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Systemic Lupus Erythematosus (SLE)
The patient could be suffering from SLE as she reported muscle aches without stiffness and a skin rash with an increased photosensitivity. These symptoms are associated with Lupus, the chronic inflammatory condition that is most commonly found in women of childbearing age (Bartels, 2016). The reasonableness of this diagnosis is confirmed by the presence of the shallow bilateral ulcers in the patients buccal mucosa.
Lyme Borreliosis (or Lyme Disease)
A skin rash is one of the first symptoms of Lyme disease; the later symptoms include joint pain and fatigue, among others (NHS, n.d.). However, even though the patient seems to display all of these symptoms, their characteristics are different from those typical of Lyme disease. For instance, Lyme disease is known for the bulls eye-shaped rash and joint pain that goes together with swelling the signs that Mary does not have. This is why this diagnosis is less likely than the first one. In addition, the patient has mentioned that she had spent a week hiking and camping in the Appalachians; and therefore, it is possible that she could have been bitten by the tick that causes the development of infection leading to Lyme disease.
Mononucleosis
The patients skin rash, fatigue, and a sore throat also match the set of signs associated with mononucleosis (Mayo Clinic, 2017). However, this diagnosis is secondary because Mary does not display fever, swollen lymph nodes and tonsils, and headaches that are the other major symptoms of mononucleosis.
Teaching and Nursing Care Plan
For Systemic Lupus Erythematosus
The additional tests required for the confirmation of this diagnosis include antibody test, urine analysis, and a chest x-ray; also, the patient might be referred to a rheumatologist for the treatment related to joint and muscle pain (Bartels, 2016). Moreover, the patient will be prescribed anti-inflammatory medication for joint aches, a steroid crème to treat the skin lesions, and corticosteroids to control the response of the immune system (Bartels, 2016).
For Lyme Disease
A 2 to 4-week course of antibiotics is required depending on the severity of the condition and its stage. Also, the patient should be referred to a specialist for intravenous antibiotics should her symptoms become especially severe (NHS, n.d.).
In addition, the patient should be educated about the effect some antibiotics may have on her skin. In particular, it can become very sensitive to sunlight; and in that way, the patient should be recommended to stay away from direct sunlight and try to stay inside as much as possible in order to minimize her exposure while the treatment is still in process. The patient has to be informed about the cause of her disease (the infection vectored by a tick) and advised to take all the necessary precautions to avoid exposing herself to a tick bite in the future.
For Mononucleosis
The required tests are antibody test and white blood cell count, they will help to confirm that the patient is suffering from mononucleosis. As for the medication, the patient may need antibiotics in case she has any bacterial infections that accompany her conditions (a sore throat and tonsillitis may be caused by such infections). Other than that, the patient will be advised drinking plenty of fluids (water and fruit juices mainly), have a lot of bed rest, and have wholesome and healthy meals.
Moreover, the patient needs to be educated about the impact mononucleosis produced on spleen and thus be asked to avoid engaging in physical activities to prevent the rupturing of spleen.
References
Bartels, C. M. (2016). Systemic Lupus Erythematosus (SLE). Web.
Mayo Clinic. (2017). Mononucleosis. Web.
NHS. (n.d.). Lyme disease. Web.
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