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SafetyNurse1968 ADN, BSN, MSN, PhD

Oncology, Home Health, Patient Safety

If I were in charge of the universe, there would be staffing ratio laws and unions in every state and you'd get written up for NOT taking your breaks.

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SafetyNurse1968 has 20 years experience as a ADN, BSN, MSN, PhD and specializes in Oncology, Home Health, Patient Safety.

Kristi Sanborn Miller RN, PhD, CPPS, HNB-BC is A?Patient Safety Specialist. She just finished her doctorate in nursing at East Tennessee State University. She is an Assistant Professor at the University of South Carolina -Upstate. She is also a mother of 4 and loves being in the woods of Western North Carolina, when she's not obsessing over patient safety research. Kristi is a board certified professional in patient safety, and a published author. She has over 10 years of experience in nursing in areas like oncology, integrative health and home health with over 20 years of experience in education.

SafetyNurse1968's Latest Activity

  1. If you think you know the correct diagnosis for this Case Study (CSI)... DO NOT POST ANSWER HERE. Instead, post your answer in the ADMIN HELP DESK.; We don't want to spoil it for others who are late in joining us. In a few days, after I post the diagnosis, the Admins will announce the names of those members who correctly identified the problem. We hope to turn this into a friendly competition with more Case Studies to come. You CAN post questions and post comments below. BUT... Do NOT post your diagnosis guess below. Disclaimer: These case studies are presented for learning purposes only and with full understanding that it is outside the scope of practice for a nurse to make a medical diagnosis. When participating, assume that a licensed healthcare provider is making the actual diagnosis, ordering all the tests and interpreting the results. You are looking at the case retrospectively to learn from the data presented – the idea is to increase your knowledge so you can sharpen your assessment and teaching skills. Chief Complaint A 50-yr-old male of mixed-race states that over the past six months he has been experiencing mood swings and outbursts of anger. “I’m out of control. One minute I’m happy and the next I’m furious. I’ve been screaming at my poor husband. The other day I even pushed him, and all he did was break my favorite coffee mug. I didn’t push him hard, but it frightened me. My dad used to knock my mother around and I don’t want to be like him. If I sit still for too long, I start thinking about all the bad things in my life and my heart starts racing. It feels sometimes like the world is coming to an end. I don’t understand what’s going on – I’m a happy person. I hope I don’t have a brain tumor or something.” History of Present Illness Patient states that after pushing his partner last week, they sat down and talked about the incident. “My husband helped me realize that I’ve been getting worse. I hadn’t realized it, but when I think back I can recall these feelings being around for at least 6 months. I think I’ve been in denial.” Patient has gained 20 lbs since his last visit 9 months ago. General Appearance Patient appears tired and is tearful. His skin is light brown in color, and he appears to be slightly overweight, though he is also muscular. He has male pattern baldness and wears glasses. His hair is cut short and he is clean-shaven and appropriately dressed. Speech is rushed at times, but content is normal. Patient has difficulty making eye contact during assessment. Past Medical History Unremarkable Family History Father died from colon cancer 5 years ago at the age of 67. Patient states his friends from back home report his mother is alive and well. His only sibling, a brother died of an opioid overdose at age 41. No other known family history of mental illness. Social History The patient has been married to his partner for over ten years He and his partner are physically active and enjoy hiking and gardening together. Eighteen months ago, his brother died of an overdose. He became estranged from his parents fifteen years ago after coming out. “My brother kept me posted about my father’s illness, but they didn’t want me to visit. I wasn’t invited to the funeral. Now there’s no chance for reconciliation. I don’t even know if my mother knows where I live. I really wish she could accept me for who I am. I