Sample Answer for NURS 6512 Assignment 1: Differential Diagnosis for Skin Conditions Included After Question
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
BY DAY 7 OF WEEK 4
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A Sample Answer For the Assignment: NURS 6512 Assignment 1: Differential Diagnosis for Skin Conditions
Title: NURS 6512 Assignment 1: Differential Diagnosis for Skin Conditions
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.
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
A Sample Answer 2 For the Assignment: NURS 6512 Assignment 1: Differential Diagnosis for Skin Conditions
Title: NURS 6512 Assignment 1: Differential Diagnosis for Skin Conditions
SUBJECTIVE DATA: “I have indented reddened streaks on my skin that started appearing on the second month when I became pregnant.” “Too many stretch marks on my stomach since being pregnant”
Chief Complaint (CC): Picture #2- I have a concern with the stretch marks on my stomach which first noticed at the end of my first trimester in pregnancy.
History of Present Illness (HPI): Ms Caroline Fisher is a 32 year old female is a gravida 1, para 0 Black American who is pregnant and in her 24 weeks gestational period who came today and complained about the changes she has been noticing on her abdomen that is characterized by streaks of reddened skin which continued to darken as the pregnancy progresses, last menstrual period was 9/21/21. Ms Caroline stated that the stretchmarks are more prominent on the anterior abdominal while few lines run towards the back. Ms Caroline at this time stated that sometimes she feels itchy but denies any pain or any discomfort. Ms Caroline stated that her friends introduced her to an herbal therapy known as cocoa butter which she has been apply but no obvious changes. Ms Caroline is so much concerned about the recent changes to her body and skin and doesn’t feel good about her recent look, Ms Caroline has a believe that she has actually put on weight and that might have worsened the stretchmarks.
Medications:
Patient is on the following medications;
Pregnacare which contains mostly vitamins
400 μg of folic acid prescribed once daily
Iron 600mg Daily
Metformin 500mg twice daily for diabetes
Norvasc 10mg daily for hypertension
Allergies: Allergic to Sulphur medications. No known food allergies.
Past Medical History (PMH): Ms Craoline is a known Type 2 diabetic patient, was last hospitalized in 2020 prior to her recent pregnancy on account of uncontrolled hyperglycemia which was managed and well controlled during the 2 days’ hospitalization before being discharged, patient also has history of borderline hypertension.
Past Surgical History (PSH): Patient denies any surgical history.
Sexual/Reproductive History: Ms. Caroline is Straight and is sexually active. No positive history of sexual abuse, has had 2 partners since she became sexually active. Menarche started at the age of 12 and since then have always had a regular menstrual cycle of 28days.
Personal/Social History: Ms Caroline is an elementary school teacher and lives with the boyfriend in a single family house. Denied history of illegal drug use, drinks alcool occasionally but stopped since she got pregnant.
Health Maintenance: Ms Caroline has been compliant with her regular pregnancy checkup and consults as advised.
Immunization History: Mrs Coroline is upto date with her vaccinations including covid vaccine and the last immunization was the flu shot which she got on 1/3/22
Significant Family History: Father has history of Diabetes which is well controlled with insulin and Mother had hypertension before her death at the age of 60 years in 2021 due to complication of coronavirus.
Review of Systems:
General: Ms Caroline is in a stable condition, no obvious distress noted. She just doesn’t feel good about the recent skin changes since she got pregnancy as that is her first pregnancy.
HEENT: Ms. Caroline denies having any problems with hearing, vision, nasal congestions, nil swelling and no remarkable change on the throat.
Respiratory: Ms Caroline denies any breathing problems
Cardiovascular/Peripheral Vascular: Ms Caroline denies any episodes of irregular heartbeats, denies any heart murmur and not chest pain.
Gastrointestinal: Patient denies any problems with appetite. Confirmed she has regular bowel movements. Patient is positive for constipation occasionally.
Genitourinary: Patient denies any history of urinary tract infection.
Musculoskeletal: Patient is positive mild back pain which she takes regular Tylenol 375mg orally every 8 hrs. when needed.
Neurological: Patient is alert and oriented, no neurological deficit noted. Denies any history of epilepsy or seizures.
Psychiatric: Patient denies any history of mental health illness.
Skin/hair/nails: Ms Caroline is very much concerned about the new stretch
marks that runs through her abdominal wall. Patient does not have any other skin alteration. Patient complained of hair dandruff.
OBJECTIVE DATA:
Physical Exam:
Vital signs: Patients blood pressure measured on the right arm was 144/81, Temperature is 97.7 degree Fahrenheit, Pulse is 72bpm, Respiration is 17c/m, Weight is 179 pounds, height is 5 feet 6 inches and a calculated BMI of 28.9.
General: Ms. Caroline came in alert and oriented to time and place. The vital signs showed that the patient is overweight with a BMI of 28.9 and blood pressure is elevated.
HEENT: On examination of the hair, there were presence of dandruff on the scalp.No inflammation noted on the tonsil and no tenderness noted at the temporomandibular joint. The pupils were equal, round, reactive to light. No discharges noted from ears.
Neck: There was normal range of motion, and no distended juggler vein noted.
Chest/Lungs: The trunk was clear. The intercostal movements were nornmal.no abnormal breath sounds like wheezes. Respiration rate of 18 b/min.
Heart/Peripheral Vascular: On auscultation, the S1 and S2 heart sounds were present and heart rate was within normal limits of 72bpm.
Abdomen: There was positive fetal heart rate of about 128b/m and thee were marked indented streaks on the abdominal wall.
Genital/Rectal: The vagina was free from any signs of infection, nil swelling, discharge or inflammation noted during assessment of the genitalia.
Musculoskeletal: There are no muscle or joint pains noted and there is full range of motion with no limitation.
Neurological: Mrs Caroline is oriented to time, place and person. Patient scored high on assessment of mental status. The mental assessment shows patient has memory intact both recent and past events.
Skin: Patients skin is warm to touch with a temperature of 97.8, nil discoloration noted except the indented stretch marks on the abdominal wall
Diagnostic results:
- There was Lab draw for White blood count which was unremarkable for infection
- On observation of the skin, the streaks and discoloration of the skin were present
- A culture of the skin is important to rule other causes of skin infections.
- Scraping of the nail and skin is key to rule out infections of the skin (Colyar,2015).
ASSESSMENT:
Differential diagnoses
- Linea nigra
- Linear focal elastosis
- Striae from topical steroid abuse, such as in the treatment of psoriasis.
- Cushing’s syndrome.
Primary diagnosis:
After a thorough consideration of other possible causes of this condition, I was able to narrow down the diagnosis based on my assessments and patients present condition to be Striae gravid arum.
Pregnancy as we all know comes with different skin changes as the body adjust to the new normal of accommodating the baby such as the changes that occur within the connective tissues as the skin continues to stretch as the uterus enlarges leads to the stretch marks (Ball, J et.all 2019). This evidence of stretch march shows poor skin elasticity which further puts the patient at risk perineal or vaginal tears due to poor elasticity. When stretch marks becomes evident, it’s as a result of damage to the dermal collagen and further dilation of blood vessels (Dains, Baumann & Scheibel, 2019).
PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
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.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Student checklist. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
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Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three or more of the following elements
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| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in the all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three of the following elements
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| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
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Demonstrated 3 of the following:
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Demonstrated 2 of the following:
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Demonstrated 1 or less of the following:
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| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
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The following was present:
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| 0 Points Deducted | 5 Points Lost | |||||
| Participation
Requirements |
Demonstrated the following:
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| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |