Chief complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever and chills.
PMH: Diabetes Mellitus, type 2.
Medication: Metformin 500mg PO BID.
Vaccination History: Immunization is up to date and she received her flu shot this year.
Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: Regular rhythm.
Skin: Right great toe swollen, itchy, painful and discolored.
Psychiatric: No anxiety. No depression.
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.
SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH: Normal affect. Cooperative.
Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
Primary Diagnosis: Proximal subungual onychomycosis
Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Fungal culture confirms fungal infection.
As an NP student, you need to determine the medications for onychomycosis.
- According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.
- What labs for baseline and follow up of therapy would you order for this patient? Give rationale.
Plan approaches to improve fittingness Propriety reflects class or amenability and is characterized as "the voidance of damaging social or relational standards, principles, or desire (Kova, 1997). Correspondence ability might be accomplished by picking the most fitting channel, and the one that will be powerful or achieve one's objective (Kova, 1997). The picked channel might be a powerful method to accomplish the objective, yet it might not have a required level of social nearness or wealth. The apparent fittingness and viability of five correspondence channels were configuration to improve correspondence inside Simplicity Pastry, for example, meeting, gathering, workshops, email, and video meetings (Kova, 1997). Workshops: One of the most problems that need to be addressed inside Simplicity Pastry is the need to improve correspondence and relational aptitudes (Kova, 1997). Successful relational abilities are a center competency at all dimensions particularly senior supervisory group, division groups, deals power, and client administration. Workshop can be use to improve effortlessness correspondence level among representative (Kova, 1997). Straightforwardness Pastry Company will offer intelligent workshops altered for their customers that address their particular and one of a kind issues. While this workshop is a piece of the interchanges arrangement, the other piece of the arrangement rests with the members. On the off chance that they need to turn out to be increasingly powerful in relational correspondence, they should be happy to work and amid the workshop, however after the workshop. The workshop's objective ought to be at the focal point of all arranging. Imaginative activities will get everybody loose and included, and remember to catch up a while later: Although it very well may be startling to hear what individuals truly thought of all your diligent work, it will just improve the following occasion and the business. The workshop will prepare staffs and upgrade their insight and abilities in correspondence. Meetings: A yearly gathering will unite operators, masters and REC staff for casual systems administration, program arranging and formal instructive open doors that address the association's and person's issues (Kova, 1997). Gatherings give time to yearly program arranging work. Straightforwardness Pastry will have a decent measure of time to chip away at their program plans and update data recorded on their site. The gathering will likewise give a yearly instruction experience identified with the mission of Simplicity Pastry the and hence conform to government necessities for yearly instructive in-administration (Kova, 1997). Gatherings: The motivation behind the all-staff gatherings is to proceed to improve and advance two-path correspondence among all staff so as to feature and give data with respect to hierarchical wide goals, qualities and standards (Kova, 1997). The essential advantages of getting together on more than one occasion per year keeps up and fabricate network among staff. Different advantages of gatherings are: To improve correspondence and worker relations between all division bunches inside Simplicity Pastry, chances to commend victories and give acknowledgment to meriting and submitted staff and it is a perfect time to request staff contribution on future authoritative advancement exercises (Kova, 1997). Meeting supports efficiency of organizations since it give the staff chances to voice their feeling, resolve issues before struggle emerge, etc. Messages: Electronic mail (email), by its very plan is fit to fill in as a standout amongst the most commonsense correspondence mediums accessible. It very well may be utilized for all correspondence inside the association whenever utilized legitimately (Kova, 1997). Sending and Receiving email to and from Simplicity Pastry will be a straightforward undertaking (if representatives can deal with the composing). Basic assignments like recognizing receipt of email and reacting rapidly can make correspondence through email effective (Kova, 1997). Anyway Simplicity can make email simpler for all it partners by establishing system, for example, setup automated assistants to demonstrate that our email customer has in reality gotten the mail peruse email, act suitably, set ourselves time-points of confinement to react to/remark on email solicitation to be expelled from a correspondence list which we are not engaged with (the procedure or the correspondence), to maintain a strategic distance from false recognition to the rest use email to reinforcement discussion or correspondence of some other sort Video conferencing: A video gathering is a quicker method to speak