Four clients with different skin alterations come to the emergency department. Which client should the nurse advise that the health care provider (HCP) see first?

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Petechiae (small pinpoint red/purple spots on mucus membrane or skin) and purpura (irregular purplish blotches) can be a sign of blood dyscrasia, including thrombocytopenia due to a severe drug response. This systemic symptom takes priority over a more localized dermatological presentation. (Option A) Oropharyngeal candidiasis/thrush (moniliasis) is a fungal infection of skin or mucous membranes. It resembles curdled milk and can bleed when removed. The etiology may be due to not rinsing the mouth after steroid inhaler use. It is treated with antifungal suspensions (nystatin) and is nonurgent. (Option C) Shingles (herpes zoster) is reactivation of dormant varicella virus. The lesions follow the nerve dermatome and can be quite painful. Incidence increases after age 50. Active chickenpox requires airborne and contact precautions, but not the shingles with crusted lesions, especially if the lesions are covered with clothes. It can be contagious to individuals who have not had varicella or who are immunocompromised. However, this is the second priority as this is a localized issue; the nurse can place this client in a private area. (Option D) Folliculitis is usually due to the presence of staphylococci in moist areas where there is friction. It is most common in the scalp, beard, and extremities in men. It can be treated with medicated soap, topical antibiotics, and warm compresses. The systemic issue in Client 2 is a priority. Educational objective: Petechiae (small circles) and purpura (blotches) are reddish/purple rashes that do not blanch. They indicate systemic blood dyscrasias and are a priority for treatment.

Four Clients with Different Skin Alterations Come to the Emergency