was close to my brother – I really miss him. The last few years have been hard.” Patient drinks 1-2 beers several times a week, has never smoked. “I used to party pretty hard in college, but I don’t use drugs anymore, not with my brother’s situation. It just seemed wrong.” The patient is an attorney for a low-cost legal service in his county. His partner is an elementary school teacher. They are very active in their Unitarian Church. Medications He takes loratadine for allergies and atorvastatin for high cholesterol. Allergies NKA Questions Is there a mental health diagnosis that fits these symptoms? If not, what’s causing his mood swings and outbursts of anger? What about the weight gain, racing heart and feelings of worry? What information could you ask for that would give you the most information for a diagnosis? What labs do you want? What other diagnostic tests should we run? Ask me some questions! REMEMBER: DON’T post the ANSWER HERE! Ask questions and I’ll give you more information.
  2. If you think you know the correct diagnosis for this Case Study (CSI)... DO NOT POST ANSWER HERE. Instead, post your answer in the ADMIN HELP DESK.; We don't want to spoil it for others who are late in joining us. In a few days, after I post the diagnosis, the Admins will announce the names of those members who correctly identified the problem. We hope to turn this into a friendly competition with more Case Studies to come. You CAN post questions and post comments below. BUT... Do NOT post your diagnosis guess below. Disclaimer: These case studies are presented for learning purposes only and with full understanding that it is outside the scope of practice for a nurse to make a medical diagnosis. When participating, assume that a licensed healthcare provider is making the actual diagnosis, ordering all the tests and interpreting the results. You are looking at the case retrospectively to learn from the data presented – the idea is to increase your knowledge so you can sharpen your assessment and teaching skills. Chief Complaint An 85-yr-old Cherokee woman living in a skilled nursing facility in Western North Carolina (WNC) has been reluctant to socialize or join in activities. She has lost 10 lbs in the month since she has been admitted. Her hair is unwashed and the aids state she often refuses a bath. She takes her meals in her room saying, “I just don’t feel comfortable here. I want to go home.” The patient has complained of not liking the food. Staff members have reported overhearing her talking about getting messages from “plant people.” The cafeteria staff have reported that she questions them constantly about the ingredients in the food and how it is prepared. The cafeteria manager states, “She keeps asking for a bunch of weird TEAS we don’t have, and I don’t know where to get them.” History of Present Illness She was admitted to the facility one month ago due to multiple falls in her home. Her most recent fall resulted in loss of consciousness when she hit her head on the bathroom sink. She currently uses a rolling walker for ambulation. The patient has been observed sleeping or sitting in chair for 90% of day; she refuses to participate in physical activity. Past Medical History Depression x 3 years, osteoarthritis x 12 years and GERD x 3 years Family History One child, alive and well who lives in Oklahoma. Mother died in her 80s from stroke, father died at 60 from acute MI, two sisters, ages 78 and 80 are alive and well and living in Oklahoma. Husband died of MI 6 months ago. Social History After she married her husband 50 years ago, they moved from Oklahoma to WNC where her husband’s family lives. After he died, she tried living on her own in their small home, but she fell several times and her daughter insisted she move into a SNF. No alcohol or tobacco use, no reports of using recreational drugs. She has a history of not taking her medications saying, “I don’t believe in taking a pill for everything that is wrong. A pill can’t teach you anything.” Medications OTC ibuprofen, Esomeprazole and Citalopram. Allergies Cephalexin – severe hives Questions 1- Why is this patient talking about "Plant People"? 2- How would you approach a diagnosis for this patient? 3- What strategies will you need to use for patient centered care? 4- What labs do you want? 5- What other diagnostic tests should we run? REMEMBER: DON’T post the ANSWER HERE! Ask questions and I’ll give you more information.
  3. SafetyNurse1968

