Walden University – NURS 6512 Week 4 Discussion: Differential Diagnosis for Skin Conditions

Walden University – NURS 6512 Week 4 Discussion: Differential Diagnosis for Skin Conditions Assignment

NURS 6512 Week 4 Discussion: Differential Diagnosis for Skin Conditions: Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Differential Diagnosis for Skin Conditions Discussion, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

Note: Your Differential Diagnosis for Skin Conditions Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance.Remember that not all comprehensive SOAP data are included in every patient case.

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To prepare FOR NURS 6512 Week 4 Discussion: Differential Diagnosis for Skin Conditions Paper:

• Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion
• Consider the abnormal physical characteristics you observe in the graphics you selected. How would you describe the characteristics using clinical terminologies?
• Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
• Consider which of the conditions is most likely to be the correct diagnosis, and why.

Post a 1 page paper APA formatYour Differential Diagnosis for Skin Conditions Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format,

• a description of the two graphics you selected (identify each graphic by number). (see sample skin conditions attached)
• Use clinical terminologies to explain the physical characteristics featured in each graphic.
• Formulate a differential diagnosis of three to five possible conditions for each.
• Determine which is most likely to be the correct diagnosis, and explain your reasoning.

Walden University – NURS 6512 Week 4 Discussion: Differential Diagnosis for Skin Conditions Readings

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

o   Chapter 8, “Skin, Hair, and Nails” (pp. 114-165)

This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.

•   Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

o   Chapter 28, “Rashes and Skin Lesions” (pp. 325-343)

This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.

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Note: Download and use the Adult Examination Checklist and the Physical Exam Summary when you conduct your video assessment of the skin, hair, and nails.

•  Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for skin, hair, and nails. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
  This Adult Examination Checklist: Guide for Skin, Hair, and Nails was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
•  Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Skin, hair, and nails physical exam summary. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
  This Skin, Hair, and Nails Physical Exam Summary was published as a companion to Seidel’s guide to physical examination(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
• Chadha, A. (2009). Assessing the skin. Practice Nurse, 38(7), 43–48.
  Retrieved from the Walden Library databases.In this article, the author explains how to take a relevant skin health history. In addition, the article defines common terms used to describe skin lesions and rashes.
• Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part I. Differential diagnosis. American Family Physician, 81(6), 726–734.
  Retrieved from http://www.aafp.org/afp/2010/0315/p726.htmlThis article focuses on common, uncommon, and rare causes of generalized rashes. The article also specifies tests to diagnose generalized rashes.
• Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part II. Diagnostic approach. American Family Physician, 81(6), 735–739.
  Retrieved from http://www.aafp.org/afp/2010/0315/p735.htmlThis article revolves around the diagnosis of generalized rashes. The authors describe clinical features that may help in distinguishing generalized rashes.
•   Everyday Health, Inc. (2013). Resources for dermatology and visual conditions. Retrieved fromhttp://www.skinsight.com/ info/for_professionals This interactive website allows you to explore skin conditions according to age, gender, and area of the body.
•  Document: Skin Conditions (Word document)This document contains five images of different skin conditions. You will use this information in this week’s Discussion.
• Document:Comprehensive SOAP Exemplar (Word document)
•  Document: Comprehensive SOAP Template (Word document)

Note:To access the online resources included with the textbook, you need to complete the FREE online registration that is located at https://evolve.elsevier.com/cs/product/9780323172660?role=student. To Register to View the Content 1.      Go to https://evolve.elsevier.com/cs/product/9780323172660?role=student 2.      Enter the name of the textbook, Seidel’s Guide to Physical Examination (name of text without the edition number) in the Search textbox. 3.      Complete the registration process. To View the Content for this Textbook 1.      Go to https://evolve.elsevier.com/. 2.      Click on Student Site. 3.      Type in yourUsernameandPassword. 4.      Click on theLoginbutton. 5.      Click on the plus sign icon for Resources on the left side of the screen. 6.      Click on the name of the textbookfor this course. 7.      Expand the menu on the left to locate all the chapters. 8.      Navigate to the desired content (checklists, videos, animations, etc.). Note: Clicking on the URLs in the APA citations for the Resources from the textbook will notlink directly to the desired online content. Use the online menu to navigate to the desired content.

