HISTORY. At least 50% of patients presenting with Rocky Mountain spotted fever display the classic triad of symptoms: fever, rash, and a history of exposure to ticks. Ask about the dates of recent outdoor activities and known tick exposure. Note that only about 50% of patients actually recall tick exposure when they are diagnosed with Rocky Mountain spotted fever. Determine if the patient has pets because dogs are another source of the infection. Ask about common symptoms such as fever; severe headache; pain of the joints, muscles, and bones; malaise; and lethargy. Gastrointestinal symptoms are also common, including nausea, vomiting, diarrhea, constipation, anorexia, and abdominal pain.

PHYSICAL EXAMINATION. The patient appears acutely ill, with skin that is warm to the touch. Fevers from 102°F to 104°F are almost a universal symptom. The hallmark hemorrhagic rash that is associated with this disease appears 1 to 15 days after the onset of illness, most commonly around day 3, and therefore may not be present on the initial examination. The hands, wrists, feet, and ankles may have pink 2- to 5-mm macules that blanch with pressure. The rash spreads to the trunk, face, palms of the hands, and soles of the feet. Three days after the rash appears, it becomes fixed, a darker red with a petechial appearance. In approximately 10% of confirmed cases, there is no rash.

The patient may develop a rapid respiratory rate, shallow breathing, and a bronchial cough. Changes in mental status, such as confusion, agitation, and restlessness, may indicate a worsening condition. Fever and dehydration can lead to a rapid and thready peripheral pulse, hypotension, delayed capillary blanching, and shock. Late signs of complications include hepatomegaly and splenomegaly on palpation and pitting peripheral edema.

PSYCHOSOCIAL. Assess the patient's social support network and consider the effect the illness has on the patient's family. Expect them to be anxious and fearful about a sudden, unexpected serious illness. The patient may have to take time off from high school, college, or work and may worry about unmet financial, family, or educational obligations. Note the patient's developmental stage, and recognize the age-related concerns that a sudden illness creates.

Diagnostic Highlights

Most often the diagnosis of Rocky Mountain spotted fever is made as a result of clinical findings because diagnostic titers of antibodies are only detectable 10 days after the onset of illness. Other tests such as complement fixation titer, indirect hemagglutination titer, indirect immunofluorescence titer, and latex agglutination. Complete blood count may show thrombocytopenia (50% of patients) and anemia (30% of patients). Electrolytes may show hyponatremia (60% of patients).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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