Please review:
1. The complete instructions.
2. The grading rubric.
3. The exemplar as a guide
4. Complete the assignment in the provided template
5. Use 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.
Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions
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.
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. ( See attached documents with pictures) “Skin Conditions”
· 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. ( See attachment)
· Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment. ( See attachment and use it for this assignment)
Assignment – Instructions
· Choose one skin condition graphic from the document provided (identify by number in your Chief Complaint) “Skin Conditions”
· Document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) (Use the attached template)
· 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 three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.
NOTES FROM INSTRUCTOR – **IMPORTANT**
· “Use the SOAP template to document the skin condition you choose. You are to be creative and complete the missing information. For this assignment you will not complete a plan. You will stop aft
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Eddie Myers is a 58 year old African American male who presents today with a productive cough x 3 days, fever, muscle aches, loss of taste and smell for the last three days. He reported that the “cold feels like it is descending into his chest and he can’t eat much”. The cough is nagging and productive. He brought in a few paper towels with expectorated phlegm – yellow/green in color. He has associated symptoms of dyspnea of exertion and fatigue. His Tmax was reported to be 100.3, last night. He has been taking Tylenol 325mg about every 6 hours and the fever breaks, but returns after the medication wears off. He rated the severity of her symptom discomfort at 8/10.
Medications:
1.) Norvasc 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Advair 500/50 daily
4.) Singulair 10mg daily
5.) Over the counter Tylenol 325mg as needed
6.) Over the counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs – rash
Cipro-headache
Past Medical History (PMH):
1.) Asthma
2.) Hypertension
3.) Osteopenia
4.) Allergic rhinitis
5.) Prostate Cancer
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Prostatectomy 1986
Sexual/Reproductive History:
Heterosexual
Personal/Social History:
He has never smoked
Dipped tobacco for 25 years, no longer dipping
Denied ETOH or illicit drug use.
Immunization History:
Covid Vaccine #1 3/2/2021 #2 4/2/2021 Moderna
Influenza Vaccination 10/3/2020
PNV 9/18/2018
Tdap 8/22/2017
Shingles 3/22/2016
Significant Family History:
One sister – with diabetes, dx at age 65
One brother–with prostate CA, dx at age 62. He has 2 daughters, both in 30’s, healthy, living in nearby neighborhood.
Lifestyle:
He works FT as Xray Tech; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. He is a college grad, owns his home and financially stable.
He has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic ca
Week 4
Skin Comprehensive SOAP Note Template
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC):
History of Present Illness (HPI):
Medications:
Allergies:
Past Medical History (PMH):
Past Surgical History (PSH):
Sexual/Reproductive History:
Personal/Social History:
Health Maintenance:
Immunization History:
Significant Family History:
Review of Systems:
General:
HEENT:
Respiratory:
Cardiovascular/Peripheral Vascular:
Gastrointestinal:
Genitourinary:
Musculoskeletal:
Neurological:
Psychiatric:
Skin/hair/nails:
OBJECTIVE DATA:
Physical Exam:
Vital signs:
General:
HEENT:
Neck:
Chest/Lungs:.
Heart/Peripheral Vascular:
Abdomen:
Genital/Rectal:
Musculoskeletal:
Neurological:
Skin:
Diagnostic results:
ASSESSMENT:
PLAN:
This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.
© 2021 Walden University Page 2 of 3
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Walden University
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1
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4
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Comprehensive SOAP Note Template
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC):
History of Present Illness (HPI):
Medications:
Allergies:
Past Medical History
(PMH):
Past Surgical History (PSH):
Sexual/Reproductive History:
Personal/
Social History:
Health
Maintenance:
Immunization History
:
Significant
Family History:
Review of
9/22/21, 12:39 AM Rubric Detail – Blackboard Learn
https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16874433_1&rubric_id=_2559588_1 1/4
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Excellent Good Fair Poor
Using the SOAP
(Subjective,
Objective,
Assessment, and
Plan) note
format:
· Create
documentation,
following SOAP
format, of your
assignment to
choose one skin
condition
graphic (identify
by number in
your Chief
Complaint). ·
Use clinical
terminologies to
explain the
physical
characteristics
featured in the
graphic.
30 (30%) – 35
(35%)
The response
clearly,
accurately, and
thoroughly
follows the
SOAP format
to document
one skin
condition
graphic and
accurately
identi�es the
graphic by
number in the
Chief
Complaint. The
response
clearly and
thoroughly
explains all
physical
characteristics
featured in the
graphic using
accurate
terminologies.
24 (24%) – 29
(29%)
The response
accurately
follows the
SOAP format
to document
one skin
condition
graphic and
accurately
identi�es the
graphic by
number in the
Chief
Complaint.
The response
explains most
physical
characteristics
featured in
the graphic
using accurate
terminologies.
18 (18%) – 23
(23%)
The response
follows the
SOAP format,
with
vagueness
and some
inaccuracy in
documenting
one skin
condition
graphic, and
accurately
identi�es the
graphic by
number in the
Chief
Complaint.
The response
explains some
physical
characteristics
featured in
the graphic
using mostly
accurate
terminologies.
