Assignment NR 602 Molluscum Contagiosum Soap Note
Assignment: NR 602 Molluscum Contagiosum Soap Note
Molluscum Contagiosum
A benign common childhood viral skin infection with little health risk, molluscum contagiosum often disappears on its own in a few weeks to months and is not easily treated (Fig. 37-18). This poxvirus replicates in host epithelial cells. It attacks skin and mucous membranes and is spread by direct contact, by fomites, or by autoinoculation (typically scratching). It is commonly found in children and adolescents. The incubation period is about 2 to 7 weeks but may be as long as 6 months (Weston and Morelli, 2013). Infectivity is low but the child is contagious as long as lesions are present.
FIGURE 37-18 Molluscum contagiosum. (From Weston WL, Lane AT, Morelli JG: Color textbook of pediatric dermatology, ed 4, St. Louis, 2007, Mosby/Elsevier, p 144.)
Clinical Findings
History
- Itching at the site
- Possible exposure to molluscum contagiosum
NR 602 Molluscum Contagiosum Soap Note
Physical Examination
- Very small, firm, pink to flesh-colored discrete papules 1 to 6 mm in size (occasionally up to 15 mm)
- Papules progressing to become umbilicated (may not be evident) with a cheesy core; keratinous contents may extrude from the umbilication
- Surrounding dermatitis is common
- Face, axillae, antecubital area, trunk, popliteal fossae, crural area, and extremities are the most commonly involved areas; palms, soles, and scalp are spared
- Single papule to numerous papules; most often numerous clustered papules and linear configurations
- Sexually active or abused children can have genitally grouped lesions
- Children with eczema or immunosuppression can have severe cases; those with human immunodeficiency virus (HIV) infection or AIDS can have hundreds of lesions
Differential Diagnosis
Warts, closed comedones, small epidermal cysts, blisters, folliculitis, and condyloma acuminatum are included in the differential diagnosis.
Management
- Untreated lesions usually disappear within 6 months to 2 years but may take up to 4 years to completely go away. There is no consensus on the management of molluscum contagiosum and no evidence-based literature to show that any treatment is superior to placebo. Therapy may be necessary to alleviate discomfort, reduce itching, minimize autoinoculation, limit transmission, and for cosmetic reasons. Genital lesions may need to be treated to prevent spread to sexual partners.
- Mechanical removal of the central core is to prevent spread and autoinoculation. Using eutectic mixture of local anesthetics (EMLA) cream (lidocaine/prilocaine) 30 to 45 minutes before the procedure reduces discomfort. Curettage is done with a sharp blade to remove the papule. Piercing the papule and expressing the plug is an option but is painful.
- There are reports that irritants (such as, surgical tape, adhesive tape, or duct tape) applied each night can result in lesion resolution.
- Topical medications may prove beneficial. Recheck the patient in 1 to 2 weeks to determine need for retreatment.
- Liquid nitrogen applied for 2 to 3 seconds (easiest but also painful).
- Trichloroacetic acid 25% to 50% applied by dropper to the center of the lesion, followed by alcohol (use with caution). Surround the lesion first with petroleum jelly.
Assignment NR 602 Molluscum Contagiosum Soap Note
- Cantharidin 0.7% in collodion applied by dropper to the center of the lesion, followed by alcohol. Salicylic or lactic acid or KOH or podophyllin can also be used.
- Podofilox 0.5% topical solution or gel, or imiquimod 5% applied daily with a toothpick or cotton-tipped swab.
- Tretinoin or tazarotene cream or gel applied to lesion each night.
- Silver nitrate, iodine 7% to 9%, or phenol 1% applied for 2 to 3 seconds.
- Cimetidine 30 to 40 mg/kg/day in two divided doses orally for 6 weeks if topical treatment fails.
- Sexual abuse of children with genitally grouped lesions should be suspected and evaluated.
- Evaluate for HIV infection if hundreds of lesions are found.
- Wait and see approach—spontaneous clearing occurs over years.
Complications
Molluscum dermatitis, a scaly, erythematous, hypersensitive reaction, can occur and will respond to moisturizer; avoid hydrocortisone because it causes molluscum to flare. Impetiginized lesions, inflammation of the eyes or conjunctiva, and scarring can occur.
NR 602 Molluscum Contagiosum Soap Note
Patient and Family Education
Patients are contagious, but there is no need to exclude them from day care or school. Children with impaired immunity, atopic dermatitis, or traumatized skin are at greater risk for broader spread. Severe inflammation is possible several hours after application of cantharidin. Scarring is unusual.
Important information for writing discussion questions and participation
Hi Class,
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource
Welcome to class
Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to.
I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.
Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.
If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.
Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.
Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
