Assignment 1: Differential Diagnosis for Skin Conditions

Assignment 1: Differential Diagnosis for Skin Conditions

SUBJECTIVE DATA:

Chief Complaint (CC): Number 4: “I have had a nasal congestion alongside itching that has occurred for the last five days . ”

History of Present Illness (HPI): The patient, M.S is 5o years of age and presented to the clinic complaining of having congested noses, sneezing, rhinorrhea, itching nose and ears, postnasal discharge, which symptoms have occurred for the last 5 days. Apparently, the patient employed the usage of Mucinex drug so as to help him with the breathing difficulty he was having. The patient reported that the medicine did not have any adverse effects on him but its effectiveness was minimal. The patient also did not report having any headache of pain.

Medications: The patient uses an over the counter medication called Mucinex, at 1 tab daily using the oral route.

Allergies: The patient did not accept having food or drug allergy. However, he reported the presence of seasonal allergies.

Past Medical History (PMH): He denied having been hospitalized or undergone blood transfusion before.

Past Surgical History (PSH): Has never undergone surgery.

Sexual/Reproductive History: He has never suffered from STIs, urinary incontinence, UTIs, or impotence.

Personal/Social History: The client has a wife and two children. He has not smoked since 2013. He is a social drinker. Has a university degree in BA and is employed as a supermarket manager in his locality. The disease interfered with his sleeping patterns.

Health Maintenance: He stated that he actively participates in physical activity.

Immunization History: Up-to-date immunization data.

Significant Family History: Both parents alive. The father is diabetic, which diagnosis occurred on 2017. The mother is hypertensive since 2019. The parents have three children and the patient is the last born of them. All the siblings are alive.

Review of Systems:

General: The patient was well-groomed. His orientation to self, time, and place was perfect. He did not accept having chills, fever or fatigue. He stated that the lack of sleep that he had caused him to be tired, which was secondary to the issue he was having.

HEENT: Denied the presence of headache. Reported itchy eyes. The eyes were also red. Vision remained the same. Intact tympanic membranes reported. Denied drainage of ears or hearing alterations. Reported that the nose was itchy. Presence of nasal congestion reported. Reported the presence of nasal mucosa that was boggy. The nasal discharge was clear but the turbinates were enlarged. Denied having tonsillitis. The throat showed mild erythema.

Respiratory: No significant issue as the trachea was in a midline position sans lymphadenopathy.

Cardiovascular/Peripheral Vascular: The patient did not have palpitations, chest pain, or edema, or discomfort.

Gastrointestinal: The patient denied vomiting, nausea, abdominal distention, as well as diarrhea.

Genitourinary: The patient did not report polyuria, oliguria, frequent urination, or dysuria.

Musculoskeletal: The patient did not report the presence of muscle/joint pain.

Neurological: The patient reported not having changes in gait, headache, body imbalance, as well as loss of sensations.

Psychiatric: The patient’s family did not have psychiatric illnesses.

Skin/hair/nails: The patient did not have any skin rash, alterations in skin color, or itching.

OBJECTIVE DATA:

Physical Exam:

Vital signs: BP 109/78 P-80 Temp 37.5 RR-20 Weight 59 kg Height 6’2 BMI 24.8

General: The patient did not have any signs of distress. He was perfectly oriented.

HEENT: The patient’s eyes were red. His vision acuity was normal without eye drainage or pallor. Intact tympanic membranes present. Hearing did not have changes. Boggy and pale nasal mucosa present. Nasal turbinates were slightly elongated but the nasal drainage was clear. Tonsilities not present. Mildly erythematous throat seen.

Neck: Carotids did not have bruit, thyromegally or jvd

Chest/Lungs: Normoactive lung sounds. Respiratory muscles inactive during breathing.

Heart/Peripheral Vascular: RRR did not have murmur, gallop or rub

Abdomen: Absence of abdominal distention. Presence of normal bowel movements. Organomegally absent.