    Case Study: It’s a Lump, but is it Breast Cancer?

    Diagnosis: Core-needle biopsy of large left breast mass: pathology consistent with invasive ductal carcinoma (infiltrating breast carcinoma), tubules observed in 85% of sample, 3-5 cell divisions in high-power observation with mild pleomorphism, tumor positive for estrogen and progesterone receptors. Ultrasound of left breast and axilla: four cystic lesions in the left breast, solid-appearing, non-cystic mass consistent with cancer in upper outer quadrant, ill-defined mass with abnormal vascularity, the mass measures the same as with the mammogram (2,1x3x3.1 cm), there is some suggestion of skin thickening and mild tissue edema. Ultrasound of liver: clear Bone scan: no definitive evidence of bone metastasis, positive for mild degenerative changes consistent with degenerative joint disease. Invasive ductal carcinoma (IDC), also known as infiltrating ductal carcinoma, is cancer that began growing in a milk duct and has invaded the fibrous or fatty tissue of the breast outside of the duct. IDC is the most common form of breast cancer, representing 80 percent of all breast cancer diagnoses. As with any breast cancer, there may be no signs or symptoms Make an appointment to have a breast lump evaluated if: The lump feels firm or fixed The lump doesn't go away after four to six weeks You notice skin changes on your breast, such as redness, crusting, dimpling or puckering You have discharge, possibly bloody, from your nipple Your nipple is turned inward and isn't normally positioned that way You can feel a lump in your armpit and it seems to be getting bigger Thickening of the breast skin Swelling in one breast New pain in one particular location of a breast Changes in the appearance of the nipple or breast that are different from the normal monthly changes a woman experiences Now that you know the patient has IDC – what’s next? Clinical course: The oncologist met with the patient and together they decided on breast conservation therapy/lumpectomy with sentinel lymph node biopsy, radiation and chemotherapy. The nodes were negative and surgical margins were clear. After radiation treatment, the patient was placed on tamoxifen. She will have follow-up appointments every 3-4 months for the first two years and then every 6 months for the next three years, then annually. For more information on options for treating IDC, check out https://www.breastcancer.org/symptoms/types/idc/treatment Treatments for invasive ductal carcinoma (IDC) include surgery, chemotherapy, radiation therapy, hormonal therapy, and targeted therapy. Surgery is used to treat IDC not only to remove the breast tumor itself, but also to confirm whether or not cancer is in the lymph nodes. Surgery is considered a local treatment because it treats just the tumor and surrounding area. A lumpectomy removes only the tumor (the “lump”) and some of the normal tissue that surrounds it. In a Sentinel lymph node biopsy, the surgeon looks for the very first lymph node — the “sentinel node” — that filters fluid draining away from the area of the breast that contains the cancer. If cancer cells are breaking away from the tumor and traveling away from your breast through the lymph system, the sentinel lymph node is more likely than other lymph nodes to contain cancer. The surgeon uses a special radioactive substance or dye to identify that first node and the couple of nodes where it drains. These nodes are then removed and sent for examination by a pathologist. If the lymph nodes are cancer-free, no further surgery is necessary. If cancer is found, then more lymph nodes in the armpit need to be removed, either now or at a later date. Radiation therapy is most often recommended after surgeries that conserve healthy breast tissue, such as lumpectomy and partial mastectomy. If the IDC is larger than 1 centimeter in diameter and/or has spread to the lymph nodes, chemotherapy is usually recommended or, at the very least, seriously considered. When chemotherapy is given after surgery, it is called “adjuvant therapy.” In cases where the tumor is large, or breast cancer cells have traveled to many lymph nodes or other parts of the body, chemotherapy may be given before surgery to shrink the cancer. This approach is called “neoadjuvant therapy.” In either case, chemotherapy will be given in cycles, usually with a day (or days) of treatment followed by a period of “off” days. The exact schedule can vary depending on the medication or medications used. An entire course of chemotherapy usually takes about 3 to 6 months. Hormonal therapy for IDC is recommended if the cancer tested positive for hormone receptors, Hormonal therapy, also called anti-estrogen therapy or endocrine therapy, works by lowering the amount of estrogen in the body or blocking the estrogen from signaling breast cancer cells to grow. For small tumors, it’s common for hormonal therapy (adjuvant treatment) to be given after other treatments. Tamoxifen acts like estrogen and attaches to the receptors on the breast cancer cells, taking the place of real estrogen. As a result, the cells don’t receive the signal to grow. Tamoxifen can be used to treat both pre- and postmenopausal women. Other examples of SERMs are Evista (chemical name: raloxifene) and Fareston (chemical name: toremifene). References Breast lumps https://www.mayoclinic.org/symptoms/breast-lumps/basics/causes/sym-20050619 Invasive ductal carcinoma https://www.hopkinsmedicine.org/breast_center/breast_cancers_other_conditions/invasive_ductal_carcinoma.html Risk factors for Breast Cancer at a Young Age https://www.CDC.gov/cancer/breast/young_women/bringyourbrave/breast_cancer_young_women/risk_factors.htm?s_cid=byb_sem_013 Treatment for IDC https://www.breastcancer.org/symptoms/types/idc/treatment
  4. SafetyNurse1968

    Case Study: It’s a Lump, but is it Breast Cancer?

