Sample Answer for NURS 6512 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 Differential Diagnosis for Skin Conditions
Title: NURS 6512 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.
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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.
A Sample Answer 2 For the Assignment: NURS 6512 Differential Diagnosis for Skin Conditions
Title: NURS 6512 Differential Diagnosis for Skin Conditions
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.
A Sample Answer 3 For the Assignment: NURS 6512 Differential Diagnosis for Skin Conditions
Title: NURS 6512 Differential Diagnosis for Skin Conditions
Chief Complaint (CC): “Red patches on the beard with pus-filled pimples.” (Graphic 3)
History of Present Illness (HPI):
B.B is a 32-year-old White male with chief complaints of having red patches on the beard with pus-filled pimples. He states that the patches are on the left side of the lower beard. The patches started as acne papules about ten days ago, which later turned yellow and pus-filled. The pimples begin as papules and progress to pustules, which have proliferated over the days. The client reports that the part with the red patches is tender to touch. Besides, he experiences a mild itching sensation, and some hair plucks when he scratches the beard. He states that the beard hair on and around the red patch is brittle and lusterless. The patient mentions that he bought OTC Betamethasone cream four days ago to alleviate the itchiness and eliminate the pimples, but it has not had any effect.
Medications: OTC Betamethasone cream.
Allergies: Allergic to Sulphur- causes a rash.
Past Medical History (PMH): History of Asthma- diagnosed at 6 years. Last exacerbation at 25 years.
Past Surgical History (PSH): None
Sexual/Reproductive History: Denies history of STIs.
Personal/Social History:
B.B is married and lives with his spouse and two children aged 5 and 2 years. He has a Bachelor’s in Mass Communication and works as an editor in a publishing company. He reports taking 3-4 glasses of whiskey on his day offs but denies smoking or using drug substances. His hobbies include playing basketball and reading fictional novels. He is the captain of the basketball team in his organization and coaches the basketball team in the local high school in his free time. He reports sleeping 6-7 hours daily and eating 4-5 healthy meals daily.
Health Maintenance: The patient goes to the gym 3-4 days a week. He plays basketball on weekends. He reports attending annual wellness exams.
Immunization History:
Last Tdap- 07/2015
Influenza shot- 06/2022
COVID-19 vaccine- 03/2021 (1st dose) 05/2021 (2nd dose) AstraZeneca
Significant Family History:
The paternal great-grandfather had HTN and died from stroke at 92 years. His maternal grandmother has DM and rheumatoid arthritis. His Father has controlled HTN, diagnosed at 54 years. Siblings and children are alive and well.
Review of Systems:
General: Negative for weight changes, fever, chills, or fatigue.
HEENT: Negative for headache, double/blurred vision, excessive lacrimation, ear pain/discharge, hearing loss, nasal secretions, sneezing, or throat pain.
Respiratory: Denies cough, sputum, chest pain, or breathing difficulties.
Cardiovascular/Peripheral Vascular: Negative for lower limbs edema, palpitations, chest pain, increased fatigue, or dyspnea on exertion.
Gastrointestinal: Negative for nausea, vomiting, regurgitation, epigastric/abdominal pain, rectal bleeding, or diarrhea/constipation.
Genitourinary: Negative for blood in urine, dysuria, urinary frequency, or urgency.
Musculoskeletal: Negative for joint pain/stiffness, muscle pain, or lower back pain.
Neurological: Denies headaches, dizziness, black spells, or tingling sensations.
Psychiatric: Denies having depressive, anxiety, obsessive symptoms, or suicidal thoughts.
Skin/hair/nails: Positive for mild itching on the lower left beard area. Pus-filled pimples on the beard and red skin patches. Brittle beard hair.
A Sample Answer 4 For the Assignment: NURS 6512 Differential Diagnosis for Skin Conditions
Title: NURS 6512 Differential Diagnosis for Skin Conditions
OBJECTIVE DATA:
Physical Exam:
Vital signs: BP-110/68; HR- 72; RR- 16; Temp-98.2 Ht-5’7; Wt-171 lbs.
