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1. Week 5: Treatment for onychomycosis
Week 5: Treatment for onychomycosisWeek 5: Treatment for onychomycosisNow that you
have identified the treatment for onychomycosis and labs for baseline and follow up
therapy.Specify when to refer the patient after therapy and why? Provide
rationale.According to the recommended guidelines, what are the non-pharmacological
approaches to Onychomycosis?Provide patient education. Keep in mind the past medical
history of this patient.ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERSChief
complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy,
swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the
gym”.HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain,
itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately
itching after she took a shower at the gym. She did not pay much attention. About two
weeks after the itching became intense and she applied Benadryl cream with only some
relief. She continued going to the gym and noticed that the itching got worse and her toe
nail started to change color. She also indicated that the toe got swollen, painful and turned
completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her
symptoms. She has not tried other remedies. Denies associated symptoms of fever and
chills. Week 5: Treatment for onychomycosisPMH:Diabetes Mellitus, type 2.Surgeries:
NoneAllergies: AugmentinMedication: Metformin 500mg PO BID.Vaccination History:
Immunization is up to date and she received her flu shot this year.Social history: College
graduate married and no children. She drinks 1 glass of red wine every night with dinner.
She is a former smoker and quit 6 years ago.Family history:Both parents are alive. Father
has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis,
HTN.ROS:Constitutional: Negative for fever. Negative for chills.Respiratory: No Shortness of
breath. No OrthopneaCardiovascular: Regular rhythm.Skin: Right great toe swollen, itchy,
painful and discolored.Psychiatric: No anxiety. No depression.Physical examination:Vital
Signs Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R
22, non-laboredHEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No
teeth loss seen. Gums no redness.NECK: Neck supple, no palpable masses, no
lymphadenopathy, no thyroid enlargement.LUNGS: No Crackles. Lungs clear bilaterally.
Equal breath sounds. Symmetrical respiration. No respiratory distress.HEART: Normal S1
with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle
bilaterally.ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants.
No organomegaly. Normal contour; No palpable masses.GENITOURINARY: No CVA

2. tenderness bilaterally. GU exam deferred.MUSCULOSKELETAL: Slow gait but steady. No
Kyphosis.SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate.
Marked periungual inflammation. + dryness. No pus. No neuro deficit.PSYCH: Normal affect.
Cooperative.Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187,
HDL 37, LDL 190, TSH 3.7, glucose 98.A:Primary Diagnosis: Proximal subungual
onychomycosisDifferential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail
PsoriasisSpecial Lab: Fungal culture confirms fungal infection.Patient’s Name: E.DLamisil
250 mg tablet once daily for 12 weeks.Dispense: 30 tabletsInstructions: take 1 tablet by
mouth daily for 12 weeks.Refills: 2Generic substitute permitted: Terbinafine 250 mg
tabletYou must proofread your paper. But do not strictly rely on your computer’s spell-
checker and grammar-checker; failure to do so indicates a lack of effort on your part and
you can expect your grade to suffer accordingly. Papers with numerous misspelled words
and grammatical mistakes will be penalized. Read over your paper – in silence and then
aloud – before handing it in and make corrections as necessary. Often it is advantageous to
have a friend proofread your paper for obvious errors. Handwritten corrections are
preferable to uncorrected mistakes.Use a standard 10 to 12 point (10 to 12 characters per
inch) typeface. Smaller or compressed type and papers with small margins or single-spacing
are hard to read. It is better to let your essay run over the recommended number of pages
than to try to compress it into fewer pages.Likewise, large type, large margins, large
indentations, triple-spacing, increased leading (space between lines), increased kerning
(space between letters), and any other such attempts at “padding” to increase the length of
a paper are unacceptable, wasteful of trees, and will not fool your professor.The paper must
be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of
each page. When submitting hard copy, be sure to use white paper and print out using dark
ink. If it is hard to read your essay, it will also be hard to follow your argument.