Discussion: Diagnosing Integumentary Disorders Family Nurse Practitioner

Discussion: Diagnosing Integumentary Disorders Family Nurse Practitioner

Discussion  Diagnosing Integumentary Disorders Family Nurse Practitioner

 

Primary Diagnosis

            The primary diagnosis is Tinea Versicolor, which is a common fungal infection that affects the skin and is present in about 30-40% of people living in the tropical regions. It is usually caused by lipophilic yeast that mostly appear as small circular scaling of the upper trunk muscles, arm and back (Varada, Dabade, & Loo, 2014). In tanned or dark skin individuals, the affected area usually appears to be hyperpigmented, while in light skin individuals the affected area might appear pink in color or fawn. The patient might also complain of itchiness of the affected area.

Differential Diagnosis

1. Vitiligo: This is a skin disorder that leads to skin depigmentation in the form of symmetrical muscles on the hand’s wrist and face. The condition causes the destruction of melanocytes as a result of neural, autoimmune or genetic response (Varada, Dabade, & Loo, 2014). More than half of individuals diagnosed with this condition are below the age of twenty. The condition is also 30% positive for family history.
2. Pityriasis rosea: This is an inflammatory condition which affects mostly the skin around the trunk especially in fall, spring or secondary to a respiratory infection. It is common among individuals between the ages of 10 and 35 years. The initial lesion usually appears on the trunk as a herald patch (Ghafourian et al., 2014). The lesions appear like salmon colored papules which develop thin collarette scale as central desquamates. Past medical history is essential since tinea versicolor can also result among patients with decreased resistance to infections such as Cushing’s syndrome, burns, pregnancy, adrenalectomy, malnutrition, and use of corticosteroids.
3. Pityriasis alba: This is a skin condition which mostly affects young adults and children. The exact cause of the infection is unknown. It is however believed that it may be associated with common skin disorders which cause scaly itchy rashes and eczema. It is characterized by oval, round or irregular patches of red or pale pink skin (Varada, Dabade, & Loo, 2014).

Role of the History and Physical Exam

Accurate diagnosis is based on the patient’s history taken in addition to physical examination results. In the assigned case scenario,

the patient had recently returned to Florida which predisposed him to the fungal infection. He confirms that the rash is only on his back, arms and chest, which are indications for tinea versicolor based on the named areas (Gupta et al., 2014). The patient also displays signs of flat, circular and light colored patches that also indicates the same condition, tinea versicolor.

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Treatment Plan

Specific Examination: complete patient history and physical examination.

Screening Tools: Microscope for skin observation; Woods’ light examination for spotting the hyperpigmented areas; and #15 scalpel for scraping the scale; and a microscope to examine the scale (Ghafourian et al., 2014).

Tests, cultures, lab work: Diagnosis of this condition rarely requires cultures. However, it can be diagnosed with a potassium hydroxide examination.

Prescriptions: 2.5 % Selenium sulfide shampoo. For topical application. The patient should wash off after 10 minutes of application (Ghafourian et al., 2014).

Lifestyle changes/ Interventions: Inform the patient to utilize oil-free products for skin application and sunscreen when outdoors to avoid accentuation of the affected areas when the skin tans.

Referrals: None at this point given that the condition is a non-contagious fungal infection. However, referrals may be necessary in case of worsening of the symptoms.

Follow up: Follow up after completing the selenium sulfide 2.5% dose for evaluation of the treatment plan by skin improvement.

Education: The patient needs to be adequately informed on the course and management of tinea versicolor. He also needs to be aware of the fact that after a successful treatment using topical antifungals, it takes weeks for the skin abnormalities of the pigmentation to return to normal (Ghafourian et al., 2014).

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 1

A 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.

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.

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Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

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Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource