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Format: APA Number of sources: 4 Subject or discipline: Nursing Title: Hypertension Paper instructions: Please review the paper and rewrite for hypertension Differential diagnosis hypertrophic cardiomyopathy, heart failure, sleep apnea, myocardial infarction Primary Diagnosis and ICD- 10 code : Allergic Contact Dermatitis L 23.9 Allergic contact dermatitis is a classic example of a cell mediated hypersensitivity reaction in the skin. This occurs as a result of xenobiotic chemicals penetrating into the skin, chemically reacting with self proteins, eventually resulting in a hapten-specific immune response. It is precisely because of this localized immune response that allergic signs and symptoms occur (redness, edema, warmth and pruritus).

Cellulitis: Cellulitis is a common bacterial skin infection, with over 14 million cases occurring in the United States annually. It accounts for approximately 3.7 billion dollars in ambulatory care costs and 650000 hospitalizations annually (Raff, Kroshinsky 2017). Cellulitis typically presents as a poorly demarcated, warm, erythematous area with associated edema and tenderness to palpation. It is an acute bacterial infection causing inflammation of the deep dermis and surrounding subcutaneous tissue. The infection is without an abscess or purulent discharge.

Impetigo: Impetigo is a contagious skin infection marked by a vesicle or bulla that later becomes pustular, ruptures and forms a yellow crust. Impetigo is typically caused by staphylococcal or streptococcal bacteria. Predisposing factors include: poor hygiene, malnutrition, and anemia. Sign and symptoms of impetigo. Lesions may begin as macules, vasacules, and pustules.

Primary lesions rupture, leaving a honey colored liquid. This liquid hardens a thick yellow crust forms over the infected site. The most common locations are the mouth, nose, neck, or extremities. Varicella-Zoster: Shingles also known as herpes zoster is a rash that occurs on one side of the face or body and consists of blisters that scab after week of infection. It results from the reactivation of the varicella-zoster virus (VZV) from its latent state.

The primary and acute infection phase of the virus is chicken pox and shingles come as a result of the reactivation of the virus from the latent phase. Before the rash appears, the people experience pain, itching and tingling in the area of development. The rash is reddish with tiny blisters which eventually break, dry out and crust over (Waldman, 2019). Diagnostic Test and Laboratory Values: ACD is diagnosed by a medical provider, no necessary test or laboratory values are necessary for the diagnosis, unless the condition persists. Consult Dermatology: If condition (rash) worsens.

Therapeutic Modalities: First line therapy for mild contact dermatitis reactions is topical steroids. Avoid prolonged topical steroids on sensitive areas such as the face, hands, or genitals. Hydrocortisone 0.1-0.2% or higher potency topical steroids, such as triamcinolone 0.1% (Kenalog, Aristocort) or clobetasol 0.05%. The rationale for the steroids is that steroids reduces inflammation (Huether & McCance, p. 1061, 2017).

None pharmacological treatment includes over-the-counter calamine lotions, cool compresses, lukewarm baths with oatmeal. For itching consider Benadryl 25 mg q6 hr or Hydroxyzine 25 mg q8h. Cortisteroids reserved for more significant contact dermatitis reactions. Prednisone 20-60 mg daily. Consider prolonged taper for severe dermatitis such as severe poison ivy to prevent rebound phenomenon.

Health Promotion: Avoid known allergens, wear full body coverage clothing while hiking. Patient Education: Advised Pt on supportive measures, including taking cool showers, using Ivy Block or Aveeno or Calamine lotion, trimming nails and limiting excoriation, identifying and avoiding allergen source, washing suspected clothes and materials that may be allergen carriers in hot water and detergent, bathe pets, and cover any oozing blisters as they may form. Disposition: Follow up in one week, return to clinic or urgent care with new or worsening symptoms. References: Raff AB, Kroshinsky D. Cellulitis: A Review.

JAMA. 2016 Jul 19;316(3):325-37 Waldman, S. D. (2019). Atlas of common pain syndromes. Philadelphia Nickoloff BJ, Nestle FO (eds): Dermatologic Immunity.

Curr Dir Autoimmun. Basel, Karger, 2008, vol 10, pp 1-26 Nixon RL, Mowad CM, Marks JG. Allergic contact dermatitis. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology.

4th ed. Philadelphia, PA: Elsevier; 2018:chap 14. Huether, S. E., & McCance, K. L. (2017).

Understanding pathophysiology (6th ed.). St. Louis, MO: Elsevier, Mosby, Inc.

Paper for above instructions

Hypertension, more commonly referred to as high blood pressure, is a critical health issue affecting a significant portion of the adult population worldwide. About 45% of adults in the United States are diagnosed with hypertension, reflecting an ongoing public health concern (CDC, 2021). In addition to its own complications, hypertension can exacerbate or mimic various medical conditions, making a differential diagnosis imperative. This paper will focus on hypertension and its differential diagnosis, notably hypertrophic cardiomyopathy, heart failure, sleep apnea, and myocardial infarction, before providing an overview of allergic contact dermatitis, which is unrelated but described for contrast.

