NUR 6512 Differential Diagnosis for Skin Conditions

Assignment 1: Differential Diagnosis for Skin Conditions

Comprehensive SOAP Template 

 

Patient Initials: ____H.J___ Age: ___26____ Gender: ___Male____ 

SUBJECTIVE DATA 

 

Chief Complaint (CC): The patient number 3 complains of a painful rash  

 

History of Present Illness (HPI): Hillary James is a 26 years old African American who presents with an onset of a plague-like rash that has been persisted for three weeks. The patient reports that he first noticed the rash on the knee but later spread to the scalp and elbows. He indicates that the rash is itchy. The patient is disturbed by the condition and indicates that she has been stressed as the issue seems to progress. She has over-the-counter painkiller medication to help relieve the pain. He indicates that the rashes are severe and the associated pain to be 7/10. He suspects that he acquired the skin condition during camping three weeks ago. 

Medications: The patient’s current medication includes ibuprofen 400mg PO every 8 hours.  

 

Allergies: The patient has no known drug or food allergy. 

 

Past Medical History (PMH): The patient was recently treated for recurring tonsillitis. He denies having been hospitalized for the past 12 months.  

 

Past Surgical History (PSH): The patient has undergone any surgical procedure in his life.  

 

Sexual/Reproductive History: The patient is married to one wife and they have three children. 

 

Personal/Social History: The patient denies using tobacco or any illicit drug. On the other hand, he enjoys taking alcohol, especially on the weekends. Furthermore, he likes traveling and making new friends.  

 

Immunization History: The patient’s immunization is up to date. His last Tdap was three years ago. Also, he received the flu vaccine a year ago. On the other hand, the patient was not eligible for the pneumonia vaccine at the time he came to the clinic.  

Significant Family History: The patient denies a family history of dermatitis or skin rashes. 

 

Lifestyle: The patient works as an electrical technician. He states that he goes to church every Sunday despite his drinking habits. Also, he sleeps late sometimes because of his demanding work. He has an insurance plan and so seeks medical interventions regularly whenever he feels unwell. Furthermore, the patient indicates that he participates in regular dieting and physical exercise. He believes that living an active life reduces the risks of cardiovascular diseases and other conditions. 

 

Review of Systems:  

 

General: The patient is alert and denies experiencing night sweats. He has not gained or lost weight in the past six months. The patient appears energetic; though, slightly disturbed by the skin lesion. Furthermore, the patient has no nail or hair change.  

HEENT: There are no changes in the hearing or vision. The patient has a normal visual acuity. The head is intact with no injuries.  

Neck: The neck is supple with a full range of motion. There are no signs of lymphadenopathy noted.  

Breasts: n/a 

Respiratory: No signs of dyspnea or murmurs from the lungs. The lungs are symmetrical. The patient has a normal heart rhythm.  

Cardiovascular/Peripheral Vascular: The blood pressure is normal. No signs of peripheral edema.  

Gastrointestinal: The patient has a normal bowel movement.  

Genitourinary: No pain during micturition. The patient empties their bladder completely  

Musculoskeletal: The patient has a full range of motion. No pain in the muscles indicated.  

Psychiatric: The patient is calm and cooperative. No signs of depression or hallucination  

Neurological: 

Skin: Include rashes, lumps, sores, itching, dryness, changes, etc. 

Hematologic: Normal C2-C12 

Endocrine: 

 

Allergic/Immunologic: NKDA 

 

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. Do not use WNL or normal. You must describe what you see. 

 

Physical Exam: 

Vital signs: Ht 5’8’’ Wt=137 lbs, BMI=24.8, T=37.2 degrees Celsius, BP = 125/73mmhg 

General: The patient is oriented and well-nourished.  

HEENT: 

Neck:  No JVD 

Chest/Lungs: The lung and chest are symmetrical and clear to auscultate  

Heart/Peripheral Vascular: Normal heart rate, no cyanosis  

Abdomen: Soft, non-tender, and non-distended.  

Genital/Rectal:  

Musculoskeletal: Full range of motion 

Neurological: C2-C12 intact  

Skin: the moist, presence of lesions and painful rashes. The pain increases in hot temperatures and on touch.  

 

ASSESSMENT:  

The differential diagnosis for the patient includes contact dermatitis, heat rash, and plaque psoriasis. Contact dermatitis is a condition characterized by causes reddening on the skin and mainly emerges when the skin comes to contact with chemicals (Esser & Martin, 2020). The main symptoms include dry skin and oozing blisters. Also, the patient may their skin turn dark, or swell. In this case, the patient skin is itchy and produces oozing blisters (Yadav, 2021).  