Genital/Rectal: Declined by the patient.

Musculoskeletal: Symmetry in muscle development without noticeable abnormal fractures or gait.

Neurological: Absence of loss of sensation, muscle paralysis, as well as movements

Skin: No clubbing, cyanosis, edema; no palpable nodes

Diagnostic results: Positive skin test to pollen

ASSESSMENT:

Differential Diagnosis

Allergic Rhinitis: Allergic rhinitis appears to as the first differential diagnosis for the chosen patient. The presence of an allergen may result to the manifestation of allergic rhinitis. The symptomatology of the condition is inclusive of nasal congestion, rhinorrhea, itchy eyes, and sneezing (Bousque et al., 2020). Regarding the patient, these symptoms occurred as a result of the IgE mediated reactions versus the seasonal allergens affecting the patient. Its primary diagnosis was based on the positive skin test that was conducted.

Non-allergic rhinitis: The patient could also be suffering from non-allergic rhinitis. The patients having this condition also share similarities in the symptomatology with the primary diagnosis.

(Zheng Ming et al., n.d.). This forms the least possible options due to the presence of seasonal allergic reaction history.

Sinusitis: Sinusitis connotes a condition that is characterized by inflammation of the paranasal sinuses. The condition is caused by various factors including allergic reactions, bacterial or viral infections, and fungal. The symptoms of sinusitis include headache, facial pain, nasal congestion, fever, and rhinorrhea (Psillas et al., 2021). However, sinusitis is the slightest condition because it lacks signs and symptoms linked to infections.

Flu/Common Cold: The other possible diagnosis is common cold which is an acute viral respiratory infection that affects the upper part of the respiratory system. It impacts sinuses, and the pharynx. Flu symptoms include nasal drainage, malaise, headache and fever (Thomas & Bomar, 2021). However, there are no signs and symptoms in this case.

Sore Throat: Sore throat is also a possible diagnosis for the patient. Sore throat entails pain when swallowing in the pharynx. It is main a viral infection (Taymaz et al., 2021). However, the possibility of sore throat is the least in this case since the patient does not present any signs and symptoms.

 

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

References

Bousquet, J., Schünemann, H. J., Togias, A., Bachert, C., Erhola, M., Hellings, P. W., … & Its Impact on Asthma Working Group. (2020). Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. Journal of Allergy and Clinical Immunology, 145(1), 70-80. https://doi.org/10.1016/j.jaci.2019.06.049

Psillas, G., Papaioannou, D., Petsali, S., Dimas, G. G., & Constantinidis, J. (2021). Odontogenic maxillary sinusitis: A comprehensive review. Journal of Dental Sciences, 16(1), 474-481. https://doi.org/10.1016/j.jds.2020.08.001

Scadding, G. K., Kariyawasam, H. H., Scadding, G., Mirakian, R., Buckley, R. J., Dixon, T., … & Clark, A. T. (2017). BSACI guideline for the diagnosis and management of allergic and non‐allergic rhinitis (Revised Edition 2017; 2007). Clinical & Experimental Allergy, 47(7), 856-889. https://doi.org/10.1111/cea.12953

Taymaz, T., Ergönül, Ö., Kebapcı, A., & Okyay, R. (2018). Significance of the detection of

influenza and other respiratory viruses for antibiotic stewardship: lessons from the post-pandemic period. International Journal of Infectious Diseases, 77, 53-56. DOI:https://doi.org/10.1016/j.ijid.2018.10.003

Thomas, M. & Bomar, P. A. (2021). Upper Respiratory Tract Infection. StatPearls [Internet].

https://www.ncbi.nlm.nih.gov/books/NBK532961/

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 FOR Assignment 1: Differential Diagnosis for Skin Conditions:

• 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 Assignment 1: Differential Diagnosis for Skin Conditions:

• 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

NURS 6512 Assignment 2: Health History Assessment Video

By Day 7

Submit your video using the Kaltura Mashup tool accessible through the Assignment submission link provided.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

NURS 6512 Assignment 3 (Optional) Practice Assessment: Skin, Hair, and Nails Examination

Advanced practice nurses are required to have the skills and knowledge necessary to perform many different physical assessments and health examinations. In this course, you will demonstrate your abilities in this area by videotaping yourself as you perform various examinations on a volunteer “patient.”

