Question

9\. A client comes to the clinic complaining of a rash that suddenly appeared while she was sunbathing earlier in the day. Assessment shows that the rash is bright red, covers wide symmetrical areas of the body, and has no accompanying local or systemic symptoms. Which question would be most important for the nurse to ask? a. Did you use a new brand of sunscreen? b. Did you wash with perfumed soap before sun- bathing? c. What medications do you take? d. Have you eaten any new foods in the last 24 hours?

Short answer

c. What medications do you take?

Step-by-step solution

Identify Key Symptoms

Examine the scenario carefully: A client has a sudden rash after sunbathing, which is bright red, covers wide symmetrical areas, and has no other symptoms.

Evaluate Initial Context

Understand that the rash appeared due to sun exposure earlier in the day.

Rule Out Certain Causes

Eliminate options based on symptomatology: Perfumed soap (option b) and new foods (option d) are less likely to cause a symmetrical rash from sun exposure.

Consider Medication Side Effects

Some medications can increase sensitivity to sunlight, causing a rash when exposed. Ask about any medications the patient is taking (option c).

Review External Factors

New sunscreen could also be a suspect, as chemical reactions might cause a sun-related rash. Thus, asking about sunscreen usage (option a) is relevant.

Determine Most Important Question

All options are somewhat relevant, but asking about medications is typically most important, as drug-induced photosensitivity can lead to rashes from sun exposure (option c).

Key concepts

photosensitivity in medications

Photosensitivity is a skin reaction that occurs when certain medications cause increased sensitivity to sunlight. This can result in sun-induced rashes, which are often red, patchy, and symmetric. Medications can lead to photosensitivity through phototoxic or photoallergic reactions. Phototoxic reactions are more common and occur when a drug absorbs UV light and releases it into the skin, causing damage.
Photoallergic reactions are less common and involve an immune response, where the skin becomes sensitized to sunlight after drug interaction.
Common medications that may cause photosensitivity include:

• Antibiotics (e.g., tetracyclines, quinolones)
• Antifungals
• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like ibuprofen
• Diuretics
• Anti-arrhythmic drugs

Understanding whether a patient is on any of these medications is crucial because discontinuing the offending drug can often mitigate the photosensitive reaction.

patient history and medication review

A thorough patient history and medication review are critical steps in assessing sun-induced rashes.
Status of the patient's current health conditions, previously known allergies, and any over-the-counter supplements they may be taking can provide clues.
Important aspects to cover include:

• Details of the current rash, including onset, duration, and progression.
• Any recent changes in diet, new products used on the skin, or variations in lifestyle.
• Exercise habits that could involve sun exposure, like outdoor workouts.
• Comprehensive list of all medications, including dose and frequency.
• Times of recent sun exposure—frequency, duration, and intensity.

Identifying which questions are most essential helps in forming a coherent diagnostic approach. In the case of assessing photosensitivity-induced rashes, asking specific questions about medications taken is often prioritized.

differential diagnosis for rashes

Differential diagnosis involves distinguishing a particular skin condition among various possible diagnoses.
This process typically starts with a detailed assessment of the rash's characteristics, patient history, and any triggers that may have led to its development, such as medication or allergens.
For sun-induced rashes, possible differential diagnoses include:

• Solar urticaria – hives triggered by sun exposure.
• Phototoxic reactions – direct damage from a combination of UV light and specific substances.
• Photoallergic reactions – immune response leading to skin sensitivity to sunlight.
• Polymorphous light eruption – common sunlight-induced rash characterized by itchy red spots.
• Heat rash (miliaria) – usually from blocked sweat ducts, not usually symmetric but often linked with intense sun exposure.
• Allergic contact dermatitis – caused by contact with allergens like new sunscreen.

By consolidating information from patient history and analysis of the rash, healthcare providers can more accurately pinpoint the exact cause and prescribe targeted treatments.
This approach ensures a higher likelihood of effective management of sun-induced rashes.