SUBJECTIVE: Juan, is a 36-year-old Caucasian male,

SUBJECTIVE: Juan, is a 36-year-old Caucasian male, who presents to the primary care clinic for a routine follow-up for the treatment and management of hypertension. During the visit, he mentions that he has several lesions on his left lower leg and abdomen that are not healing. He has tried over-the-counter antibiotic ointments, and these areas are not getting better. The areas are painful and have had no fever. He has noticed similar lesions on the arms and of his 2 children, ages 6 and 8 years. He attributes this spread to a possible spider bite or tick bite. He wants to be tested for Lyme disease since he is active outdoors with his children. He denies joint pain, and the rest of his review of systems is negative. Past medical history: Hypertension Past surgical history: None Family history: Noncontributory Social history: Lives at home with his wife and 2 children. Works as a fundraising representative for a nonprofit organization. Is very active outdoors with his family. His hobbies include camping, biking, and Nordic skiing Medications: HCTZ, 25 mg daily; Lisinopril, 10 mg daily Allergies: NKDA OBJECTIVE: General appearance: 36-year-old male, pleasant, in no acute distress; good eye contact Vital signs: T: 98.2; P:86 RR: 18; SO2: 99; B/P 128/70. Weight: 190 lbs, height is 71 inches. HEENT: Negative Neck: Thyroid non-palpable, No lymphadenopathy Cardiac: RRR, no murmur, rub, gallop, or click Respiratory: Lungs clear to auscultation; No wheezes, or crackles Abdomen: +BS; non-distended, non-tender, soft, no organomegaly appreciated Neurological: A&O x 4, CIN II-XII grossly intact; Patient health questionnaire depression scale 0/2 Musculoskeletal: Full ROM, no deformities, muscle strength 5/5 Skin: Lesions of the left lower leg are round, erythematous, and non-healing with scant exudates No lymphadenopathy, no rash or erythema migrans noted Critical Thinking!! Which diagnostic or imaging studies should be considered to assist or confirm the diagnosis? _Skin cultures _CBC with differential _Urinalysis _Metabolic panel _HBA1c What is the most likely differential diagnosis and why? _ Spider bite _Cellulitis _Community acquired Methicillin-resistant Staph _Lyme disease _Contact Dermatitis What is your plan of treatment? Are there any referrals needed? Are there standardized guidelines or resources that would help this case? SCIENCE HEALTH SCIENCE NURSING NURSING 774

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."