, Sarah’ s mother received a narcotic analgesic 1 hour prior to birth. Sarah was delivered via spontaneous vaginal delivery and her A scores were 7 at 1 minute and 9 at 5 minutes.
Social history: Sarah was born to a single, 18 – year – old mother. Sarah’ s father is involved but does not reside in the household. Sarah lives in a 2 – bedroom apartment with her mother and maternal grandmother (MGM). The MGM can help Sarah’ s mother provide care. Sarah’ s mother receives several governmental subsidies such as Women, Infants, and Children (WIC) Supplemental Nutrition Program, Temporary Assistance for Needy Families (TANF), and Medicaid. Educationally, Sarah’ s mother is completing coursework for her high school diploma. Sarah’ s father is also a high school student. There are no smokers in the home. The family has a dog.
Diet: Sarah is being fed a milk – based formula — 2 oz every 3 – 4 hours.
Elimination: 6 – 8 wet diapers daily with 3 – 4 yellow, seedy bowel movements.
Sleep: Sleeps between feedings
Family medical history: PGF (age 40): asthma; PGM (age 38): obesity, high cholesterol, hypertension; MGF (age 36): sickle cell trait; MGM (age 34): bipolar disorder; mother (age 18): sickle cell trait; father (age 17): eczema.
Medications: Currently taking no prescription, herbal, or over – the – counter medications.
Allergies: No known allergies to food, medications, or environment.
Objective
Vital signs: Weight: 3690 g; length: 44 cm; temperature: 36.8 ° C (rectal).
General: Alert; well – nourished; well – hydrated baby.
Skin: Scattered 1 – cm, yellow – white papules on an erythematous base on the trunk, upper arms, and thighs; lesions are nontender to touch; lanugo over shoulders; no cyanosis of lips, nails, or skin; no diaphoresis noted; good skin turgor.
Head: Normocephalic; anterior fontanel open and flat (0.3 cm × 3 cm); posterior fontanel open and flat (0.5 cm × 0.5 cm).
Eyes: Red reflex present bilaterally; pupils equal, round, and reactive to light; no discharge noted.
Ears: Pinnae normal; tympanic membranes gray bilaterally with positive light reflex.
Nose: Both nostrils patent; no discharge.
Oropharynx: Mucous membranes moist; no teeth present; no lesions.
Neck: Supple; no nodes.
Respiratory: RR = 28; clear in all lobes; no adventitious sounds noted; no retractions; no deformities of the thoracic cage noted.
Cardiac/Peripheral vascular: HR = 120; regular rhythm; no murmur noted; brachial and femoral pulses present and 2 + bilaterally
Abdomen/Gastrointestinal: Soft, nontender, nondistended, no evidence of hepatosplenomegaly. Umbilical cord is in place without signs and symptoms of infection.
Genitourinary: Normal male; testes descended bilaterally; circumcision healing well.
Back: Spine straight.
Extremities: Full range of motion of all extremities; warm and well – perfused; capillary refill < 2 seconds; negative hip click.
Neurologic: Good suck and cry; good tone in all extremities; positive Moro, rooting, plantar, palmar, and Babinski reflexes.
Questions
1.Which diagnostic or imaging studies should be considered to assist with or confirm the diagnosis? ___Skin biopsy
___Peripheral blood smear
___Bacterial/viral culture from the lesion
2. What is the most likely differential diagnosis and why?
___Milia
___Erythema toxicum
___Herpes simplex virus
3. What is your plan of treatment?
4. Does the patient’ s psychosocial history impact how you might treat this patient?
5. Are any referrals needed?
6. Does the patient’ s psychosocial history impact how you might treat this patient?
Use APA 7th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. Remember that you need a cover page and a reference page. All paragraphs need to be cited properly. Please use headers. All responses must be in a narrative format and each paragraph must have at least 4 sentences. Lastly, you must have at least 2 pages of content, no greater than 4 pages, excluding cover page and reference page.
