NURS 6512 Week 4 Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions Sample Essay

NURS 6512 Week 4 Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions Sample Essay

NURS 6512 Week 4 Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions Sample Essay

Patient Information: R.S, 50-year-old male

Subjective

CC: Nasal congestion as well as itching for the last 5 days

HPI: R.S is a 50-year-old male that came to the unit with complaints of nasal congestion, rhinorrhea, sneezing, itchy nose, postnasal discharge, and itching ears and nose for the last 5 days. The patient reported using Mucinex medication to help ease breathing but it has been associated with minimal effectiveness. The patient denied any history of pain or headache.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: on NURS 6512 Week 4 Assignment 1 Lab Assignment Differential Diagnosis for Skin Conditions

Medications: The patient currently uses Mucinex over-the-counter medication 1 tab orally on a daily basis.

Allergies: The patient denied any history of drug or food allergy. The patient reported history of seasonal allergies.

PMHx: The patient denied history of hospitalization, surgery, and blood transfusion. The immunization history of the client is up to date.

Social Hx: The patient is married with two children. The patient stopped smoking in 2012. He drinks alcohol on occasional basis. His highest level of education is university. He has a degree in business administration and works at a local supermarket as a manager. He reported to engage in active physical activity. He reported that the symptoms of the disease had affected his sleeping patterns significantly.

Family Hx: The parents of the patient are both alive. His father was diagnosed with diabetes in 2016 and has been on treatment. His mother was diagnosed with hypertension in 2020 and is on treatment. The patient is the second born in a family of three. His siblings are all alive and healthy.

General: The patient appeared well groomed for the occasion. He was oriented to time, place, and self.

He denied fevers, fatigue, or chills. The patient reported being tired due to lack of enough sleep secondary to the symptoms of the health problem.

HEENT: The patient denied headaches. The patient reported that his eyes are itchy and red. There were no changes in the vision. The tympanic membranes are intact, with absence of ear drainage of changes in hearing. The patient reported nasal congestion, itchy, with pale and boggy nasal mucosa. There was clear nasal drainage with slightly enlarged nasal turbinates. There was absence of tonsillitis. The throat was mildly erythematous.

Neck: The trachea was midline without any deviation or lymphadenopathy.

Skin: The patient denied skin rash, changes in skin color, and itching.

Cardiovascular: The patient denied chest pain, palpitations, discomfort, or edema.

Respiratory: The patient denied shortness of breath, cough or difficulty in breathing

Musculoskeletal: The patient denied joint or muscle pain.

Lymphatic: The client denied lymphadenopathy

Allergies: The client denied any known food or drug allergy. He reported seasonal allergies.

Objective

HEENT: The patient reports that his eyes are itchy. The eyes appear red. The tympanic membranes are intact with the absence of any drainage. The nasals are congested, with boggy, pale mucosa and inflamed nasal turbinates. There is the evidence of drainage of thin, clear secretion. There is mild erythema on the throat with absence of tonsillitis and bleeding.

Diagnostic Results

The skin test revealed a positive reaction to pollen. The results showed that the patient has allergic rhinitis. Allergic rhinitis is a condition of the upper respiratory system that arises from an individual exposure to an allergen. Patients experience symptoms that include sneezing, rhinorrhea, itchy nose and eyes, nasal congestion, and sore throat among others.

Diagnostic investigations are not recommended in allergic rhinitis since they do not have any cost benefits. Healthcare providers can utilize history taking and physical examination to diagnose patients with the condition. It is however important to perform tests such as skin tests to determine whether a patient has allergic rhinitis in people without history of allergic reactions.

Differential Diagnosis

Allergic Rhinitis: The first differential diagnosis for the patient is allergic rhinitis. As noted initially, allergic rhinitis is a respiratory condition that develops following an individual exposure to an allergen. The symptoms associated with allergic rhinitis include sneezing, nasal congestion, rhinorrhea, and itchy eyes. The symptoms developed due to IgE mediated reactions against the allergens (Okubo et al., 2020). Allergic rhinitis is the primary diagnosis for the patient due to the positive skin test.

Non-allergic rhinitis: Non-allergic rhinitis is the other possible condition affecting the client. Patients present with symptoms such as nasal congestion, rhinorrhea, sneezing, and itchy eyes among others. However, patients do not have history of allergic reactions to allergens (Zheng Ming et al., n.d.). This is the least diagnosis for the client in the case study because he has history of seasonal allergy.