    Thank you so much for your questions and comments! Here is the first update: Finding a lump in your breast can be frightening — but although breast cancer is the most common cancer found in women, most breast lumps are not cancer. In fact, more than 80 percent of them end up being benign Breast lumps can be caused by: Breast cancer Breast cysts (fluid-filled sacs in breast tissue that are usually benign) Fibroadenoma (a solid, benign mass most common in young women) Fibrocystic breasts (lumpy or rope-like breast tissue) Galactocele (a milk-filled cyst that's usually harmless) Injury or trauma to the breast Intraductal papilloma (a benign, wartlike growth in a milk duct) Lipoma (a slow-growing, doughy mass that's usually harmless) Mastitis (an infection in breast tissue that most commonly affects women who are breast-feeding) Risk Factors Most breast cancers are found in women 50 years or older. Most of us have some risk factors, but most women don’t get breast cancer. Risk factors include getting older, early menstruation and menopause after age 55 Other risk factors for breast cancer: close relatives who were diagnosed with breast cancer before the age of 45 – especially if more than one relative was diagnosed changes in BRCA1 and BRCA 2 genes Ashkenazi Jewish heritage radiation therapy to the breast or chest during childhood history of breast cancer or other health problems like in situ carcinomas, atypical ductal hyperplasia or atypical lobular hyperplasia dense breasts on a mammogram lack of physical activity, being overweight or obese after menopause, taking hormones, first pregnancy after 30, not breastfeeding, never having a full-term pregnancy, drinking alcohol and smoking Review of Systems: only abnormal values presented Lymph nodes/neck: one movable, firm, non-tender axillary lymph node of approximately 1.5 cm palpated under left arm Breast exam: Symmetric breasts No dimpling or erosion of skin, no nipple retraction or discharge, no erythema, discoloration or swelling Multiple, diffuse, small (0.4-1.2 cm) mobile, apparently cystic lesions palpable throughout both breasts. One 2 cm mass palpated in upper outer quadrant of left breast, mass is firm and not fixed to the chest wall and is not tender to the touch. Vital signs: BP 136/85 sitting, RA HR 70 RR 15 T 98.3oF HT 5’ 6” WT 135 lbs Laboratory Test Results: Na 139 meg/L (135-145) K 4.1 meq/L (3.5-5) Cl 107 (101-112) HCO3 24 mg/dL (22-32) BUN 9 mg/dL (8-20) Cr 1.0 mg/dL (0.6-1.2) Glu fasting 88 mg/dL (60-110) Hb 14.3 g/dL females (12-15.5) Hct 37.5% females (35-45%) Plt 420,000 cu/mm (150,000-450,000) WBC 8.0 x 103/mm3 (4,800- 10,800) Neutros 60% (57-67) Lymphs 31% (25-33) Eos 3% (1-4) Monos 6% (3-7) AST 38 IU/L (0-35) ALT 30 IU/L (7-56) Alk phos 97 IU/L Albumin 4.0 g/dL (3.4-4.7) Bilateral mammogram: There were three 1.0-1.5 cm masses distributed diffusely throughout the right breast and four 0.5-1,0 cm masses in the left breast. There also was a 2.1 cm x 3.0 cm x 3.1 cm mass with irregular borders within the upper outer quadrant of the left breast. Associated with the suspicious lesion was diffuse skin thickening and an enlarged axillary lymph node of approximately 1.5 cm. Seven Y-shaped microcalcifications extending to the nipple were seen in the left breast. There is some evidence of extension of the abnormal mass into the pectoral muscle. Can you identify at least six clinical manifestations that might support a diagnosis of breast cancer?
  5. If you think you know the correct diagnosis for this Case Study (CSI)... DO NOT POST ANSWER HERE. Instead, post your answer in the ADMIN HELP DESK.; We don't want to spoil it for others who are late in joining us. In a few days, after I post the diagnosis, the Admins will announce the names of those members who correctly identified the problem. We hope to turn this into a friendly competition with more Case Studies to come. You CAN post questions and post comments below. BUT... Do NOT post your diagnosis guess below. Disclaimer: These case studies are presented for learning purposes only and with full understanding that it is outside the scope of practice for a nurse to make a medical diagnosis. When participating, assume that a licensed healthcare provider is making the actual diagnosis, ordering all the tests and interpreting the results. You are looking at the case retrospectively to learn from the data presented – the idea is to increase your knowledge so you can sharpen your assessment and teaching skills. Presentation A 45-yr-old, white, premenopausal woman presents for her annual exam. About 5 weeks ago, she noticed a small, painless lump in the upper outer quadrant of her left breast. “I didn’t think much about it because I’ve had so many lumps – they always pop up when I get my period.” She states that usually the lumps become palpable and bother her about 10 days before her menses, but then they go away. Right now, she is about 4 days from her expected date of menstruation. She is a nonsmoker, nondrinker and denies recreational drug use. She only takes PRN medications occasionally. She has a supportive partner and two children ages 13 and 17. Chief Complaint “My breasts have always been cystic, but I found a new lump in my left breast that has me worried.” History of Present Illness She has no history of dysmenorrhea, but the lump hasn’t gone away and seems to have grown in size. She denies tenderness, pain, nipple discharge and skin changes in her breasts and no masses in the axillary region of her left arm are found. She states that she practices breast self-exams, “but not as often as I should.” She has never had a mammogram. Several years ago, she had a breast biopsy that was consistent with fibrocystic changes. Her only Pap smear was done two years ago, and the result was normal. Past Medical History Her medical history is unremarkable except for a broken arm in grade school. Menarche was at age 11. Her first pregnancy was at age 27 and her second at age 32 – both pregnancies were full term and deliveries were vaginal with no complications. Family History Paternal grandmother diagnosed with breast cancer before menopause at age 48. Mother died of breast cancer at age 75, though the cancer was diagnosed when she was 45. She had two periods of long-term remission, but it recurred again 16 years ago. Her father is 88 and has HTN, history of stroke, type 2 DM and Alzheimer’s disease. He lives in a nursing home. Social History Drinks 6-8 cups of coffee weekly, exercises 3x weekly, has a degree in communications from a local college, but she now works as a personal life coach. Allergies Latex and adhesive tape cause a rash. Questions What are the possible reasons for this lump? Is it just another cyst? How many reasons for breast lumps can you come up with off the top of your head? How many risk factors for breast cancer can you spot? What labs do you want? What other diagnostic tests should we run? REMEMBER: DON’T post the ANSWER HERE! Ask questions and I’ll give you more information.
  6. SafetyNurse1968