with partners of Simplicity Pastry. If there should be an occurrence of any crises or long separation for instance a financial specialist can't make it to a gathering base on specific conditions a video telephone call would be reasonable to lead the gathering with no missing data (Kova, 1997). Venturing to removed area to participate in up close and personal connections with clients, accomplices, and associates is a respected business custom however can be disposed of by conveying over video. With tremendous enhancements in quality, accessibility, and usability, and with the capacity to associate and share content in superior quality, the present video conferencing is as near "being there" as one can get without really making the trek. Travel decrease is the least demanding cost to compute while deciding ROI of a video conferencing speculation inside Simplicity Pastry. Execute enhancements to guarantee more noteworthy mix of frameworks of correspondence in that association Effortlessness Pastry needs to guarantee that they accomplish full mix and utilization of video all through your association. In spite of the fact that there are clear unmistakable advantages to the utilization of video, a few representatives will require extra consolation and preparing to incorporate video into their working lives. Through key gaining from clients steps were distinguished to help make progress in the execution of video conferencing framework inside Simplicity Pastry. Effortlessness Pastry should Securing Executive Sponsorship once Simplicity Pastry has settled on the choice to buy video interchanges and introduced the gear, it is fundamental that Simplicity Pastry secure an Executive Sponsor to put resources into the innovation. Preparing is an indispensable in any association in this way Simplicity Pastry ought to guarantee that workers feel good enough with video to begin utilizing it when it is sent and continue utilizing it. An extraordinary method to uncover Simplicity Pastry staff to video is to hold Open Days or compose a 30 minute instructional meeting for all workers, strolling them through the rudiments of putting a call. The usage of Workshops will rouse staff. This is an extraordinary path for Simplicity staff to pick up learning and data that will be usefully to both the organization and partners. Then again gathering and meeting is an extraordinary method to get criticism from staff. As this show how critical their supposition are to the business achievement. Meeting will likewise give a quick react to questions ask just as achieving consolvement without or before strife emerges. Meeting likewise empowers coordinated effort and commitment of staff. This settles on staff feels include in basic leadership. By executing every one of the upgrades, Simplicity Pastry will appreciate a scope of advantages, for example, increment in representative efficiency, increment profitability of the business, quantifiable rate of return for partners, improve brand picture, assemble solid relationship among staff, the board and providers, etc. Make an individual intend to improve claim relational abilities Before the scientist begins to make an individual intend to improve claim relational abilities the analyst must comprehend the two parts of straightforwardness baked good. These perspectives are the setting which is nature which the scientist works both inside and remotely, lastly the substance which is the job of the specialist inside Simplicity Pastry. The scientist should likewise realize the PEST FACTORS which will influence the association remotely The substance in which the specialist works was that the scientist needs to know the polices and standards and guideline of effortlessness baked good so as to do the undertaking given. While the setting in which the scientist works was to distinguished the elements that will influence Simplicity Pastry remotely by completing a natural output. The variables that influence Simplicity Pastry are Political factor which manage government laws and guideline of the nation that all business needs to cling to. For instance when the administration raises charges on sustenance item this will influence Simplicity Pastry since it will just power them to raise the cost of their item and shopper may gripe and look for other option. All things considered Simplicity Pastry won't find the opportunity to sell their item as they feel important on account of the laws and guideline of the nation. A financial factor that may influence Simplicity Pastry is that base on the subsidence emergency that Jamaica is confronting Simplicity will feel the impact of it unequivocally. That as well as with the depreciation of the Jamaica dollars individuals are whining about discovering nourishment to help themselves and that there is no activity in the nation. Social factors that may influence Simplicity Pastry Through an examination of clients and potential clients, their adjustments in mentalities, ways of life and conclusions, were found that the great wedding cake is a custom of the past is as yet drifting in the 21century anyway the exploration as demonstrated that the cupcake business is a developing domain to supplant old conventions. Innovation factors this factor can influence Simplicity in the most emotional way. Innovation is what is drifting in the 21 century, subsequently innovation is use to speak with clients and workers, and even providers. Innovation is fundamental to any association since it's a method for conveying to the groups of onlookers. Five noteworthy vital objectives of Simplicity Pastry are as per the following: Increment benefits and decrease costs: Simplicity Pastr>GET ANSWER