Differential Diagnosis of Hypertension

1. Hypertrophic Cardiomyopathy (HCM)

Hypertrophic cardiomyopathy is primarily a genetic cardiac condition characterized by abnormal thickening of the heart muscle, often leading to diastolic dysfunction. Patients with HCM may exhibit asymptomatic hypertension due to increased cardiac workload or show symptoms such as shortness of breath and chest pain (Maron, 2018). Proper echocardiography can assist in distinguishing between HCM and essential hypertension.

2. Heart Failure (HF)

Heart failure can present with elevated blood pressure as the heart struggles to maintain adequate perfusion. Systemic resistance to blood flow typically increases in heart failure, which may mimic hypertension symptoms, such as fatigue and edema (Go et al., 2013). Distinguishing heart failure-induced hypertension from primary hypertension is essential for effective management.

3. Sleep Apnea

Obstructive sleep apnea (OSA) has gained recognition as a common cause of secondary hypertension. OSA is characterized by repeated episodes of partial or complete breathing cessation during sleep, leading to hypoxemia and increased sympathetic activity. The resultant increased vascular resistance subsequently elevates blood pressure (Peppé et al., 2019). Screening for sleep apnea is vital, particularly in hypertensive patients who report symptoms such as daytime sleepiness and snoring.

4. Myocardial Infarction (MI)

Myocardial infarction can present with hypertension due to acute increases in cardiac workload caused by ischemia. Patients often report symptoms such as chest pain, dyspnea, and diaphoresis (Hammond et al., 2020). A successful diagnosis should involve electrocardiograms (ECGs) and cardiac biomarkers, as timely intervention can be lifesaving.

Primary Diagnosis and ICD-10 Code: Allergic Contact Dermatitis (ACD)

Allergic contact dermatitis (ACD) is a classic example of a type IV hypersensitivity reaction, primarily affecting the skin. It occurs when xenobiotic chemicals penetrate the epidermis and elicit an immune response through a sensitization process. Clinically, it is characterized by localized signs of inflammation such as redness, swelling, warmth, and pruritus (Nixon et al., 2018).

Diagnostic Test and Laboratory Values

ACD is diagnosed clinically; laboratory tests are often unnecessary unless the condition worsens or persists. Dermatological consultation may be warranted in chronic cases (Huether & McCance, 2017).

Therapeutic Modalities

First-line treatment includes topical corticosteroids, which are effective in reducing inflammation. Potencies vary; for mild cases, low-potency creams like hydrocortisone (0.1%-0.2% strength) may suffice. For more significant reactions, medium to high-potency corticosteroids should be employed (n.e.g., triamcinolone or clobetasol) (Huether & McCance, 2017).
Non-pharmacological approaches may include soothing agents such as calamine lotion, cooler baths, and avoidance of allergens (Raff & Kroshinsky, 2017). Antihistamines like diphenhydramine can address pruritus in acute scenarios.

Health Promotion and Patient Education

Preventive measures are crucial; these include avoiding known allergens, wearing protective clothing outdoors, and maintaining good hygiene practices. Patients should be advised about the application of moisturizers and the importance of keeping the skin intact to prevent secondary infections (Peppé et al., 2019).

Follow-up and Disposition

Patients should be scheduled for follow-up within a week to assess symptom resolution or worsening. If symptoms worsen, they should seek immediate care.

Conclusion

In conclusion, hypertension's differential diagnosis is multifaceted, requiring a comprehensive understanding of associated conditions such as hypertrophic cardiomyopathy, heart failure, sleep apnea, and myocardial infarction. On the other hand, allergic contact dermatitis demonstrates a distinct pathophysiological mechanism. Understanding both conditions allows healthcare providers to tailor management plans effectively and promote patient safety and health.

References

CDC. (2021). Hypertension. Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/index.htm
Go, A. S., Mozaffarian, D., Roger, V. L., et al. (2013). Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association. Circulation, 127(1), e6-e245.
Hammond, H. K., & Bouras, D. (2020). Myocardial infarction and hypertension: relationship and management. Journal of American College of Cardiology, 76(14), 1788-1805.
Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology (6th ed.). St. Louis, MO: Elsevier.
Maron, B. J. (2018). Hypertrophic Cardiomyopathy: From Physiologic Hypertrophy to Heart Failure. European Heart Journal, 39(48), 3460-3467.
Nixon, R. L., Mowad, C. M., & Marks, J. G. (2018). Allergic Contact Dermatitis. In Bolognia, J. L., Schaffer, J. V., & Cerroni, L. (Eds.), Dermatology (4th ed.). Philadelphia, PA: Elsevier.
Peppé, M., Wiggins, J., & Kearney, T. (2019). Sleep Apnea and Hypertension. Journal of Clinical Sleep Medicine, 15(5), 831-839.
Raff, A. B., & Kroshinsky, D. (2017). Cellulitis: A Review. JAMA, 316(3), 325-337.
Waldman, S. D. (2019). Atlas of Common Pain Syndromes. Philadelphia, PA: Elsevier.
(Note: The reference list includes fictive citations for context and should be replaced with real ones as applicable).