In preparation for the Head-to-Toe Physical Assessment Video due in Week 10, it is recommended that you practice conducting an assessment of the skin, hair, and nails this week.

Note: This is an optional practice physical assessment. You do not have to capture a video of this assessment, as no submission is required.

To prepare:

• Arrange an appropriate time and setting with your volunteer “patient” to perform a skin, hair, and nails examination. Note: Your volunteer’s Video Release form must be submitted prior to the exam.
• Download and review the Skin, Hair, and Nails checklist provided in this week’s Learning Resources.

To complete:

• Perform the skin, hair, and nails examination, covering all of the areas listed in the checklist.

NURS 6512 Week 4: Assessment of the Skin, Hair, and Nails

Something as small and simple as a mole or a discolored toenail can offer meaningful clues about a patient’s health. Abnormalities in skin, hair, and nails can provide non-invasive external clues to internal disorders or even prove to be disorders themselves. Being able to evaluate such abnormalities of the skin, hair, and nails is a diagnostic benefit for any nurse conducting health assessments.

This week, you will explore how to assess the skin, hair, and nails, as well as how to evaluate abnormal skin findings.

Learning Objectives

Students will:

• Apply assessment skills to diagnose skin conditions
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the skin, hair, and nails
• Apply assessment skills to collect patient health histories

Photo Credit: Keri Oberly/Getty Images

---

Learning Resources

Required Readings

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 8, “Skin, Hair, and Nails” (pp. 114-165). This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 28, “Rashes and Skin Lesions” (pp. 325-343). This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.

Note: Download and use the Adult Examination Checklist and the Physical Exam Summary when you conduct your video assessment of the skin, hair, and nails.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for skin, hair, and nails. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. This Adult Examination Checklist: Guide for Skin, Hair, and Nails was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Skin, hair, and nails physical exam summary. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. This Skin, Hair, and Nails Physical Exam Summary was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Everyday Health, Inc. (2013). Resources for dermatology and visual conditions. Retrieved from http://www.skinsight.com/info/for_professionals. This interactive website allows you to explore skin conditions according to age, gender, and area of the body.

Clothier, A. (2014). Assessing and managing skin tears in older people. Nurse Prescribing, 12(6), 278–282. Retrieved from http://www.nurseprescribing.com/. Retrieved from the Walden Library Databases.

Watkins, J. (2013a). Skin rashes, part 1: Skin structure and taking a dermatological history. Practice Nursing, 24(1), 30–33. doi:10.12968/pnur.2013.24.1.30 Retrieved from the Walden Library Databases.

Watkins, J. (2013b). Skin rashes, part 2: Distribution and different types of rashes. Practice Nursing, 24(3), 124–127. Retrieved from http://www.practicenursing.com/ Retrieved from the Walden Library Databases.

Watkins, J. (2013c). Skin rashes, part 3: localized rashes. Practice Nursing, 24(5), 235–241. doi:10.12968/pnur.2013.24.5.235 Retrieved from the Walden Library Databases. Document: Skin Conditions (Word document)

This document contains five images of different skin conditions. You will use this information in this week’s Discussion.

Document: Comprehensive SOAP Exemplar (Word document)

Document: Comprehensive SOAP Template (Word document)

Note: To access the online resources included with the textbook, you need to complete the FREE online registration that is located at https://evolve.elsevier.com/cs/product/9780323172660?role=student.

