Nurse’s Toolbox : Skin Rashes
Evaluating Skin Rashes in Telephone Triage
Our skin is our first line of protection. It keeps us warm in the cold and cools us when we are too hot. It also acts as a barrier to bacteria, viruses and other organisms.When we notice a rash, we tend to want an instant diagnosis and treatment to make it disappear. However, with so many possible causes of the rash, it is difficult to assess over the phone and the nurse must take extra time when obtaining her assessment.
What the patient thinks : You look down at your 6-year-old and notice red, raised splotchy areas all over his face. He has been outside playing. You do what any parent would do, you instantly look for more areas that appear to be developing the redness. These red areas seem to be all over and spreading fast! What do you do? Is this an emergency room trip or is there anything at home you can do first? Many parents live the above or similar scenarios every day. Rashes are one of the most common reasons parents of small children visit doctors. With differing causes of rash, it can be difficult for parents to know if they should be concerned. Rashes can be caused by anything from an allergic reaction to viral illness to something more serious. Parents often rely on nurse triage to help them determine if their child needs to be seen immediately or if their symptoms can be soothed and they can see their physician the next day.
What the nurse thinks : While nurses cannot diagnose, they can make working diagnoses in order to assess their patients. Once meningitis and a severe allergic reaction are ruled out, the triage nurse will turn her attention towards gathering information to narrow down the potential cause. New detergents, soap, body lotion, and medications must be explored as well as the patient’s previous dermatologic history. Viruses, fungi, bug bites, eczema, tick bites and bacteria can all cause redness and rashes on the skin. Many times the nurse may not determine the exact cause of the rash, but is able to reassure the caller that the rash is probably not serious and can offer home care advice to make the patient more comfortable.
Conclusion : Most childhood rashes are no cause for concern, but it’s always best to talk to your pediatrician. To aid the physician in determining the cause of the rash, it is important to tell callers to write down when it was first noticed, what they were doing when it appeared, what it looks like, if it has spread or changed in appearance, it if is painful or itchy and any new exposures. One important thing to remember about rashes is that if it does not resolve itself in three days or if it changes or worsens before three days, it is always best to have see your physician.