Gender Ethnicracial And Life Span Considerations

^ ASSESSMENT

HISTORY. Approximately one to two out of four patients with allergic purpura have GU symptoms such as dysuria and hematuria. Other symptoms include headaches; fever; peripheral edema; and skin lesions accompanied by pruritus, paresthesia, and angioedema (swelling of the skin, mucous membranes, or organs). Other patients describe severe GI symptoms (spasm, colic, constipation, bloody vomitus, bloody stools) and joint pain.

PHYSICAL EXAMINATION. Inspect the patient's skin for the typical skin lesions—patches of purple macular lesions of various sizes that result from vascular leakage into the skin and mucous membranes. These lesions most commonly occur on the hands and arms. Note that, in children, the lesions more commonly start as urticarial areas that then expand into hemorrhagic lesions. Determine if the patient has any peripheral swelling, particularly in the hands and face. Perform gentle range of motion of the extremities to determine the presence and location ofjoint pain. Assess the color of the patient's urine and stool, and note any bleeding.

PSYCHOSOCIAL. The patient may experience a disturbance in body image because of the disfigurement caused by the rash and swelling. Determine the patient's response to her or his appearance, and identify whether the changes interfere with implementing various roles such as parenting or work.

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