NURS 6512 Week 4 Discussion: Differential Diagnosis for Skin Conditions Media

Online media for Seidel’s Guide to Physical Examination

In addition to this week’s media, it is highly recommended that you access and view the online resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 8 that relate to the assessment of the skin, hair, and nails.

The following suturing tutorials provide instruction on the basic interrupted suture, as well as the vertical and horizontal mattress suturing techniques:

• Tulane Center for Advanced Medical Simulation & Team Training. (2010, July 8). Suturing technique.Retrieved from https://www.youtube.com/watch?v=c-LDmCVtL0o
• Mikheil. (2014, April 22). Basic suturing: Simple, interrupted, vertical mattress, horizontal mattress. Retrieved from https://www.youtube.com/watch?v=MFP90aQvEVM

•  LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.

o   Chapter 6, “The Skin and Nails”

In this chapter, the authors provide guidelines and procedures to aid in the diagnosis of skin and nail disorders. The chapter supplies descriptions and pictures of common skin and nail conditions.

•  Ethicon, Inc. (n.d.a). Absorbable synthetic suture material. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/absorbable_suture_chart.pdf
• Ethicon, Inc. (2006). Dermabond topical skin adhesive application technique. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_application_poster.pdf
• Ethicon, Inc. (2001). Ethicon needle sales types. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/needle_template.pdf
• Ethicon, Inc. (n.d.b). Ethicon sutures. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/suture_chart_ethicon.pdf
• Ethicon, Inc. (2002). How to care for your wound after it’s treated with Dermabond topical skin adhesive. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_wound_care.pdf
• Ethicon, Inc. (2005). Knot tying manual. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/knot_tying_manual.pdf
• Ethicon, Inc. (n.d.c). Wound closure manual. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/ethicon_wound_closure_manual.pdf

Please proceed to the Discussion.

NURS 6512 Week 4 Discussion: Differential Diagnosis for Skin Conditions

Comprehensive SOAP Exemplar

Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.

Patient Initials: _______ Age: _______ Gender: _______

SUBJECTIVE DATA:

Chief Complaint (CC): Coughing up phlegm and fever

History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.

Medications:

1.) Lisinopril 10mg daily

2.) Combivent 2 puffs every 6 hours as needed

3.) Serovent daily

4.) Salmeterol daily

5.) Over-the-counter Ibuprofen 200mg -2 PO as needed

6.) Over-the-counter Benefiber

7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms

Allergies:

Sulfa drugs – rash

Past Medical History (PMH):

1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.

2.) Hypertension – well controlled

3.) Gastroesophageal reflux (GERD) – quiet, on no medication

4.) Osteopenia

5.) Allergic rhinitis

Past Surgical History (PSH):

1.) Cholecystectomy 1994

2.) Total abdominal hysterectomy (TAH) 1998

Sexual/Reproductive History:

Heterosexual

G1P1A0

Non-menstruating – TAH 1998

Personal/Social History:

She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.

Immunization History:

Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.

Significant Family History:

Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.

Lifestyle:

She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.

She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.

Review of Systems:

General: + fatigue since the illness started; + fever, no chills or night sweats; no recent weight gains of losses of significance

HEENT: No changes in vision or hearing; she does wear glasses, and her last eye exam was 1 ½ years ago. She reported no history of glaucoma, diplopia, floaters, excessive tearing, or photophobia. She does have bilateral small cataracts that are being followed by her ophthalmologist. She has had no recent ear infections, tinnitus, or discharge from the ears. She reported her sense of smell is intact. She has not had any episodes of epistaxis. She does not have a history of nasal polyps or recent sinus infection. She has a history of allergic rhinitis that is seasonal. Her last dental exam was 3/2014. She denied ulceration, lesions, gingivitis, gum bleeding, and has no dental appliances. She has had no difficulty chewing or swallowing.

