NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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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?

· 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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

· 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. Remember that not all comprehensive SOAP data are included in every patient case.NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

· 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.  NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

Chapter 8 : Skin, Hair, and Nails

RTF-downloadable Physical Exam Summary

This review discusses examination of the skin, hair, and nails.

Before the exam, gather the necessary equipment: a clear, flexible centimeter ruler; flashlight with transilluminator; handheld magnifying glass; and Wood’s lamp.

To examine the skin, perform the following.

Use inspection and palpation to examine the skin. Make sure you have adequate lighting, preferably with daylight.

 

  • Inspect the skin in two ways.
  • First, perform a brief overall visual sweep of the entire skin surface. This helps identify the distribution and extent of any lesions, assess skin symmetry, detect differences between body areas, and compare sun-exposed areas to areas that were not exposed to the sun. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment
  • Second, observe the skin as each part of the body is examined.
  • During inspection, expose the skin completely. As you finish inspecting each area, remember to redrape or cover the patient for warmth and modesty.

 

When evaluating the skin (and mucous membranes) in each part of the body, note six characteristics.

NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

  • The first characteristic is color, which can vary from dark brown to light tan with pink or yellow overtones.
  • The second characteristic is uniformity. The skin should be uniform in color overall with no localized areas of discoloration. However, the skin may have sun-darkened areas as well as darker skin around the knees and elbows.
  • The third characteristic is thickness, which varies over the body. The thinnest skin is on the eyelids. The thickest is in areas of pressure or rubbing, such as the soles and palms.
  • The fourth characteristic is symmetry. Normally, the skin appears bilaterally symmetrical.
  • The fifth characteristic is hygiene, which may contribute to skin condition. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment
  • The final characteristic is the presence of any lesions, which are any pathologic skin change or occurrence.
  • During inspection, also palpate the skin to determine five characteristics.
  • First, palpate to detect moisture. Minimal perspiration or oiliness should be present. Even intertriginous areas should display little dampness.
  • Second, use the dorsal surface of your hands to assess temperature. The skin may feel cool to warm, but should be bilaterally symmetrical.
  • Third, check the texture, which should be smooth, soft, and even. However, roughness on exposed skin or areas of pressure may occur.
  • Finally, evaluate the last two characteristics, turgor and mobility, by pinching up a small section of skin on the forearm or sternum, releasing it, and watching for it to immediately return to place.
  • If a lesion is present, inspect and palpate it fully. Remember: Not all lesions are cause for concern, but they should all be examined. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

 

First, describe its size (measured in centimeters in all dimensions), shape, color, texture, elevation or depression, and attachment at the base.

 

  • If the lesion has exudates, note their color, odor, amount, and consistency.
  • If there is more than one lesion, describes their configuration as annular (or ring-shaped), arciform (or bow-shaped), grouped, linear, or diffuse.
  • Also record the lesions’ location and distribution, noting whether they appear generalized or localized, affect a specific body region, form a pattern, and are discrete or confluent.
  • Use a light and magnifying glass to determine the lesion’s subtle details, such as color, elevation, and borders.
  • To see if fluid is present in a cyst or mass, transilluminate it in a darkened room. A fluid-filled lesion transilluminates with a red glow; a solid lesion does not.
  • To further identify a lesion, shines a Wood’s lamp on the area in a darkened room. Look for the well-demarcated hypopigmentation of vitiligo, the hyperpigmentation of café au lait spots, and the yellow-green fluorescence that suggests fungal infection. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

 

To examine the hair, perform the following.

  • To assess the hair, palpate its texture. Scalp hair may be coarse or fine, and curly or straight. It should be shiny, smooth, and resilient.
  • During palpation, also inspect the hair for three characteristics: color, distribution, and quantity.
  • Hair color ranges from very light blond to black to gray.
  • Hair distribution and quantity varies with genetics. Hair commonly appears on the scalp, lower face, neck, nares, ears, chest, axillae, back, shoulders, arms, legs, toes, pubic area, and around the nipples.

To examine the nails, perform the following.

