6.12 Clinical Judgment: Case Study

A 64-year-old client attends a primary health care clinic reporting a burning and tingling sensation with pain and rash under their breast on the left side of the trunk. The client indicates difficulty sleeping due to pain and irritation and rates the pain as 6/10. The client reports that the burning and tingling pain started 8 days ago and the rash started 5 days ago and has progressively worsened and spread slightly. Upon assessment, you note a linear red rash with vesicles spanning from the midline of the trunk to the posterior scapula on the left side (following dermatome). Several vesicles appear to have erupted and are crusted over. Client’s vital signs are: blood pressure: 135/89 mm Hg, pulse 89 beats per minute, respirations 18 breaths per minute, O2 saturation: 98%, temperature: 38.6 °C / 101.4 °F tympanic. Client has not received immunizations in 20 years.