Sinusitis: sinusitis refers to a condition where the paranasal sinuses are inflamed. Sinusitis is attributed to causes such as fungal, viral or bacterial infections and allergic reactions. Patients with sinusitis experience symptoms such as nasal congestion, headache, rhinorrhea, fever, and facial pain (Little et al., 2018). Sinusitis is however, the least possible condition due to the absence of signs and symptoms associated with infections.

Flu/Common cold: Common cold is the other potential diagnosis. Common cold is an acute viral infection affecting the upper respiratory system. It may involve sinuses, larynx or the pharynx. Patients experience symptoms such nasal drainage, malaise, fever, and headache among others. It is however the least likely due to the absence of signs and symptoms of infection (Sadeghirad et al., 2017).

Sore throat: Sore throat is the other potential diagnosis for the patient. Patients experience pain in the pharynx on swallowing. Sore throat is largely attributed to viral infections. The patient however is least suffering from sore throat because of the absence of signs and symptoms of infection (Mahalingam et al., 2020).

References

Little, R. E., Long, C. M., Loehrl, T. A., & Poetker, D. M. (2018). Odontogenic sinusitis: A review of the current literature. Laryngoscope Investigative Otolaryngology, 3(2), 110–114. https://doi.org/10.1002/lio2.147

Mahalingam, N. V., Abilasha, R., & Kavitha, S. (2020). Awareness of symptomatic differences COVID-19, sars, swine flu, common cold among dental students. International Journal of Research in Pharmaceutical Sciences, 11(Special Issue 1). https://doi.org/10.26452/ijrps.v11iSPL1.3431

Okubo, K., Kurono, Y., Ichimura, K., Enomoto, T., Okamoto, Y., Kawauchi, H., Suzaki, H., Fujieda, S., Masuyama, K., & Allergology, T. J. S. of. (2020). Japanese guidelines for allergic rhinitis 2020. Allergology International, 69(3), 331–345. https://doi.org/10.1016/j.alit.2020.04.001

Sadeghirad, B., Siemieniuk, R. A. C., Brignardello-Petersen, R., Papola, D., Lytvyn, L., Vandvik, P. O., Merglen, A., Guyatt, G. H., & Agoritsas, T. (2017). Corticosteroids for treatment of sore throat: Systematic review and meta-analysis of randomised trials. BMJ, 358, j3887. https://doi.org/10.1136/bmj.j3887

Zheng Ming, Wang Xiangdong, Ge Siqi, Gu Ying, Ding Xiu, Zhang Yuhuan, Ye Jingying, & Zhang Luo. (n.d.). Allergic and Non-Allergic Rhinitis Are Common in Obstructive Sleep Apnea but Not Associated With Disease Severity. Journal of Clinical Sleep Medicine, 13(08), 959–966. https://doi.org/10.5664/jcsm.6694

 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/

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 successfully treated with Nitrofurantoin. She was previously on IUD.

 Personal/Social History: W.T. is married and lives with her husband in Baltimore, MD. She has a Diploma in Secretarial studies and works as a corporate secretary. Her hobbies are baking and traveling. She reports having about six small meals and about 3L of water daily. She used to smoke ½ PPD and drink 2-3 glasses of vodka on her off days before getting pregnant. She denies currently taking alcohol, smoking, or using any drug substances. The patient states that her husband and elder sister are her support system.

Health Maintenance: The patient reports attending antenatal checkups and adheres to the daily Iron and Folic Acid supplements.

 Immunization History: Her immunization status is up to date. She had a TT2 booster in the last antenatal visit. The last Flu shot was 8 months ago.

Significant Family History: The maternal grandmother has Rheumatoid arthritis and HTN. The father was recently diagnosed with diabetes. Her siblings are alive and well.

Review of Systems:

General: Denies fever, generalized weakness, or chills.

HEENT: Denies eye redness, excessive tearing, blurred vision, nasal secretions, or swallowing difficulties.  

Respiratory: Denies breathing difficulties, wheezing, or coughing.

Cardiovascular/Peripheral Vascular: Denies edema, chest tightness, palpitations, or exertional dyspnea.

Gastrointestinal: Reports occasional nausea and vomiting. Denies abdominal pain, heartburn, diarrhea, or constipation.  

