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[ANSWERED 2022] Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions

Assignment 1: 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.

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.
  • Week 4: Assessment of the Skin, Hair, and Nails

Something as small and simple as a mole or a discolored toenail can offer meaningful clues about a patient’s health. Abnormalities in skin, hair, and nails can provide non-invasive external clues to internal disorders or even prove to be disorders themselves. Being able to evaluate such abnormalities of the skin, hair, and nails is a diagnostic benefit for any nurse conducting health assessments.

This week, you will explore how to assess the skin, hair, and nails, as well as how to evaluate abnormal skin findings.

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.

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.
  • Week 4: Assessment of the Skin, Hair, and Nails

Something as small and simple as a mole or a discolored toenail can offer meaningful clues about a patient’s health. Abnormalities in skin, hair, and nails can provide non-invasive external clues to internal disorders or even prove to be disorders themselves. Being able to evaluate such abnormalities of the skin, hair, and nails is a diagnostic benefit for any nurse conducting health assessments.

This week, you will explore how to assess the skin, hair, and nails, as well as how to evaluate abnormal skin findings.

Expert Answer and Explanation

Comprehensive Soap Note

Subjective Data 

Chief Complaint: “The client in image 1 complains of red patches in the feet, neck, and upper chest.

History of Present Illness:

Mrs. AD is a 60-years-old while male patient who presented today complaining of red patches in the feet, neck, cracked, and dry skin. The patient notes that his skin has been itching and dry for the past two weeks. The itching may often increase during the night. He also feels a lot of pain. When asked to state the level of her pain, he scaled it in a scale of 8/10. He reports that the red patches have affected his upper chest, neck, feet, and knees.

Medication:

Amlodipine 5mg/day PO and Hydrocortisone (OTC).

Allergies: No allergies. 

Past Medical History:  Well-controlled HBP.

Past Surgical History: Negative for surgery.

OB/GYN History: N/A

Personal/Social History: The patient drinks two beers a night and smokes three packets of cigarettes per week. He also wears seatbelt when in a car and does not use phones when driving.

Immunizations: He was immunized for tetanus three months ago. He also received pneumonia vaccine six moths ago.

Family History: Father died of diabetes at the age of 65 and mother died of heart attack at the age of 57. He has a sister and a brother. His sister was diagnosed with dementia and the brother is heathy.

Lifestyle: The patient likes swimming and watching movie during his free time. He also goes to the gym several times a week to improve his health.

Review of Systems

General: Negative for fatigue, fever, diarrhea, weight loss, or nausea.

HEENT: Negative for runny nose, sore throat, blurred vision, ear problem, cough, vision problems.

Respiratory: Negative for chest congestion, discomfort, pain or sputum.

CV: Negative for CV illnesses.

GI: Negative GI health issues.

GU: The patient is sexually active.

MS: Negative for MS conditions.

Integument/Heme/Lymph: The patient has dry, sore, cracked, and red patched skin.

Objective Data

Physical examination: The patient was seen scratching his skin and had a frowned face showing that he was feeling pain. During physical observations, red patches, sore, cracked skin on his upper chest, neck, feet, and knees.

Vitals: WH: 89 kg, He 161 cm, BP 142/92, HR 85, RR 20.

General: Dry, itchy, cracked, red patched skin.

 HEENT: Clear.

Neck: Clear.

Chest/Lungs: Clear.

Heart/Peripheral Vascular: High BP.

Abdomen: No rebound.

Musculoskeletal: Clear.

Skin: Dry, itchy, cracked, red patched skin.

Assessment

      Lab Tests: According to Davies et al. (2018), there are no existing laboratory tests for skin diseases. The disease is often diagnosed through physical examination.

      Diagnostics: Skin diseases can be diagnosed through physical examination and reviewing the patient’s medical history (Solman et al., 2019).

      Differential Diagnosis

  1. Atopic DermatitisAtopic dermatitis is a skin condition that makes one’s skin becomes itchy and red (Solman et al., 2019). This disease has been selected as the primary diagnosis because the patient experiences the majority of the illness’ symptoms.
  2. Psoriasis-This disease has been included in the diagnosis because it also causes itchy red scaly patches (Mehta et al., 2018).
  3. Acne Acne affects the skin by causing pimples, whiteheads, or blackheads and itchiness (O’Neill & Gallo, 2018). However, this disease has been ruled out because the patient does not have pimples.

References

Davies, E., Rogers, N. K., Lloyd‐Lavery, A., Grindlay, D. J. C., & Thomas, K. S. (2018). What’s new in atopic eczema? An analysis of systematic reviews published in 2015. Part 1: epidemiology and methodology. Clinical and Experimental Dermatology, 43(4), 375-379. https://onlinelibrary.wiley.com/doi/full/10.1111/ced.13377

Mehta, N. N., Shin, D. B., Joshi, A. A., Dey, A. K., Armstrong, A. W., Duffin, K. C., … & Menter, A. (2018). Effect of 2 psoriasis treatments on vascular inflammation and novel inflammatory cardiovascular biomarkers: a randomized placebo-controlled trial. Circulation: Cardiovascular Imaging, 11(6), e007394. https://doi.org/10.1161/CIRCIMAGING.117.007394

O’Neill, A. M., & Gallo, R. L. (2018). Host-microbiome interactions and recent progress into understanding the biology of acne vulgaris. Microbiome, 6(1), 177. https://link.springer.com/article/10.1186/s40168-018-0558-5

Solman, L., Lloyd‐Lavery, A., Grindlay, D. J. C., Rogers, N. K., Thomas, K. S., & Harman, K. E. (2019). What’s new in atopic eczema? An analysis of systematic reviews published in 2016. Part 1: treatment and prevention. Clinical and experimental dermatology, 44(4), 363-369. https://doi.org/10.1111/ced.13885

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