The second diagnosis is heat rash, a condition resulting from the blockage of the sweat ducts. The signs and symptoms of heat rash include red bumps on the skin. The patient presents with rashes that are characterized by red bumps and some of them scaly.  

The third diagnosis is plaque psoriasis, a condition characterized by raised red patches covered with white build-up (Havnaer & Han, 2019). The kin condition usually shows up in the knees and scalp. The common causes of plaque psoriasis include autoimmune diseases where the body’s immune system fights the healthy cells. Furthermore, injuries to the skin could also trigger the reaction (Rendon & Schäkel, 2019).  

 

REFLECTION:  

The clinical experiences provided a good opportunity for learning about the various skin conditions and their presentations. A clear analysis of the skin characteristics in terms of size, component, and the nature of swelling may help in making the right diagnosis. On the other hand, many skin conditions could assume similar characteristics and this makes them prone to misdiagnosis. Furthermore, it was apparent that skin conditions can be traumatizing especially when they are itchy. Patients tend to feel uncomfortable and so the treatment plan should focus on providing relevant psychological counseling to the victims (Wu et al., 2020).  

Understanding the anatomical structures of the skin helps in identifying the affected areas and the possible contributing factors. Furthermore, hormonal changes in the body also cause a skin rash; therefore, the hallmark in the diagnosis and treatment process is to identify the causative factors and address them. Not all conditions may require medical intervention as some may only need skincare (Havnaer & Han, 2019). Furthermore, it was evident that having theoretical knowledge is important in the diagnosis process. However, the causes and manifestations of the skin conditions may vary from one individual to the other depending on the socio-cultural and demographic factors.  

Besides, the clinical experience allowed me to take a patient’s history and interact with them to understand their underlying conditions and the possible contributing factors. Creating a conducive environment is necessary during the history taking to allow the patients to feel comfortable and share vital information that could help in better management of their conditions. The patient was cooperative and ready to share. He described the onset of the conditions and exposure factors that could be linked with it.  

On the other hand, I felt like I did not provide adequate patient education to the client. Patient education is important in equipping the patient with self-care skills and addressing possible social and cultural factors that could be affecting their health condition. Proper hygiene is dietary intake is important. Therefore, in the subsequent clinical practice, I would consider taking good time to offer relevant patient education to improve the treatment outcomes. Other than the nutritional education, I will let the client understand the importance of identifying the skin irritants and avoiding them. Most of the patients tend to seek anti-allergy medications without confirming what illnesses they are having. Skin conditions, like any other disease, may have a poor prognosis if not treated in time.  

I agree with the preceptor based on the evidence. The literature analyzed indicates the variations in the characteristics of the various skin conditions. However, there are key features used in the diagnosis that was relevant in this case and guided the differential diagnosis.  

 

NUR 6512 Differential Diagnosis for Skin Conditions  References 

Esser, P. R., & Martin, S. F. (2020). Extended understanding of pathogenesis and treatment of contact allergy. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete, 71(3), 174-181. https://doi.org/10.1007/s00105-019-04527-9 

Havnaer, A., & Han, G. (2019). Autoinflammatory disorders: a review and update on pathogenesis and treatment. American journal of clinical dermatology, 20(4), 539-564. 

Rendon, A., & Schäkel, K. (2019). Psoriasis pathogenesis and treatment. International journal of molecular sciences, 20(6), 1475. 

Wu, H., Yin, H., Chen, H., Sun, M., Liu, X., Yu, Y., Tang, Y., Long, H., Zhang, B., Zhang, J., Zhou, Y., Li, Y., Zhang, G., Zhang, P., Zhan, Y., Liao, J., Luo, S., Xiao, R., Su, Y., … Lu, Q. (2020). A deep learning, image-based approach for automated diagnosis for inflammatory skin diseases. Annals of Translational Medicine, 8(9), 581-581. https://doi.org/10.21037/atm.2020.04.39 

Yadav, A. (2021). A study of diagnosis of skin disease using deep learning techniques. International Journal for Research in Applied Science and Engineering Technology, 9(3), 771-774. https://doi.org/10.22214/ijraset.2021.33310 

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 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.

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.

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.

Submission and Grading Information

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