    Case Study: Newborn with Vomiting and Diarrhea

    Thank you so much - I've posted before that I'm a generalist, so I always appreciate it when folks who know more than I do add to the discussion.
  7. SafetyNurse1968

    Huge Zoom Mistake....Nurse Instructors Caught!

    As the chair of the diversity, equity and civility council at my SON, I want to suggest that you recommend the students go to the dean. This is unacceptable behavior on the part of the two instructors and they need to be counseled and/or encouraged to find other employment. I am so sorry that this happened to you/OP and the students - nursing school is stressful enough without having to deal with racist instructors. We are allowed to have our own opinions, but they must be kept private. If a nursing student can be ejected from a program for an inappropriate FB post, then the same standards should apply to instructors, regardless of intent.
  8. SafetyNurse1968

    Case Study: Newborn with Vomiting and Diarrhea

    And the answer is...Neonatal Abstinence Syndrome. Neonatal abstinence syndrome (NAS) can occur in response to newborn withdrawal from drugs taken by the mother during pregnancy. It is a group of conditions most often related to opioid abuse. Most babies who get treatment improve in a few days or weeks; however, NAS may lead to long-term health and developmental problems, including hearing and vision loss and problems with learning and behavior. Signs of NAS can be different for each infant. Most symptoms occur within 3 days (72 hrs) of birth, but some may not happen right away. Signs include tremors, convulsions, twitching, fussiness, poor feeding, breathing problems, fever, trouble sleeping, lots of yawning, diarrhea or vomiting, stuffy nose or sneezing. The signs depend on the drug used during pregnancy. Finnegan Score This infant has a Finnegan NAS score of 26 The Finnegan scale assesses 21 of the most common signs of neonatal drug withdrawal syndrome and is scored on the basis of pathological significance and severity of the adverse symptoms. Infants scoring an 8 or greater are recommended to receive pharmacologic therapy. Link to online calculator: https://www.mdcalc.com/modified-finnegan-neonatal-abstinence-score-nas There is currently no national monitoring system to collect data about NAS in the US. There are laws in six states that require public health monitoring of NAS (Arizona, Florida, Georgia, Kentucky, Tennessee and Virginia). This type of monitoring could provide information about opportunities for treatment and prevention. Follow up: After admission, the infant was started on methadone for pharmacologic treatment of withdrawal symptoms. NAS score was 20 at 24 hours and 12 at 48 hours. Infant was successfully weaned from methadone after 21 days and discharged with a NAS score of 3 at 24 days. The mother refused treatment and left the hospital after 3 days of rooming-in. Volunteers found that swaddling was the most effective method of comforting the child. When the child was discharged in the care of foster parents, he weighed 6 lbs. References Ball, J. W., Bindler, R. C., Cowen, K., & Shaw, M. R. (2017). Principles of pediatric nursing: Caring for children (7th ED.) Pearson. Finnegan, L. P. Modified Finnegan Neonatal Abstinence Score (NAS). MD+Calc. https://www.mdcalc.com/modified-finnegan-neonatal-abstinence-score-nas MacMullen, N. J., Dulski, L. A. & Blobaum, P. (2014). Evidence-based interventions for neonatal abstinence syndrome. Continuing nursing education. Pediatric Nursing, 40(4). p. 164-173. Wachman, E. M. & Werler, M. M. (2019). Neonatal abstinence syndrome: Which medication is best? Journal of the American Medical Association Pediatrics, 173(3), p221-223.
  9. SafetyNurse1968