Genitourinary: Reports urine frequency and increased PV discharge. Denies foul-smelling discharge, lower abdominal pain, or urinary urgency.

Musculoskeletal: Denies back pain, joint stiffness, or pain.

Neurological: Negative for headaches, dizziness, or muscle weakness.

Psychiatric: Negative for psychotic, mood, or anxiety symptoms.

Skin/hair/nails: Reports stretch marks. Denies itching, burning sensation, rashes, bruising, or brittle nails

OBJECTIVE DATA:

Physical Exam:

Vital signs: BP-122/78; HR-80; RR-16; Temp-98.4; HT-5’4; WT- 154 lbs.

General: AA female client in no distress. She is alert and oriented x3.

HEENT: Head is symmetrical; Eyes: Sclera is white; Conjunctiva is pink; PERRLA; Ears: Intact and shiny TMs

Neck: Symmetrical and Supple. Thyroid gland normal on palpation.

Chest/Lungs: Uniform chest expansion. Smooth respirations; Lungs clear on auscultation.

Heart/Peripheral Vascular: No edema or neck vein distension. Regular heart rate and rhythm; S1 and S2 present; No murmurs.

Abdomen: Gravid abdomen; The abdominal skin is stretched with marked striae. Linea nigra present; Normoactive BS; FHR-142b/min; Gravid mass on palpation; No tenderness on palpation; No organomegaly.

Genital/Rectal: Normal female genitalia. Intact anal sphincter.

Musculoskeletal: Active ROM; No joint deformities.

Neurological: Clear speech; CNs are intact; Muscle strength- 5/5; Upright posture; Steady gait.

Skin: Flat dark streaks on the abdomen. The dark streaks are raised, 1-10 mm wide, and the length varies at 1-5 cm. A dark vertical line runs from the diaphragm to the pubic area.

 Diagnostic results: No tests were ordered.

ASSESSMENT:

Striae gravidarum: Striae gravidarum are stretch marks that appear during pregnancy. They are caused by thin tears in the dermal collagen. They appear as flat red or hypopigmented stripes that become raised, longer, wider, and violet-red (Abbas et al., 2018). The patient has dark flat streaks on the abdomen that first occurred during pregnancy, which align with Striae gravidarum.

Anetoderma: It is characterized by flaccid, well-circumscribed areas of slack skin. Sac-like protrusions can sometimes be observed in some lesions. It is attributed to the loss of elastic fibers within the dermis (Genta et al., 2020). Histopathology is necessary to confirm or rule out Anetoderma to determine if elastic tissue is lost in the dermis.

Lichen sclerosus: This is a rare autoimmune skin condition characterized by skin atrophy and hypopigmentation. It commonly affects genital skin. It typically begins as a sharply demarcated erythema that progresses into thin, hypopigmented, ivory-white, and sclerotic plaques. The plaques are surrounded by a purple, red, or violet border (Singh & Ghatage, 2020). The hypopigmented streaks make this a differential diagnosis. However, the patient has no plaques, and the streaks are not in the genital area ruling Lichen sclerosus as the primary diagnosis.

Elastotic striae: This is a rare skin condition that manifests as asymptomatic atrophic yellow lines on the thighs, mid or lower back, arms, or breasts. It manifests clinically with asymptomatic, numerous, yellowish, elevated, irregularly indurated, striae-like lines or bands spread horizontally across the lower and middle part of the posterior trunk (Palaniappan et al., 2023). The patient has raised irregular streaks, but they are not in the posterior trunk, making this an unlikely primary diagnosis.

Scarring: Scars present as raised, firm nodules or plaques, usually at sites of previous trauma (Barone et al., 2021). However, the patient has no history of abdominal trauma, which rules out scarring as the cause of the hypopigmented streaks.

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

References

Abbas, A. M., Kamel, F. M., & Salman, S. A. (2018). Clinical significance and treatment of striae gravidarum during pregnancy: a review article. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(1), 368. doi:10.18203/2320-1770.ijrcog20185454 

Barone, N., Safran, T., Vorstenbosch, J., Davison, P. G., Cugno, S., & Murphy, A. M. (2021). Current Advances in Hypertrophic Scar and Keloid Management. Seminars in plastic surgery, 35(3), 145–152. https://doi.org/10.1055/s-0041-1731461 Lokhande, A. J., & Mysore, V. (2019). Striae Distensae T