  • Use inspection and palpation to assess the nails. Ask yourself: Are the nails dirty, bitten to the quick, or unkempt? Or are they clean, smooth, and neat? The condition of the hair and nails provides clues to the patient’s self-care, emotions, and social integration. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment
  • I nspect the nails for five characteristics: color, length, condition, configuration, symmetry, and cleanliness.
  • Although nail shape and opacity can vary greatly, the nail bed color should be pink. Pigment deposits may appear in the nail beds of dark-skinned patients.
  • The nail length and condition should be appropriate—not bitten down to the quick. The nail edges should be smooth and rounded, with no peeling or jagged, broken, or bitten nail edges or cuticles.
  • In configuration, the nail plate should appear smooth and flat or slightly convex. It should have no ridges, grooves, depressions, or pits. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment
  • The nails should appear bilaterally symmetrical.
  • And the nails should be clean, smooth, and neat.
  • Measure the nail-base angle by placing a ruler across the nail and dorsal surface of the finger and checking the angle formed by the proximal nail fold and nail plate.
  • The nail-base angle should measure 160 degrees.
  • If the nail-base angle is 180 degrees or more, clubbing is present, which suggests a cardiopulmonary or other disorder. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment
  • Inspect and palpate the proximal and lateral nail folds for redness, swelling, pain, and exudate as well as warts, cysts, and tumors. Pain usually accompanies ingrown nails or infections.
  • Palpate the nail plate for four characteristics: texture, firmness, thickness, and adherence to the nail bed.
  • The texture of the nail plate should be hard and smooth.
  • The nail base should be firm—not boggy.
  • The nail thickness should be uniform. Thickened nails may result from tight-fitting shoes, chronic trauma, or a fungal infection. Nail thinning may accompany a nail disease.
  • The nail should adhere to the nail bed when you gently squeeze the patient’s nail between your thumb and fingerpad. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

Comprehensive SOAP Template

This template is for a full history and physical. For this course include only areas that are related to the case.

Patient Initials: _______ Age: _______ Gender: _______

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

L =location

O= onset

C= character

A= associated signs and symptoms

T= timing

E= exacerbating/relieving factors

S= severity

SUBJECTIVE DATA: Include what the patient tells you, but organize the information.

Chief Complaint (CC): In just a few words, explain why the patient came to the clinic. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. 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. If the CC was “headache”, the LOCATES for the HPI might look like the following example: NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Medications: Include over-the-counter, vitamin, and herbal supplements. List each one by name with dosage and frequency. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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.

Past Surgical History (PSH): Include dates, indications, and types of operations.

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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). Remember that the information you include in this section is based on what the patient tells you so ensure that you include all essentials in your case (refer to Chapter 2 of the Sullivan text). NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. You only need to examine the systems that are pertinent to the CC, HPI, and History unless you are doing a total H&P- only in this course. Do not use “WNL” or “normal.” You must describe what you see. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

Physical Exam:

Vital signs: Include vital signs, ht, wt, and BMI.

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. NURS 6512 Week 4 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.

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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

REFLECTION: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. 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? NURS 6512 Week 4 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. 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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. NURS 6512 Week 4 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):

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment 2

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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: NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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

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PLAN: [This section is not required for the assignments in this course but will be required for future courses.] NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

ADULT EXAMINATION CHECKLIST

Guide for Skin, Hair, and Nails

Check (✔) if normal, * if abnormal, Ø if absent

Subjective Data

Skin Hair ______ Eruptions ______ Use of dyes, permanents ______ Lesions/sores/rashes ______ Changes in: ______ Color changes ______ Amount ______ Texture changes ______ Texture ______ Bruising ______ Character ______ Infections ______ Hair loss ______ Birthmarks ______ Hair care: ______ Skin growths ______ Shampoo ______ Acne ______ Conditioner ______ Moles ______ Distribution ______ Itching ______ Body hair ______ Masses ______ Hair on head ______ Excessive sweating ______ Shaving ______ Skin care ______ Face

______ Bathing ______ Axillary ______ Soaps ______ Legs ______ Lotions

______ Pigmentation changes or Nails discoloration ______ Changes in appearance

______ Splitting ______ Cracking ______ Peeling ______ Discoloration

______ Texture ______ Nail care

Detail those marked abnormal:  NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment 6512_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

Objective Data: Inspection and Palpation

Skin Primary Lesions Configuration of Lesions ______ Grouped (clustered) ______ Macule (flat, < 1 cm) ______ Herpetiform (Zosteriform)—nerve ______ Patch (> 1 cm) ______ Linear (line) ______ Papule (palpable, < 1 cm) ______ Annular (circle) ______ Plaque (> 1 cm) ______ Polycyclic (multiple circles) ______ Nodule (solid, raised, deep, 1-2 cm) ______ Arciform (bow-shaped) ______ Tumor (2 cm) ______ Reticular (lesions meshed) ______ Vesicle (fluid-filled, < 1 cm) ______ Confluent (lesions merged) ______ Bulla (> 1 cm) ______ Discrete (individual) ______ Pustule (purulent vesicle/bulla) ______ Iris/target (concentric rings) ______ Wheal (cutaneous edema) ______ Gyrate (spiral) ______ Cyst (encapsulated) NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

Color of Lesions Secondary Lesions __________________________________ ______ Scale (loose surface epithelium) __________________________________ ______ Crust (dried surface fluids) __________________________________ ______ Excoriation (scratch)

______ Erosion (loss of epidermis) Description of Lesions ______ Scar __________________________________ ______ Ulcer (loss of epidermis, dermis) __________________________________ ______ Atrophy __________________________________ ______ Keloid (enlarged scar)

______ Fissure (crack) Texture and Firmness ______ Lichenification (thickened, with irrita- __________________________________ tion) __________________________________ __________________________________

Distribution __________________________________ __________________________________ __________________________________

NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

Vascular Lesions ______ Purpura (red/purple, > 0.5 cm) ______ Mongolian spots ______ Petechiae (< 0.5 cm) ______ Pattern injuries ______ Ecchymosis (bruise) Location ________________________ ______ Spider angioma ________________________________

(red body, radiating legs) ________________________________ ______ Venous star (blue spider, linear) ________________________________ ______ Telangiectasia ______ Dry skin

(dilated capillaries) Location ________________________ ______ Capillary hemangioma ________________________________

(red, irregular patches) ________________________________ ______ Cherry angioma ________________________________ ______ Strawberry angioma ______ Skin turgor ______ Port-wine stain ______ Tenting

______ < 2 sec Other Skin Lesions ______ 2-3 sec ______ Corn ______ 3-4 sec ______ Callus ______ > 4 sec ______ Cutaneous tag ______ Contact dermatitis

Other Skin Conditions Detail those marked abnormal: ______ Pallor ______________________________________

Location __________________ ______________________________________ __________________________ ______________________________________ __________________________ ______________________________________

______ Erythema ______________________________________ Location __________________ ______________________________________ __________________________ ______________________________________ __________________________ ______________________________________

______ Cyanosis Location __________________ Hair: Inspection and Palpation __________________________ ______ Texture _________________________ __________________________ ______ Color ___________________________

______ Jaundice ______ Distribution ______ Vitiligo Body ___________________________ ______ Location __________________ ________________________________

__________________________ Head ___________________________ __________________________ ________________________________

________________________________ ______ Clean shaven

Thickness _______________________ ________________________________

______ Dryness

NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

______ Inflammation Detail those marked abnormal: ______ Alopecia ______________________________________

____________________________ ______________________________________ ______________________________________

Nails: Inspection and Palpation ______________________________________ ______ Color _______________________ ______________________________________ ______ Length______________________ ______________________________________ ______ Clean ______________________________________ ______ Pigment deposits ______________________________________ ______ Bands ______________________________________ ______ Streaks ______________________________________ ______ Spots ______________________________________ ______ Smooth nail edges ______________________________________ ______ Ridging ______________________________________ ______ Grooves ______________________________________ ______ Pitting ______________________________________ ______ Curved, smooth nail plate ______________________________________ ______ Nail base angle—160 degrees ______________________________________ ______ Adheres to nail bed ______________________________________ ______ Clubbing ______________________________________

NURS_6512_Week_4_Assignment1_Rubric

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Points:

Points Range: 2 (2%) - 2 (2%)

Contains several (3-4) grammar, spelling, and punctuation errors. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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Points:

Points Range: 0 (0%) - 1 (1%)

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

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

Points Range: 5 (5%) - 5 (5%)

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

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Points:

Points Range: 3 (3%) - 4 (4%)

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

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

Points:

Points Range: 2 (2%) - 2 (2%)

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

Feedback:

Points:

Points Range: 0 (0%) - 1 (1%)

Contains no parenthetical/in-text citations and 0 evidenced based references listed.

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

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

Levels of Achievement:

Excellent 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.

Good 24 (24%) - 26 (26%) NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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

Fair 21 (21%) - 23 (23%) Assignment : Differential Diagnosis for Skin Conditions NURS 6512

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

Poor 0 (0%) - 20 (20%)

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

Feedback:

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.--

Levels of Achievement:

Excellent 27 (27%) - 30 (30%)

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

Good 24 (24%) - 26 (26%)

Demonstrates a clear understanding of key concepts.

Fair 21 (21%) - 23 (23%) Assignment : Differential Diagnosis for Skin Conditions NURS 6512

Shows some degree of understanding of key concepts.

Poor 0 (0%) - 20 (20%)

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

Feedback:

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.--

Levels of Achievement:

Excellent 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.

Good 16 (16%) - 17 (17%) NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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

Fair 14 (14%) - 15 (15%)

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

Poor 0 (0%) - 13 (13%)

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

Feedback:

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

Levels of Achievement: NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

Excellent 9 (9%) - 10 (10%)

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

Good 8 (8%) - 8 (8%)

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

Fair 7 (7%) - 7 (7%)

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

Poor 0 (0%) - 6 (6%)

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

Feedback:

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

Levels of Achievement:

Excellent 5 (5%) - 5 (5%) NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

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

Good 3 (3%) - 4 (4%)

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

Fair 2 (2%) - 2 (2%)

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

Poor 0 (0%) - 1 (1%)

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

Feedback:

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

Levels of Achievement:

Excellent 5 (5%) - 5 (5%)

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

Good 3 (3%) - 4 (4%)

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

Fair 2 (2%) - 2 (2%)

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

Poor 0 (0%) - 1 (1%) NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment

Contains no parenthetical/in-text citations and 0 evidenced based references listed.

Feedback:

Total Points: 100

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NURS 6512 Week 4 Differential Diagnosis for Skin Conditions Assignment