Nursing Case Study On Rash

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Melanie is a 29yo, G5 P2022, who was seen for an ultrasound evaluation and consultation over the development of a rash. Her history is significant for a gastric sleeve that occurred in February 2013. Based on her height and weight at the start of the pregnancy, her BMI was 49. She did have a LEEP procedure on her cervix in 2014 after her last delivery. She does have 2 term deliveries in 2008 and 2014 without complications. Lastly, she developed a rash about 4 weeks ago that began on her abdomen that was reddish and raised and pruritic that has now extended to her arms and legs. She reportedly did receive a corticosteroid injection one week ago and she states that this did improve her symptoms and the rash but again it is still present. This…show more content…
The first is cholestasis, which really is not a rash but produces itching but this does not fit this finding due to the early onset gestational age, the fact that she has not had it in any prior pregnancy, the fact that this began with a rash and cholestasis is not associated with a rash and therefore this is not…show more content…
The 2nd possibility would be PUPPP, which is pruritic urticarial papules and plaques of pregnancy. This typically is red and begins on the abdomen and then spreads to the extremities which is consistent with her history but it is unusual to also start this early in pregnancy.
3. Pemphigous gestationous is unlikely because this begins with blisters and is really an autoimmune disorder.
4. In addition, it does not appear to be folliculitis of pregnancy. Since this would be associated with hair folic aldonates in many areas in which there are no hair follicles.
5. The final diagnosis is prurigo of pregnancy which is somewhat a catch all for reddish rashes that itch that are not one of the above 4 discussed issues.

PUPPP and prurigo of pregnancy are treated similar with corticosteroids and she did appear to improve with this and therefore we would recommend potentially starting her on a low-dose oral 5 mg daily prednisone treatment. This will likely increase her likelihood for developing GDM, but she is miserable with the rash. The only other possibility that comes to mind currently would be an allergy and she was told to keep a food and diet catalog to determine if she notices any spikes in symptoms after certain meals. Food allergies are difficult to determine especially if they are new onset in
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