NURS 6512 Week 4 Assignment 1- Differential Diagnosis for Skin Conditions

NURS 6512 Week 4 Assignment 1- Differential Diagnosis for Skin Conditions

Diagnosis of Skin Conditions

Patient Initials: ___PN____               Age: _29______                                 Gender: F_______

SUBJECTIVE DATA:

Chief Complaint (CC): #2 ‘Stretch marks on my stomach.’

History of Present Illness (HPI): The patient is a 28-year-old African-American female who presents with a chief complaint of increased stretch marks. She is in her 30-week gestation, but reports have stretch marks as early as 22 weeks but have increased during the last two months. She states to have tried various over-the-counter cocoa butter and shea butter creams to help with the stretch marks, but they have been ineffective.

Medications:

• Prenatal Rx; 1 tablet daily
• Albuterol 90 mcg; 2 puffs for Asthma
• Nasonex; 2 sprays per nostril for seasonal allergies
• Shea butter cream; is applied thrice per day for stretch marks.
• Amlodipine; 10mg daily for hypertension
• Iron and folic supplements

Allergies:

• Dust; sneezing, itching, and watery eyes
• Pollen; sneezing, itchy eyes, and watery eyes
• Metronidazole; systemic uticaria
• Penicillin; Rash
• Denies any food or latex allergies

Past Medical History (PMH):

• Hypertension diagnosed at 24
• Asthma diagnosed at 4
• Allergic rhinitis diagnosed at 7

Past Surgical History (PSH): No past surgical history

Sexual/Reproductive History: The patient is a heterosexual female pregnant in her 30-gestation week. She denies any history of STDs or genital problems. She states to have been having regular menstrual periods before her pregnancy. She states to have regular STI screenings; her last was one month ago.

Personal/Social History: The patient works as a Middle school teacher. She is unmarried but lives with her new partner in their private home. She has a degree in education and is looking forward to advancing in the Masters program. She denies the use of alcohol, tobacco, or any illicit substance. She states to eat a healthy diet and drinks much water.

Health Maintenance: The patient reports attending her prenatal checkups regularly and adheres to her daily intake of iron and folic supplements. Reports her pap smear and HPV examination revealed normal findings. The last physical assessment was eight months ago—reports getting 8-10 hours of sleep.

Immunization History: The patient reports being up-to-date with her immunizations. States to have received her tetanus booster in the last antenatal visit, and her influenza vaccine was nine months ago.

Significant Family History:

Mother, 59, has a history of hypertension, Asthma, and anxiety.

Father, alive, 61, no medical history

Brother, 24, has no health complications

Paternal grandmother, 73 histories of hypertension

Paternal grandfather, alive, history of hypertension

Review of Systems:

General: Denies chills, fever, or sleep disturbances—reports of fatigue over the past few months and to have gained 10 pounds in the last month.

            HEENT: Denies headaches, lightheadedness, or head injury. Denies any visual changes or eye problems. Reports of itchy and watery eyes when exposed to dust, mold, or pollen. Denies any hearing problems. Denies any nose infections or breathing problems. Denies pain when swallowing or chewing.

            Respiratory: Denies breathing difficulties, wheezing, or coughing.

            Cardiovascular/Peripheral Vascular: Denies chest tightness, palpitations, or exertional dyspnea.

            Gastrointestinal: Reports occasional nausea and vomiting associated with the pregnancy. She denies heartburn, diarrhea, or constipation.

            Genitourinary: States an increase in urine frequency and increased vaginal discharge.

            Musculoskeletal: Denies any joint pain or swelling—no muscle pains.

            Neurological: Denies any dizziness, seizures, or lightheadedness.

            Psychiatric: Denies a history of depression, anxiety, or psychiatric problems.

            Skin/hair/nails: Reports stretch marks around the abdomen area. Denies any rashes, bruising, or brittle nails.

OBJECTIVE DATA:

Physical Exam

Vital signs: BP 156/87, Weight;186 lbs, P:80 and regular, BMI:30.2, -Ht:5’4”, RR:20, T: 36.6.

General: The patient is a 29-year-old African-American who is appropriately dressed. With appropriate mood and affect.

HEENT: Head is normocephalic and faces symmetrical. Moist and pink conjunctiva, white and clear sclera. The intact tympanic membrane, pink and moist mucus membrane, and ear canals patent.

Neck: Carotid, no bruit, trachea midline, and neck ROM full range.

Chest/Lungs: Breath sounds clear to auscultation, and symmetrical chest expansions

Heart/Peripheral Vascular: Regular rate and rhythm, no heart murmurs, s1,s2, and s3 audible.

Abdomen: The abdominal skin is stretched with marked striae—normoactive bowel sounds, Gravid mass on palpation; No tenderness on palpation, No organomegaly.

Genital/Rectal: Normal female genitalia

Musculoskeletal: Muscle strength 5/5, full ROM on upper and lower extremities.

Neurological: Clear speech; CNs are intact; facial symmetry intact.