0 (0%) – 17 (17%)
The response
inaccurately
follows the
SOAP format
or is missing
documentation
for one skin
condition
graphic and is
missing or
inaccurately
identi�es the
graphic by
number in the
Chief
Complaint. The
response
explains some
or few physical
characteristics
featured in the
graphic using
terminologies
with multiple
inaccuracies.
Name: NURS_6512_Week_4_Assignment_1_Rubric EXIT
Grid View List View
9/22/21, 12:39 AM Rubric Detail – Blackboard Learn
https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16874433_1&rubric_id=_2559588_1 2/4
Excellent Good Fair Poor
· Formulate a
di�erent
diagnosis of
three to �ve
possible
considerations
for the skin
graphic. ·
Determine which
is most likely to
be the correct
diagnosis, and
explain your
reasoning using
at least three
di�erent
references from
current
evidence-based
literature.
45 (45%) – 50
(50%)
The response
clearly,
thoroughly,
and accurately
formulates a
di�erent
diagnosis of
�ve possible
considerations
for the skin
graphic. The
response
determines the
most likely
correct
diagnosis with
reasoning that
is explained
clearly,
accurately, and
thoroughly
using three or
more di�erent
references
from current
evidence-
based
C H A P T E R 2 8
Rashes and skin lesions
Dermatologic problems result from a number of mechanisms, including inflammatory, infectious, immunologic,
and environmental (traumatic and exposure induced). At times, the mechanism may be readily identified, such
as the infectious bacterial etiology in impetigo. However, some dermatologic lesions may be classified in more
than one way. Most insect bites, for example, involve both environmental (the bite) and inflammatory (the
response) mechanisms. Awareness of the potential mechanism of any skin disorder is most helpful in
identifying the risk a person may have for other illnesses. For example, people with eczema are also frequently
at risk for other atopic conditions, notably asthma and allergic rhinitis. Thousands of skin disorders have been
described, but only a small number account for the majority of patient visits.
Evaluation of rashes and skin lesions depends on a carefully focused history and physical examination. The
provider needs to be familiar with the characteristics of various skin lesions; anatomy, physiology, and
pathophysiology of the skin; clinical appearance of the basic lesion; arrangement and distribution of the lesion;
and associated pathological conditions. It is also important to know common symptoms associated with specific
lesions such as itching or fever. It is necessary to quickly identify life-threatening diseases and those that are
highly contagious. Ultimately, competence in dermatologic assessment involves recognition through repetition.
Diagnostic reasoning: Initial focused physical examination
Initial inspection
Dermatologic assessment is similar to the assessment of most other body systems in that it depends on patient
history and physical assessment. However, sometimes a brief physical assessment preceding the history can
assist in the development of
©
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h
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L
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Clinical review
A review of the effects of ageing on
skin integrity and wound healing
Abstract
It is well known that advancing age is a factor
that affects the normal course of wound
healing. The population over the age of 65
years is increasing globally, and this may be
accompanied by an increase in the number
of individuals experiencing delayed wound
healing. There is a breadth of research to show
that age-related changes in the epidermis
and dermis change the skin’s ability to resist
damage and injury. In particular, the dermo-
epidermal junction becomes flattened, which
predisposes the tissue to shear and friction
forces. Within the dermis, alterations in the
amount and structure of collagen also mean
that the tissue is much more rigid. Prompt
assessment of the skin to identify existing
conditions as well as preventive measures is
therefore essential. This article discusses the
anatomy of the skin and the effects of ageing
on the tissues. It also offers some guidance on
skin assessment and the basics of skin care.
■ Ageing ■ Skin integrity ■ Wound healing ■ Skin tears ■ Fragility
Hilary Bonifant
Senior Diabetes Podiatrist, Tū Ora Compass
Health, Wellington, New Zealand
Year 2 Student, Masters in Wound Healing
and Tissue Repair, Cardiff University School
of Medicine, College of Biomedical and
Life Sciences
Samantha Holloway
Reader, Centre for Medical Education
Programme Director, MSc in Wound Healing and
Tissue Repair
Cardiff University School of Medicine, College of
Biomedical and Life Sciences
Accepted for publication: January 2019
Wound healing is a complex, highly orchestrated process requiring a well-coordinated series of cellular activities and the action of mediators which,
under normal conditions, occurs over a number of overlapping
events and collectively leads to repair of the injured tissue
(Ashcroft et al, 2002). Many factors affect and interfere with
normal wound healing, such as infection, medication, complex
comorbidities, age, obesity, smoking and nutrition (Guo and
DiPietro, 2010; Gould and Fulton, 2016).
Morbidity associated with delayed wound healing imposes an
enormous social and financial burden on the healthcare system
(Ashcroft et al, 1995; Guest et al, 2017). The world population is
rapidly increasing, and older adults comprise the fastest growing
age group worldwide: the proportion of the world’s population
over 60 years of age is expected to double between the years
2000 and 2050, from 11% to 22% (World Health Organization,
2013). It is estimated that there are 11.8 million people in t
Week 4 Lab Assignment:
Differential Diagnosis for Skin Conditions
1:
2:
3.
4.
5.
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