Differential Diagnosis for Skin Conditions Assignment

Differential Diagnosis for Skin Conditions Assignment

Assignment 1: 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.Differential Diagnosis for Skin Conditions Assignment

In this 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.

To prepare:

Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Assignment.
Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?Differential Diagnosis for Skin Conditions Assignment
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.
Download the SOAP Template found in this week’s Learning Resources.
To complete:

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. Differential Diagnosis for Skin Conditions Assignment.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 3 different references from current evidence based literature.Differential Diagnosis for Skin Conditions Assignment

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Comprehensive SOAP Template

Patient Initials: _______                 Age: _______                                   Gender: _______

 

Note: The mnemonic below is included for your reference and should be removed before the submission of your final note.

O = onset of symptom (acute/gradual)

L= location

D= duration (recent/chronic)

C= character

A= associated symptoms/aggravating factors

R= relieving factors

T= treatments previously tried – response? Why discontinued?

S= severity

 

SUBJECTIVE DATA: Include what the patient tells you, but organize the information.Differential Diagnosis for Skin Conditions Assignment

 

Chief Complaint (CC): In just a few words, explain why the patient came to the clinic.

 

History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.Differential Diagnosis for Skin Conditions Assignment. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list:

  1. Location
  2. Quality
  3. Quantity or severity
  4. Timing, including onset, duration, and frequency
  5. Setting in which it occurs
  6. Factors that have aggravated or relieved the symptom
  7. Associated manifestations

 

Medications: Include over-the-counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.

 

Allergies: Include specific reactions to medications, foods, insects, and environmental factors. Identify if it is an allergy or intolerance.

 

Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations., and

 

Past Surgical History (PSH): Include dates, indications, and types of operations.Differential Diagnosis for Skin Conditions Assignment

 

Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, sexual function, and. risky sexual behaviors.

 

Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.

 

Immunization History: Include last Tdap, Flu, pneumonia, etc.

 

Significant Family History: Include history of parents, grandparents, siblings, and children.

 

Lifestyle: Include cultural factors, economic factors, safety, and support systems and sexual preference.

 

Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses).Differential Diagnosis for Skin Conditions Assignment. Remember that the information you include in this section is based on what the patient tells you. To ensure that you include all essentials in your case, refer to Chapter 2 of the Sullivan text

General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.

            HEENT:

Neck:

            Breasts:

            Respiratory:

            Cardiovascular/Peripheral Vascular:

            Gastrointestinal:

            Genitourinary:

            Musculoskeletal:

            Psychiatric:

            Neurological:

            Skin:  Hematologic:

            Endocrine:

            Allergic/Immunologic:

 

OBJECTIVE DATA: From head-to-toe, include what you see, hear, and feel when doing your physical exam.. Do not use “WNL” or “normal.” You must describe what you see.

 

Physical Exam:

Vital signs: Include vital signs, ht, wt, and BMI. Pulse Ox, Pain level.

General: Include general state of health, posture, motor activity, and gait. This may also include dress, grooming, hygiene, odors of body or breath, facial expression, manner, level of consciousness, and affect and reactions to people and things.Differential Diagnosis for Skin Conditions Assignment

HEENT:

Neck:

Chest

Lungs:

Heart

Peripheral Vascular: Abdomen:

Genital/Rectal:

Musculoskeletal:

Neurological:

Skin:

Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses IF YOU ALREADY HAVE RESULTS.

 

ASSESSMENT: List your priority diagnosis(es). For each priority diagnosis, list at least three differential diagnoses, each of which must be supported with evidence and guidelines. For holistic care, you need to include previous diagnoses and indicate whether these are controlled or not controlled. These should also be included in your treatment plan.

 

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

 

Treatment Plan: If applicable, include both pharmacological and non-pharmacological strategies, alternative therapies, follow-up recommendations, referrals, consultations, and any additional labs, x-ray, or other diagnostics. Support the treatment plan with evidence and guidelines.

 

Health Promotion: Include exercise, diet, and safety recommendations, as well as any other health promotion strategies for the patient/family. Support the health promotion recommendations and strategies with evidence and guidelines.Differential Diagnosis for Skin Conditions Assignment

 

Disease Prevention: As appropriate for the patient’s age, include disease prevention recommendations and strategies such as fasting lipid profile, mammography, colonoscopy, immunizations, etc. Support the disease prevention recommendations and strategies with evidence and guidelines.