    Case Study: Newborn with Vomiting and Diarrhea

    None of the allnurses features work for me in chrome- I have to use Firefox. Any chance that might be your issue?
  10. SafetyNurse1968

    Case Study: Newborn with Vomiting and Diarrhea

    Excellent questions! More data coming soon!
  11. SafetyNurse1968

    Case Study: Newborn with Vomiting and Diarrhea

    You’re on the right track- more info coming soon!
  12. SafetyNurse1968

    Case Study: Newborn with Vomiting and Diarrhea

    If you think you know the correct diagnosis for this Case Study (CSI)... DO NOT POST ANSWER HERE. Instead, post your answer in the ADMIN HELP DESK.; We don't want to spoil it for others who are late in joining us. In a few days, after I post the diagnosis, the Admins will announce the names of those members who correctly identified the problem. We hope to turn this into a friendly competition with more Case Studies to come. You CAN post questions and post comments below. BUT... Do NOT post your diagnosis guess below. Chief Complaint A three-day old male infant is brought to the ER with vomiting and diarrhea by his 22-yr-old white mother. The mother states, “It started yesterday. He sleeps all the time, but when he’s awake he just won’t stop crying and I can’t get him to stop throwing up after he eats.” This is the mother’s first pregnancy. The infant was full term and there were no complications during the vaginal birth. A full assessment is performed, and the infant is admitted to the hospital. Assessment Findings Depressed fontanels High-pitched cry lasting more than 5 minutes. Moro reflex is hyperactive. Mild tremors when disturbed. Increased muscle tone, no excoriation of chin, knees, elbows, toes or nose, myoclonic jerks present. Yawns frequently. No nasal stuffiness, nasal flaring or sneezing apparent. Skin is dry with no mottling. Vital Signs BP 89/60 RA, lying HR 110 bpm RR 70/min with no retractions T 101o F O2 sat 98% Weight at birth 5 lbs 6 ounces Current weight: 5 lbs 4 ounces What’s going on here? What other information do you need? What labs do you want? What other diagnostic tests should we run? REMEMBER: DON’T post the ANSWER HERE! Please post your answer in the Admin Help Desk. Ask questions and I’ll give you more information.
  13. SafetyNurse1968

    Case Study: Joint Pain, Rash, Hair Loss - What's Going On?

    Excellent- thank you! I so appreciate the knowledge. I’m a generalist, so I really enjoy it when folks who know more than I do chime in.
  14. SafetyNurse1968

    Case Study: Joint Pain, Rash, Hair Loss - What's Going On?

    Like what? The issue with lupus is there are no specific labs that I know of. I’m here to learn as well. Hope I haven’t left something out!
  15. SafetyNurse1968

    Case Study: Joint Pain, Rash, Hair Loss - What's Going On?

    No other family with similar symptoms, no travel outside US, Dx from PCP 5 years ago focused on fatigue and stress. The rash was attributed to stress/ possible allergic reaction to sunscreen (they took a wait and see approach and she's not been back with any problematic symptoms until now). She has had mild joint pain on an off, but so mild she just treated it with Naproxen.
  16. SafetyNurse1968

    Case Study: Joint Pain, Rash, Hair Loss - What's Going On?

    I will post lab/radiologic/UA results on Saturday, I will go ahead and tell you her CMP is WNL and her thyroid panel is negative. Weight at most recent annual doctor’s visit 8 months ago: 120 lbs. No travel outside country.
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