General: The client is calm, alert, and oriented. He is well-groomed and displays positive body language. He maintains eye contact and has a positive attitude towards the clinician.
HEENT: Head is symmetrical and normocephalic. Eyes: Sclera is white, and conjunctiva is pink, PERRLA. Ears: Tympanic membranes are shiny and intact. Nose: The nasal septum is intact. Throat- Tongue is pink and midline; No tooth cavities, and the Tonsillar gland is non-erythematous.
Neck: Full ROM; Trachea is well-aligned.
Chest/Lungs: Uniform and smooth respirations. The chest is clear.
Heart/Peripheral Vascular: No edema or jugular vein distention. S1 and S2 are present. No gallop sound or systolic murmur.
Abdomen: The abdomen is flat and moves with respirations. Bowel sounds are normoactive. No abdominal tenderness, masses, organomegaly, or guarding.
Genital/Rectal: Normal male genitalia. Rectal sphincter is intact.
Musculoskeletal: Full ROM in all joints; No fractures, enlarged joints, or joint tenderness/stiffness.
Neurological: Muscle strength- 5/5. Normal gait, balance, and posture.
Skin: Fair, warm, and dry skin with normal turgor. The skin at the lower left beard is inflamed with red lumpy patches. Yellow pustules and crusting on the beard involve the hair root and follicle. Broken beard hairs on the red patches.
Diagnostic results: No diagnostic results are available.
ASSESSMENT:
Tinea Barbae: Tinea barbae is a dermatophyte infection occurring in the beard area. It is characterized by superficial annular lesions. However, some patients can present with a deeper infection that resembles folliculitis (Walkty et al., 2020). Tinea barbae can also be an inflammatory kerion that causes scarring hair loss. It is typically inflamed with red lumpy areas, pustules, and crusting around the hairs. The hairs can be plucked out easily. Mild itching, irritation, or pain is often present (Walkty et al., 2020). Tinea barbae is the primary diagnosis based on positive findings of patchy red areas in the beard area with pustules and mild irritation. The brittle and easily plucked-out beard hairs also support the diagnosis.
Pseudofolliculitis Barbae: This is an irritation of the skin caused by hairs that penetrate the skin before coming out of the hair follicle or come out of the follicle and curve back into the skin, resulting in a foreign-body reaction (Ogunbiyi, 2019). Pseudofolliculitis barbae mostly occurs around the beard and neck. Clinical manifestations include an erythematous papule with a hair shaft at the center (Ogunbiyi, 2019). Pseudofolliculitis barbae is a differential diagnosis based on the pustule and erythematous patches in the patient’s lower beard.
Bacterial Folliculitis: This is a bacterial infection of hair follicles. It is mostly caused by Staphylococcus aureus, but occasionally Pseudomonas aeruginosa. Clinical manifestations include mild pruritus, pain, or irritation (Jappa & Sameer, 2018). Physical findings include a superficial pustule or inflammatory nodule around a hair follicle. The infected hairs fall out or are plucked by the patient, but new papules develop (Jappa & Sameer, 2018). The growth of stiff hairs into the skin may result in chronic low-grade inflammation or irritation. Bacterial Folliculitis is a differential based on positive symptoms of mild pruritus, papules that progress to pustules on the beard area, and beard hair that easily plucks off.
PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Jappa, L. S., & Sameer, R. K. (2018). A clinical and bacteriological study of bacterial folliculitis. Panacea Journal of Medical Sciences, 8(2), 54-58. https://doi.org/10.18231/2348-7682.2018.0014
Ogunbiyi, A. (2019). Pseudofolliculitis barbae; current treatment options. Clinical, cosmetic and investigational dermatology, pp. 12, 241–247. https://doi.org/10.2147/CCID.S149250
Walkty, A., Elgheriani, A., Silver, S., Pieroni, P., & Embil, J. (2020). Tinea barbae presenting as a kerion. Postgraduate Medical Journal, 96(1137), 441-441. http://dx.doi.org/10.1136/postgradmedj-2020-137609