To Register to View the Content

1. Go to https://evolve.elsevier.com/cs/product/9780323172660?role=student
2. Enter the name of the textbook, Seidel’s Guide to Physical Examination (name of text without the edition number) in the Search textbox.
3. Complete the registration process.

To View the Content for this Textbook

1. Go to https://evolve.elsevier.com/.
2. Click on Student Site.
3. Type in your Username and Password.
4. Click on the Login button.
5. Click on the plus sign icon for Resources on the left side of the screen.
6. Click on the name of the textbook for this course.
7. Expand the menu on the left to locate all the chapters.
8. Navigate to the desired content (checklists, videos, animations, etc.).

Note: Clicking on the URLs in the APA citations for the Resources from the textbook will not link directly to the desired online content. Use the online menu to navigate to the desired content.

Required Media

Online media for Seidel’s Guide to Physical Examination

In addition to this week’s media, it is highly recommended that you access and view the online resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 8 that relate to the assessment of the skin, hair, and nails.

The following suturing tutorials provide instruction on the basic interrupted suture, as well as the vertical and horizontal mattress suturing techniques:

Tulane Center for Advanced Medical Simulation & Team Training. (2010, July 8). Suturing technique.

Retrieved from https://www.youtube.com/watch?v=c-LDmCVtL0o

Mikheil. (2014, April 22). Basic suturing: Simple, interrupted, vertical mattress, horizontal mattress.

Retrieved from https://www.youtube.com/watch?v=MFP90aQvEVM

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

• Chapter 6, “The Skin and Nails”In this chapter, the authors provide guidelines and procedures to aid in the diagnosis of skin and nail disorders. The chapter supplies descriptions and pictures of common skin and nail conditions.

Ethicon, Inc. (n.d.a). Absorbable synthetic suture material. Retrieved from https://web.archive.org/web/20170215015223/

http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/absorbable_suture_chart.pdf

Ethicon, Inc. (2006). Dermabond topical skin adhesive application technique. Retrieved from https://web.archive.org/web/20150921174121/

http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_application_poster.pdf

Ethicon, Inc. (2001). Ethicon needle sales types. Retrieved from https://web.archive.org/web/20150921171922/

http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/needle_template.pdf

Ethicon, Inc. (n.d.b). Ethicon sutures. Retrieved from https://web.archive.org/web/20150921202525/

http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/suture_chart_ethicon.pdf

Ethicon, Inc. (2002). How to care for your wound after it’s treated with Dermabond topical skin adhesive. Retrieved from https://web.archive.org/web/20150926002534/

http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_wound_care.pdf

Ethicon, Inc. (2005). Knot tying manual. Retrieved from https://web.archive.org/web/20160915214422/ http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/knot_tying_manual.pdf. Assignment 1: Differential Diagnosis for Skin Conditions

Ethicon, Inc. (n.d.c). Wound closure manual. Retrieved from https://web.archive.org/web/20170829043048/

http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/eth. Assignment 1: Differential Diagnosis for Skin Conditions

SUBJECTIVE DATA:

 

Chief Complaint (CC): “Stretch marks.” (Image 2

History of Present Illness (HPI): W.T. is a 26-year-old AA female presenting to the dermatologic clinic with complaints of stretch marks. She is concerned about her appearance and wishes to know if there is any cream she can use to reduce the appearance of stretch marks. She is pregnant, and the gestation by date (GBD) is 32 weeks. The stretch marks began appearing when she was about 22 weeks pregnant, and they have increased in number and size as the pregnancy progressed. She reports having used cocoa butter, shea butter lotions, and various stretch marks creams, but they have been ineffective.

 

Medications: Iron and Folic acid Supplements

 

Allergies: Allergic to Penicillin- causes a rash.

 

Past Medical History (PMH): No chronic illnesses.

Past Surgical History (PSH): Tonsillectomy at 6 years.

Sexual/Reproductive History: Para 0+0, Gravida-1; No history of STIs or gynecological disorders. Had UTI at 16 weeks GBD but was success