 

REFLECTION: Reflect on your clinical experience, and consider the following questions: What did you learn from this experience? What would you do differently? Do you agree with your preceptor based on the evidence? This is worth 25 points!

 

References: Should use two peer-reviewed journal articles or references to support your reflection and differentials as well as any textbooks used.Differential Diagnosis for Skin Conditions Assignment

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.Differential Diagnosis for Skin Conditions Assignment. 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:

  • Lisinopril 10mg daily
  • Combivent 2 puffs every 6 hours as needed
  • Serovent daily
  • Salmeterol daily
  • Over-the-counter Ibuprofen 200mg -2 PO as needed
  • Over-the-counter Benefiber
  • 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.Differential Diagnosis for Skin Conditions Assignment

2.) Hypertension – well controlled

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

4.) Osteopenia

5.) Allergic rhinitis

 

Past Surgical History (PSH):

  • Cholecystectomy 1994
  • 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. Differential Diagnosis for Skin Conditions Assignment.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. Differential Diagnosis for Skin Conditions Assignment.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. Differential Diagnosis for Skin Conditions Assignment.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

Differential Diagnosis for Skin Conditions Assignment

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):

  • Acute Bronchitis
  • Pulmonary Embolis
  • 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.]Differential Diagnosis for Skin Conditions Assignment

Rubric Detail

 

Excellent             Good     Fair         Poor

 

Quality of Work Submitted: The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.    

27 (27%) - 30 (30%)

Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.

24 (24%) - 26 (26%)

Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.Differential Diagnosis for Skin Conditions Assignment

21 (21%) - 23 (23%)

Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.

0 (0%) - 20 (20%)

Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.

 

 

Assimilation and Synthesis of Ideas: The extent to which the work reflects the student's ability to: Understand and interpret the assignment's key concepts.            

27 (27%) - 30 (30%)

Demonstrates the ability to critically appraise and intellectually explore key concepts.

24 (24%) - 26 (26%)

Demonstrates a clear understanding of key concepts.

21 (21%) - 23 (23%)

Shows some degree of understanding of key concepts.

0 (0%) - 20 (20%)

Shows a lack of understanding of key concepts, deviates from topics.

 

 

Assimilation and Synthesis of Ideas: The extent to which the work reflects the student's ability to: Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.               

18 (18%) - 20 (20%)

Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to support point of view.

16 (16%) - 17 (17%)

Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view.

14 (14%) - 15 (15%)

Minimally includes and integrates specific information from 2-3 resources to support major points and point of view.

0 (0%) - 13 (13%)Differential Diagnosis for Skin Conditions Assignment

Includes and integrates specific information from 0 to 1 resource to support major points and point of view.

 

 

Written Expression and Formatting Paragraph/Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Differential Diagnosis for Skin Conditions Assignment.Sentences are clearly structured and carefully focused--neither long and rambling nor short and lacking substance.     

9 (9%) - 10 (10%)

Paragraphs/Sentences follow writing standards for structure, flow, continuity and clarity

8 (8%) - 8 (8%)

Paragraphs/sentences follow writing standards for structure, flow, continuity and clarity 80% of the time.

7 (7%) - 7 (7%)

Paragraphs/sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time.

0 (0%) - 6 (6%)

Paragraphs/sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time.

 

 

Written Expression and Formatting English writing standards: Correct grammar, mechanics, and proper punctuation.     

5 (5%) - 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

3 (3%) - 4 (4%)

Contains a few (1-2) grammar, spelling, and punctuation errors.

2 (2%) - 2 (2%)

Contains several (3-4) grammar, spelling, and punctuation errors.

0 (0%) - 1 (1%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

 

 

Written Expression and Formatting The assignment follows parenthetical/in-text citations, and at least 3 evidenced based references are listed.      

5 (5%) - 5 (5%)

Contains parenthetical/in-text citations and at least 3 evidenced based references are listed.

3 (3%) - 4 (4%)

Contains parenthetical/in-text citations and at least 2 evidenced based references are listed

2 (2%) - 2 (2%)

Contains parenthetical/in-text citations and at least 1 evidenced based reference is listed

0 (0%) - 1 (1%)

Contains no parenthetical/in-text citations and 0 evidenced based references listed.Differential Diagnosis for Skin Conditions Assignment