Neck: No pain, injury, or history of disc disease or compression. Her last Bone Mineral density (BMD) test was 2013 and showed mild osteopenia, she said.

Breasts: No reports of breast changes. No history of lesions, masses, or rashes. No history of abnormal mammograms.

Respiratory: + cough and sputum production (see HPI); denied hemoptysis, no difficulty breathing at rest; + dyspnea on exertion; she has history of COPD and community acquired pneumonia 2012. Last PPD was 2013. Last CXR – 1 month ago.

CV: No chest discomfort, palpitations, history of murmur; no history of arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication. Date of last ECG/cardiac work up is unknown by patient.

GI: No nausea or vomiting, reflux controlled. No abd pain, no changes in bowel/bladder pattern. She uses fiber as a daily laxative to prevent constipation.

GU: No change in her urinary pattern, dysuria, or incontinence. She is heterosexual. She has had a total abd hysterectomy. No history of STDs or HPV. She has not been sexually active since the death of her husband.

MS: She has no arthralgia/myalgia, no arthritis, gout or limitation in her range of motion by report. No history of trauma or fractures.

Psych: No history of anxiety or depression. No sleep disturbance, delusions, or mental health history. She denied suicidal/homicidal history.

Neuro: No syncopal episodes or dizziness, no paresthesia, headaches. No change in memory or thinking patterns; no twitches or abnormal movements; no history of gait disturbance or problems with coordination. No falls or seizure history.

Integument/Heme/Lymph: No rashes, itching, or bruising. She uses lotion to prevent dry skin. She has no history of skin cancer or lesion removal. She has no bleeding disorders, clotting difficulties, or history of transfusions.

Endocrine: No endocrine symptoms or hormone therapies.

Allergic/Immunologic: Has hx of allergic rhinitis, but no known immune deficiencies. Her last HIV test was 10 years ago.

OBJECTIVE DATA

Physical Exam:

Vital signs: B/P 110/72, left arm, sitting, regular cuff; P 70 and regular; T 98.3 orally; RR 16; non-labored; Wt: 115 lbs; Ht: 5’2; BMI 21

General: A&O x3, NAD, appears mildly uncomfortable

HEENT: PERRLA, EOMI, oronasopharynx is clear

Neck: Carotids no bruit, jvd or tmegally

Chest/Lungs: CTA AP&L

Heart/Peripheral Vascular: RRR without murmur, rub, or gallop; pulses+2 bilat pedal and +2 radial

ABD: benign, nabs x 4, no organomegaly; mild suprapubic tenderness – diffuse – no rebound

Genital/Rectal: external genitalia intact, no cervical motion tenderness, no adnexal masses.

Musculoskeletal: symmetric muscle development – some age-related atrophy; muscle strengths 5/5 all groups

Neuro: CN II – XII grossly intact, DTR’s intact

Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes

ASSESSMENT:

Lab Tests and Results:

CBC – WBC 15,000 with + left shift

SAO2 – 98%

Diagnostics:

Lab:

Radiology:

CXR – cardiomegaly with air trapping and increased AP diameter

ECG

Normal sinus rhythm

Differential Diagnosis (DDx):

1.) Acute Bronchitis

2.) Pulmonary Embolis

3.) Lung Cancer

Diagnoses/Client Problems:

1.) COPD

2.) HTN, controlled

3.) Tobacco abuse – 40-pack-a-year history

4.) Allergy to sulfa drugs – rash

5.) GERD – quiet, on no current medication

PLAN: [This section is not required for the assignments in this course but will be required for future courses.]

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