Skin: Straie gravidarum present to the abdomen, linea nigra visible from the pubic area to the intermediary breast.

Diagnostic results: No tests were ordered

ASSESSMENT:

Primary Diagnosis;

Striae gravidarum: This is a common condition in women, especially during gestation. It presents as linear atopic scars and affects any color. They first present as pink to red bands, which, with time, fade and become hypopigmented (Farahnik et al., 2017). It may affect the breast, abdomen, hips, and thigh. It is also prevalent during the late second and early third semesters. The patient is currently in her third semester, and reports increased abdominal stretch marks; thus, striae gravidarum is the most likely diagnosis.

Differentials;

 Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP);  This is a condition that occurs during the last semester of the first pregnancy. It is characterized by erythema with red papules around the abdomen (Ishikawa-Nishimura et al., 2021). This is a possible diagnosis as the patient is in her third trimester and has lesions targeting her abdominal region.

Cushing Syndrome; This condition is caused by excessive production of adrenocorticotropic hormone (ACTH) or autonomous cortisol production. According to Nieman (2018), a primary sign and symptom is the presence of striae that are >1cm long. The disease is more common in patients with hypertension, diabetes, and cardiovascular disease. Though it’s a rare condition during pregnancy, this is a possible diagnosis as the patient has a history of hypertension.

References

Farahnik, B., Park, K., Kroumpouzos, G., & Murase, J. (2017). Striae gravidarum: Risk factors, prevention, and management. International Journal of Women’s Dermatology, 3(2), 77–85. https://doi.org/10.1016/j.ijwd.2016.11.001

Ishikawa-Nishimura, M., Kondo, M., Matsushima, Y., Habe, K., & Yamanaka, K. (2021). A case of pruritic urticarial papules and plaques of pregnancy: Pathophysiology and serum cytokine profile. Case Reports in Dermatology, 13(1), 18–22. https://doi.org/10.1159/000511494

Nieman, L. K. (2018). Recent updates on the diagnosis and management of Cushing’s syndrome. Endocrinology and Metabolism, 33(2), 139. https://doi.org/10.3803/enm.2018.33.2.139

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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

   Instructions for  Week 4 Assignment 1:   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 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.             

Instructions for Week 4 Assignment 2:   TO PREPARE

DIGITAL CLINICAL EXPERIENCE (DCE): HEALTH HISTORY ASSESSMENT

In Week 3, you began your DCE: Health History Assessment. For this week, you will complete this Health History Assessment in your simulation tool, Shadow Health and finalize for submission.

• Review this week’s Learning Resources as well as the Taking a Health Historymedia program in Week 3, and consider how you might incorporate these strategies. Download and review the Student Checklist: Health History Guide and the History Subjective Data Checklist, provided in this week’s Learning Resources, to guide you through the necessary components of the assessment.
• Review the DCE (Shadow Health) Documentation Template for Health History found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
• Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
• Review the Shadow Health Student Orientationmedia program and the Useful Tips and Tricks document provided in the week’s Learning Resources to guide you through Shadow Health.
• Review the Week 4 DCE Health History Assessment Rubric, provided in the Assignment submission area, for details on completing the Assignment.

Note: There are 2 parts to this assignment – the lab pass and the documentation. You must achieve a total score of 80% in order to pass this assignment. Carefully review the rubric and video presentation in order to fully understand the requirements of this assignment.

DCE   HEALTH   HISTORY   ASSESSMENT:

Complete the following in Shadow Health:

Orientation

• DCE Orientation (15 minutes) **(note this has been completed by me)
• Conversation Concept Lab (50 minutes, Required) **(Completed by me)

Health History

• Health History of Tina Jones (180 minutes)

                        Submission Information

• Complete your Health Assessment DCE assignments in Shadow Health via the Shadow Health link in Canvas.
• Once you complete your assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding assignment in Canvas for your faculty review.
• (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-passLinks to an external site.
• Complete your documentation using the documentation template in your resources and submit it into your Assignment submission link below.
• To submit your completed assignment, save your Assignment as WK4Assgn2+last name first initial.

                           References to Use

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 BiopsyDownload Chapter 1, “Punch Biopsy”
• Chapter 2, “Skin Biopsy”Download Chapter 2, “Skin Biopsy”
• Chapter 10, “Nail Removal”Download Chapter 10, “Nail Removal”
• Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”Download Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”
• Chapter 16, “Skin Tag (Acrochordon) Removal”Download Chapter 16, “Skin Tag (Acrochordon) Removal”
• Chapter 22, “Suture Insertion”Download 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”Download 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.

     Go to Week 4: Learning Resources (Required Readings)

Document: Skin Conditions Download Skin Conditions(Word document)
This document contains images of different skin conditions. You will use this information in this week’s Assignment 4/Discussion.

Document: Comprehensive SOAP Exemplar Download Comprehensive SOAP Exemplar(Word document)

Document: Comprehensive SOAP Template Download Comprehensive SOAP Template(Word document)

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)

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