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.
- 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 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.
Submit your Lab Assignment.
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.
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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
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 Lab Assignment:
Differential Diagnosis for Skin Conditions
1:
2:
3.
4.
5.
© 2021 Walden University
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
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.
Comprehensive SOAP
Patient Initials: __JJ_____ Age: __54_____ Gender: __M_____
SUBJECTIVE DATA:
Chief Complaint (CC): Small, itchy, raised patches on lower back
History of Present Illness (HPI): Jeremiah Jergens is a 54-year-old Caucasian
male who presents today with a large cluster of thick, red, raised patches on his
lower back. Jeremiah first noticed the patches 4 years ago, a few days after he
recovered from a strep throat infection. He has associated symptoms of
tenderness, itchiness and flaking of the patches. They often bleed when he
accidently scratches off a patch. He reported the he is “embarrassed by the look
of it” and will not take his shirt off at the beach. He has also noticed both his
knees, joints in his fingers and back are very stiff in the mornings but lessens
after walking and using his joints for a bit. He has been using Tylenol to help with
the joint pain and for the patches, he reports using Benadryl ointment for the
itching. Both provide minimal relief. He rates his discomfort a 4/10 today but in
mornings 7/10 due to the joint pain.
Medications:
1. Over-the-counter Tylenol 500mg PO once daily in the morning
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2. Over-the-counter Benadryl Extra Strength topical ointment as needed
3. Atenolol 75 mg PO twice daily
4. Over-the-counter Aspirin 325 mg PO once daily
5. Men’s Multivitamin once daily
6. Epi-Pen as needed
Allergies:
1. Penicillin – rash
2. Salmon – anaphylaxis
3. Peaches – lip itching
Past Medical History (PMH):
1. Chicken Pox – age 5
2. Streptococcal Pharyngitis, recurrent– age 50
3. Morbid obesity
Past Surgical History (PSH):
1. Ga
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