NURS 6512 Week 4 Lab Assignment: Differential Diagnosis for Skin Conditions

NURS 6512 Week 4 Lab Assignment: Differential Diagnosis for Skin Conditions

NURS 6512 Week 4 Lab Assignment: 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 Lab Assignment, 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.

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To Prepare
Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.
Consider the abnormal physical characteristics you observe in the graphic 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.
Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.
The Lab Assignment
Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. 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.
Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.
By Day 7 of Week 4
Submit your Lab Assignment.

Submission and Grading Information

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 9, “Skin, Hair, and Nails”

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.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.

This section explains the procedural knowledge needed prior to performing various dermatological procedures.

Chapter 1, “Punch Biopsy”

Chapter 2, “Skin Biopsy”

Chapter 10, “Nail Removal”

Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”

Chapter 16, “Skin Tag (Acrochordon) Removal”

Chapter 22, “Suture Insertion”

Chapter 24, “Suture Removal”

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 28, “Rashes and Skin Lesions”

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.

Note: Download and use the Student Checklist and the Key Points when you conduct your assessment of the skin, hair, and nails in this Week’s Lab Assignment.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Student checklist. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1 and 3)
VisualDx. (2021). Clinical decision support: For professionals. Retrieved July 16, 2021, from http://www.skinsight.com/professionals

This interactive website allows you to explore skin conditions according to age, gender, and area of the body.

Bonifant, H., & Holloway, S. (2019). A review of the effects of ageing on skin integrity and wound healing. British Journal of Community Nursing, 24(Sup3), S28–S33. https://doi.org/10.12968/bjcn.2019.24.sup3.s28

Document: Skin Conditions (Word document)

This document contains 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)

A Sample Of This Assignment Written By One Of Our Top-rated Writers

Differential Diagnosis for Skin Conditions

Patient Initials: O.C.       Age:  41      Gender: Male

SUBJECTIVE DATA:

Skin Condition #5

Chief Complaint: “I have a dry rash, which is peeling, itching, and it is worsening.”

 History of Present Illness (HPI):

Mr O. C. is a 41yo male who reports flaky, scaly, and patchy skin in his upper body parts, particularly his neck and chest. The client discloses experiencing these symptoms for the past 2-3 weeks. He adds that symptoms worsen over time. The client denies changing products applied to the skin. The client denies any pain but reports discomfort. O. C reports applying Aveeno cream on his skin relieves dryness and itching. The cream also relieves discomfort temporarily.

Medications:

• Aveeno cream is applied on the dry skin to relieve dryness, itching, and discomfort.
• Aspirin 81 mg P.O taken once daily.

Allergies:

Penicillin allergy diagnosed during childhood

Past Medical History (PMH):

No past medical condition

Past Surgical History (PSH): 

Tonsillectomy

Sexual/Reproductive History:

No information provided

Personal/Social History: 

The client denies tobacco use. He is a social drinker and only takes alcohol upon going out with friends. He reports being married to one partner.

Immunization History:

He reveals all his immunizations are up to date. The client reports receiving the flu vaccine and pneumonia immunization in 2017 and 2011, respectively.  

Significant Family History: 

The client reports that his father is an alcoholic and was diagnosed with D.M. type 2. His mother has high blood pressure.

Lifestyle: 

He was working in a manufacturing plant before being fired.

Diet:  Denies changes in appetite.  

ROS

General: Denies weight gain.

HEENT:  The client denies scars on the head, vision change, hearing difficulties, nasal congestion, swallowing difficulties, or pain in the neck.  

Neck:  The client reveals dry and scaly skin, which is covered with silvery scales. 

Respiratory:  Denies cough.

Cardiovascular/Peripheral Vascular:  Denies chest pain.

Gastrointestinal: Reports experiencing indigestion and reflux occasionally.

Genitourinary: Denies incontinence.    

Musculoskeletal:  Denies swollen joints.

Psychiatric:  Reports anxiety, distress, and insomnia.

Neurological:  Denies dizziness.

Skin: Reports scaly, dry, and patchy white lesions, which have surrounded the neck and torso region. The client further discloses four bumps on his back. Denies scaly and dry skin in other parts of the body.

Hematologic:  Denies bleeding.

 Endocrine:  Denies heat or cold intolerance

Allergic/Immunologic: Reports experiencing allergies occasionally.

OBJECTIVE DATA:

Physical Exam:

Vital signs:  B/P 114/71; P 70; T 98.0; RR 12; Wt: 207 lbs; Ht: 5’10”; BMI 24.5.   

General: The client is a 43yo male who presented to the clinic with flaky, scaly, and patchy skin in his upper body parts, particularly his neck and chest. He is well-nourished and groomed. He is alert and oriented to places, people, events, and situations. He is attentive and maintains eye contact throughout the clinical interview. His judgment is good, and he seems to be future-oriented. He appears to be in mild distress and anxious.

HEENT: No head injuries, pupils not dilated, clear canals in both ears, no nasal drainage, and no swelling in the throat. 

Neck: Flaky, scaly, and patchy white skin on the neck.

Chest: Symmetric chest movement.

Lungs: No wheezing sound.  

Heart: No murmurs.

Peripheral Vascular: No discolouration seen on the lower extremities

Genital/Rectal: No blood spots in the urine or stool.

Musculoskeletal: Depicts normal motor strength

Neurological: He seems to be in mild distress and anxious. He reports insomnia.

Skin: Flaky, patchy, and scaly lesions in areas surrounding his neck and chest and some bumps in the back region.

ASSESSMENT:

1. Psoriasis – Primary diagnosis
2. Eczema
3. Subacute Cutaneous Lupus Erythematosus (SCLE)
4. Pityriasis Rosea

The primary diagnosis for this client is psoriasis. According to Agozzino et al. (2017), psoriasis is characterized by various clinical manifestations, including red and small bumps filled with pus. These bumps cause scaly, dry, and itchy patches covered with silvery scales. The client reports flaky, patchy, dry, and scaly lesions around his chest and neck. Therefore, psoriasis qualifies as the client’s primary diagnosis. The second potential diagnosis for this client is eczema. This skin condition is mainly characterized by dry and itching skin. In most cases, these symptoms become severe at night. The client reports itching and dry skin, making Eczema a potential diagnosis. SCLE is another potential diagnosis for this client. This skin condition is characterized by rashes that may appear on the back, arms, neck, or chest (Nutan & Ortega-Loayza, 2017). The client has reported rashes surrounding his neck and chest, making SCLE a potential diagnosis. Lastly, the client can be diagnosed with Pityriasis Rosea. According to Villalon-Gomez (2018), people with this skin condition report scaly spots in various body parts, particularly the chest, back, or abdomen. These spots then spread to form an itching patch that worsens over time. The client reports itching, dry, and scaly rashes surrounding the neck and chest. For this reason, Pityriasis Rosea qualifies as a potential diagnosis for this client.

References

Agozzino, M., Noal, C., Lacarrubba, F., & Ardigò, M. (2017). Monitoring treatment response in Psoriasis: current perspectives on the clinical utility of reflectance confocal microscopy. Psoriasis; 7:27-34.

Nutan, F & Ortega-Loayza, A, G. (2017). Cutaneous Lupus: A Brief Review of Old and New Medical Therapeutic Options. J Investig Dermatol Symp Proc; 18(2):S64-S68

Villalon-Gomez, J. M. (2018). Pityriasis rosea: diagnosis and treatment. American family physician, 97(1), 38-44.