NURS 6512 WEEK 10 Assignment 1 Differential Diagnosis for Skin Conditions

Sample Answer for NURS 6512 WEEK 10 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 Discussion, 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.

Note: Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. 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.

To prepare:

Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion.

Consider the abnormal physical characteristics you observe in the graphics 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.

By Day 3

Post a description of the two graphics you selected (identify each graphic by number). Use clinical terminologies to explain the physical characteristics featured in each graphic. Formulate a differential diagnosis of three to five possible conditions for each. Determine which is most likely to be the correct diagnosis, and explain your reasoning.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days. Make sure that you respond to colleagues who selected at least one graphic that is different from the ones you selected. For each, address all of the following:

Critique your colleague’s clinical description of the physical characteristics of each.

Suggest an additional possible condition for each graphic, and explain your reasoning.

Provide an alternative correct diagnosis, and explain your reasoning.

Validate an idea with your own experience and additional research.

Week 4 Skin Comprehensive SOAP Note

Patient Initials: B.B Age: 32 years Gender: Male

A Sample Answer For the Assignment: NURS 6512 WEEK 10 Assignment 1 Differential Diagnosis for Skin Conditions

Title: NURS 6512 WEEK 10 Assignment 1 Differential Diagnosis for Skin Conditions

SUBJECTIVE DATA:

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.

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

A Sample Answer 2 For the Assignment: NURS 6512 WEEK 10 Assignment 1 Differential Diagnosis for Skin Conditions

Title: NURS 6512 WEEK 10 Assignment 1 Differential Diagnosis for Skin Conditions

SUBJECTIVE DATA:

Chief Complaint (CC): “I have some stretch marks and a line on my abdomen’

History of Present Illness (HPI): A.T. is a 28-year-old female client that came to the clinic with complaints of abnormal stretch marks and a line on her abdomen. The client is pregnant. The gestation of her pregnancy is 28 weeks. She has never started her antenatal clinic visits. The patient reports that the problem started four weeks ago and she was hopeful that it would diminish over time. She denied any associated symptoms such as pain or itchiness. However, she was worried that she may be having a skin condition that would require immediate intervention. She has not used any skin medications for the problem.

Medications: The patient denied any current use of medications. She reported occasional use of Tylenol 1 gram for headaches.

Allergies: The patient reported allergic reaction to Penicillin and pollen. She denied food allergies.

Past Medical History (PMH): The patient reported a history of hospitalization when she was 18 years old because of pneumonia. She denied any history of chronic conditions such as diabetes and depression. She also denied any history of blood transfusion.

Past Surgical History (PSH): The patient denied any history of surgeries

Sexual/Reproductive History: The patient is sexually active. Her last menstrual period was 21/10/2022. She denied any history of sexually transmitted infections. She also denied any history of increased urgency, frequency, and dysuria. She does not have any history of pregnancy loss or use of contraceptives. She is heterosexual.

Personal/Social History: The patient is married. She is the first born in a family of three. Her parents are both alive. This is her first pregnancy. She works as an accountant in a local firm. She does not use alcohol or smokes. She engages in moderate physical activities twice weekly. She is a Christian. She considers her family her source of social support. She denies stress.

Health Maintenance: The patient engages in moderate exercises twice weekly. She does not take alcohol or smokes. She reports that she takes healthy diet. Her immunization record is up-to-date. She has not started her antenatal clinic despite her pregnancy being 28 weeks. She denies caffeine use. She has not undergone cervical cancer screening. She performs monthly self-breast examination. Her last dental and eye examinations were two years ago and were unremarkable.

Immunization History: Her immunization record is up-to-date.

Significant Family History: The client reports that her parents are both hypertensive. Her mother is diabetic. Her paternal grandmother and grandfather died of coronary artery disease. Her maternal grandmother died of cervical cancer. Her sister is obese. Her brother was recently diagnosed with substance use disorder.

General: The patient is well dressed for the occasion. She denied fatigue, fever, chills or night sweats. Reports weight gain of 10 pounds since she became pregnant.

HEENT: She denies changes in vision or hearing; she does wear glasses. She has no history of glaucoma, diplopia, floaters, excessive tearing or photophobia. She has had no recent ear infections, tinnitus, or discharge from the ears. She denied changes in sense of smell. She does not have a history of nasal polyps or recent sinus infection. She denied ulceration, lesions, gingivitis, gum bleeding, and has no dental appliances. She has had no difficulty chewing or swallowing.

Neck: She denies pain, injury, or history of disc disease or compression..

Breasts: She denies history of lesions, masses or rashes.

Respiratory: She denies cough, hemoptysis, difficulty breathing or chest pain. She a history of community acquired pneumonia when she was 18 years.

CV: She denies chest discomfort, palpitations, history of murmur. She has no history of arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication.

GI: She denies nausea or vomiting, abdominal pain. She also denies changes in bowel/bladder pattern.

GU: She denies change in her urinary pattern, dysuria, or incontinence. She is heterosexual. She denies history of STD’s or HPV. She is sexually active.

MS: She denies arthralgia/myalgia, arthritis, gout or limitation in her range of motion.

Psych: She denies history of anxiety or depression. She also denies sleep disturbance, delusions or mental health history.

Neuro: She denies syncope episodes or dizziness, paresthesia, change in memory or thinking patterns. She also denies twitches or abnormal movements, gait disturbance, falls or seizure history.

Integument/Heme/Lymph: She reports stretch marks and a line in the middle of her abdomen. She denies rashes, itching, or bruising.

Endocrine: She denies polyuria/polyphagia/polydipsia. She also denies fatigue, heat or cold intolerances, or shedding of hair

Allergic/Immunologic: She is allergic to Penicillin and pollen. She has no food allergies.

OBJECTIVE DATA

Physical Exam:

Vital signs: B/P 124/78, left arm, sitting, regular cuff; P 82 and regular; T 99.9 Orally; RR 20; non-labored; Wt: 168 lbs; Ht: 6’5

General: A&O x3, NAD

HEENT: PERRLA, EOMI, oronasopharynx is clear

Neck: Carotids no bruit, jugular venous distention or thyromegally

Chest/Lungs: Lungs clear of wheezing or rhonchi

Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial

ABD: presence of bilateral strae gravidarum and central linea nigra. Normal bowel sounds with no organomegaly and suprapubic

Genital/Rectal: Non-contributory

Musculoskeletal: symmetric muscle development. Muscle strengths 5/5 all groups.

Neuro: Normal cranial nerve assessment with no gait imbalance or coordination problems. There is no loss of sensitivity to touch.

Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes

Diagnostic results: Obstetrics ultrasound performed one day ago: Intrauterine live pregnancy at 28/40 weeks in breech presentation. FHR-132 bpm, BPP 8/8, cervix closed

ASSESSMENT:

Differential Diagnosis

Linea nigra: Linea nigra is a hyperpigmentation characterized by a vertical line running down the middle of the abdomen. It is an indicator of pregnancy.
Strae gravidarum: Strae gravidarum refers to atropic linear scars that pregnant mothers develop. The form as stretch marks on the abdomen and diminish over time.
Post-inflammatory hyperpigmentation: Post-inflammatory hyperpigmentation is a disorder that develops after skin injury or inflammation. It is severe in dark-skinned individuals. It improves spontaneously but can also require treatment for immediate changes (Lawrence & Al Aboud, 2023). It is the least likely condition since the patient in the case study is pregnant.
Melanocytic naevi: Melanocytic nevi are benign hematomas or neoplasms that cause skin hyperpigmentation. It mainly affects the central nervous system and the skin. Melanocytic nevi are the least likely cause of the client’s problem since they do not occur in features such as midline vertical line that is seen in pregnancy (Yeh, 2023)

Primary diagnosis

Normal pregnancy with features that include linea nigra and strae gravidarum: The client’s primary diagnosis is normal pregnancy with features that include linea nigra and strae gravidarum. Linea nigra is a normal occurrence in pregnant women. It refers to a form of hyperpigmentation that is witnessed in pregnancy. It is a dark vertical line running down the middle of the abdomen. It is an indicator of pregnancy. Linea nigra is associated with nipple, genital areas, and areola hyperpigmentation (Cappanera, 2022; Ferrando et al., 2019; Sharma et al., 2019). Strae gravidarum refers to atrophic linear scars that develop on the abdomen during pregnancy. They appear as stretch marks that may be of considerable concern to pregnant women (Dai et al., 2021). Strae gravidarum is non-pathological. The stretch marks fade over time and become hypopigmented (Karhade et al., 2021). The patient in the case study has these features, hence, a diagnosis of linea nigra and strae gravidarum. The patient is also pregnant, hence, the primary diagnosis with these conditions.

PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.

References

Cappanera, F. F., Gisella Sorrentino, Elena. (2022). Linea Nigra: Post/Human M/Others. In Engaging Donna Haraway. Routledge.

Dai, H., Liu, Y., Zhu, Y., Yu, Y., & Meng, L. (2021). Study on the methodology of striae gravidarum severity evaluation. BioMedical Engineering OnLine, 20(1), 109. https://doi.org/10.1186/s12938-021-00945-w

Ferrando, B. F., Sorrentino, G., & Cappanera, E. (2019). Linea Nigra: Post|Human M|Others. A/b: Auto/Biography Studies, 34(3), 501–505. https://doi.org/10.1080/08989575.2019.1664152

Karhade, K., Lawlor, M., Chubb, H., Johnson, T. R. B., Voorhees, J. J., & Wang, F. (2021). Negative perceptions and emotional impact of striae gravidarum among pregnant women. International Journal of Women’s Dermatology, 7(5, Part B), 685–691. https://doi.org/10.1016/j.ijwd.2021.10.015

Lawrence, E., & Al Aboud, K. M. (2023). Postinflammatory Hyperpigmentation. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK559150/

Sharma, A., Jharaik, H., Sharma, R., Chauhan, S., & Wadhwa, D. (2019). Clinical study of pregnancy associated cutaneous changes. International Journal of Clinical Obstetrics and Gynaecology, 3(4), 71–75. https://doi.org/10.33545/gynae.2019.v3.i4b.292

Yeh, I. (2023). Melanocytic naevi, melanocytomas and emerging concepts. Pathology, 55(2), 178–186. https://doi.org/10.1016/j.pathol.2022.12.341