Case Study: Patient with “a mole” on the skin

NURS 6531: Primary Care of Adults Across the Lifespan | Week 2

The most important practical lesson that can be given to nurses is to teach them what to observe—how to observe—what symptoms indicate improvement—what the reverse—which are of importance—which are of none.

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—Florence Nightingale, Notes on Nursing: What it is and What it is Not.

Knowing what to observe and how to observe is a key skill for an advanced practice nurse. You begin observing patients from the moment that you enter the examination room, as patient evaluations typically begin prior to any questioning or physical examinations. You can gather patient information through simple visual observations of body language, demeanor, and cognitive ability. Observation is a crucial component of care, as part of the provider-patient relationship is the eye-to-eye contact. For advanced practice nurses, quick observations of the skin (integumentary) can provide clues to guide assessment and diagnosis.

Throughout the remainder of this course, you examine patient case studies and strategies for the evaluation and management of disorders for adults across the lifespan. This week, your studies begin with integumentary  disorders because they are often the first disorders noticed. You explore differential diagnoses for patients with these disorders, the role of patient information in differential diagnosis, and potential treatment options.

Learning Objectives – NURS 6531 Week 2 Case Study: Patient with “a mole” on the skin

By the end of Week 2, students will:

• Assess differential diagnoses for patients with integumentary disorders
• Analyze the role of patient information in differential diagnosis
• Evaluate patient treatment options
• Understand and apply key terms, concepts, and principles related to integumentary disorders
• Analyze pattern recognition in patient diagnoses

Discussion: Diagnosing Integumentary Disorders

When entering examination rooms, advanced practice nurses often immediately begin assessing patients by looking for external abnormalities such as skin irritations or cloudy eyes. By making these simple observations, they can determine how to proceed with their patient evaluations. During the patient evaluation, advanced practice nurses will use initial observations to guide them in acquiring the necessary medical history, performing additional assessments, and ordering the appropriate diagnostics. The information obtained during this evaluation process will help in the development of a differential diagnosis. Once a diagnosis is made, the advanced practice nurse can consider potential treatment options and work with the patient to develop a plan of care. For this Discussion, consider the following three case studies of patients presenting with integumentary disorders.

Case Study 1A 46-year-old male presents to the office complaining of a pruritic skin rash that has been present for a few weeks. He initially noted the rash on his feet, but it then spread to between the fingers, his wrist, and waist. He notes that it does not seem to be on his face or trunk. He recently came home from a trip to Florida where he had stayed in multiple hotels. He takes occasional ibuprofen for knee pain, but denies taking other medications or having other health problems. He has no known drug allergies. The physical examination reveals a male with several tiny vesicles and scales in between the fingers, on the feet and ankles, around the patient’s wrist and around the belt line.

Case Study 2

K.B., a 52 year old Irish American patient who present today complaining of “a mole” on the skin that is changing colors. He said he has had this ‘mole’ for almost two years. K.B. is a construction worker currently residing in Hawaii. As a teen he worked outside and visited the tanning bed several times a month. He is a worried that this “mole” doesn’t look like the others on his body.

On your examination, you note, the lesion as round, dark colored in appearance, and scaly. You also note the mole has an irregular border and about 0.2cm in size.

Case Study 3

J.V. 50 year old patient with history of eczema is here today complaining of lesions on the right side of her face and neck. She thinks it is a flare up of her eczema and is asking for a refill of her ointment, TAC 0.1%.

She complains of some ‘itching’ and a bit of ‘tingling and pain’ to the lesions. She’s a pharmaceutical worker and thinks that the ‘pain’ maybe due to contaminate exposure. Denies any other associating symptoms. Below is a photo of the lesions.

By Day 3

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected or were assigned a different case study than you did. Based on information missing from the patient history, suggest other possible diagnoses. Respond to questions posed to you during the week. NURS 6531 Week 2 Case Study: Patient with “a mole” on the skin