Nursing Assignment Acers
Differential Diagnosis for Skin Conditions NURS6512 Week 4
Differential Diagnosis for Skin Conditions NURS6512 Week 4
You will have 2 assignments identifying a skin disorder one you will chose and your shadow health assignment Tina Jones that is due at the end of the week.
Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions
FOR WEEK 4 shadow health hopefully you hadsome practice in week 3 . Again you must have 80% for shadow health week 4 and 9 to pass. This is combined score of DCE score and lab pass. Also, for the skin disorder, you will chose a skin disorder, You will give CC one sentence. HPI example: A 75 yo woman presents today with itchy red rash. Give location, description, onset, associating or alleviating factors. You can also use the soap note template that is attached as guide, PMH, allergies, meds. ROS ect. Please let me know if you have any questions or concerns.
- Your soap note template can also be found in the resource under week 4 which is to the right of the page. One can chose which ever picture. 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. Also, please access your grading rubric.. Differential Diagnosis for Skin Conditions NURS6512 Week 4
By Day 7 of Week 4
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.
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Differential Diagnosis for Skin Conditions Example Soap Note
Patient Initials: BA Age: 84 Gender: F
SUBJECTIVE DATA: Left axillary skin tag/growth pain. Chief Complaint (CC): Skin Condition Picture #4 History of Present Illness (HPI):
Mrs. Barbara Acosta, a Caucasian 84-year-old woman with COPD, A-Fib, non-melanoma skin malignancies, CHF, and a pacemaker on the left side, came in today worried about this new uncomfortable axilla growth. The patient claimed that around four weeks ago, while taking a shower, she felt a tender, painful skin growth mass in her left axilla. Although she reports no bleeding, it does get red and swell up when it is irritated. She claimed that because the hair growth irritates the growth more, she has been shaving the region. Additionally, the growth catches on her clothing, pulls it, and hurts her. denies that the region around the spot is itchy or dry. The current pain level is 4/10, but states with her history of skin cancers, and she is highly anxious. Differential Diagnosis for Skin Conditions NURS6512 Week 4
Medications:
- Metoprolol Tartrate 100mg oral, 1 tab, PO, Daily
- Isosorbide Mononitrate 30mg oral, extended-release, 1 tab, PO, QAM
- Furosemide 20mg oral, 1 tab, PO, Daily
- Montelukast 10mg oral, 1 tab, PO, QPM
- Atorvastatin 20mg oral, 1 tab, PO, Daily
- Famotidine 20mg oral, 1 tab, PO, Daily
- Albuterol 90 mcg/inh, 1 puff, QID, PRN: for Wheezing
- Eliquis 5mg oral, 1 tab, PO, BID
Allergies: No Know Drug Allergies, No known food allergies, No known latex allergies
Past Medical History (PMH): Of note patient has a pacemaker on the left side that is very close to the skin growth, and she has the pacemaker for a history of atrial fibrillation and CHF. The patient also has a history of chronic bronchitis and asthma. History of non-melanoma skin cancers.
Past Surgical History (PSH): Tonsillectomy 1941, Appendectomy 1947, Hysterectomy 1980, CABG 199, Pacemaker 2015.
Sexual/Reproductive History:
Heterosexual, Gravida 3, Para 3, Abortus 0, Postmenopausal, Age at menopause 45.
Personal/Social History: Quit smoking 1990. Smoked 20 years. Denies alcohol or substance use. Moderate sun exposure, she does use sunscreen.
Immunization History: Immunizations are up to date. Tdap was in 2012. Influenza vaccine November 2019. Pneumococcal vaccine received in 2016.
Significant Family History:
Mother-deceased at age 78 from breast cancer. Father-deceased at age 77 from hypertension.
Maternal grandfather- deceased at age 66, died from heart disease. Maternal grandmother- deceased at age 66, died from a stroke
Paternal grandfather- deceased at age 81, died from colon cancer. Paternal grandmother-deceased at age 78, died from a heart attack. Son- Living, No health issues, age 60
Daughter- Living, Asthma, age 58 Daughter- Living, hypertension, age 61
Sister- Living, Asthma, Heart Disease, age 86
Lifestyle: Mrs. Acosta has a technical trade school education; she is currently retired, formally employed as an administrative assistant (hospitality industry). She is presently married and lives with her husband. She has support at home from her husband, and her children live close by and are a good support system for Mrs. Acosta. She regularly goes to church and has a close church family as support as well. Differential Diagnosis for Skin Conditions NURS6512 Week 4
Review of Systems:
General: Alert and oriented, no acute distress
HEENT: Oropharynx clear, Oral mucosa is moist, No pharyngeal erythema.
Neck: Supple, Non-tender
Breast: Left axillary growth measuring 2cm X 2 cm. No palpable right or left breast mass.
Respiratory: Respirations are non-labored. Lungs are clear to auscultation. Breath sounds are equal.
CV: Normal rate, Regular rhythm, No murmur.
GI: Soft, non-tender, non-distended, positive bowel sounds GU: Denies urgency, frequency, nocturia, and incontinence. MS: Denies back or joint pain, has a full range of motion. PSYCH: Cooperative, appropriate mood, and affect.
NEURO: Alert and oriented X4
INTEGUMENT/HEME/LYMPH: Warm, dry, no rash, left axilla skin growth ENDOCRINE: No abnormalities, not on hormone replacement ALLERGIC/IMMUNOLOGIC: No known allergies, no recurrent fevers OBJECTIVE DATA-
PHYSICAL EXAM:
B/P: 141/82, left arm P: 69 BPM regular rate T: 97.7 DegF Oral
RR: 16 br/min- non labored
Sp02: 98% -Room air
Wt: 63.7 Kg
BMI: 26.86
Ht: 60.6 inches- standing height
General: Mrs. Acosta is in good health but does have some comorbidities. She is alert and oriented X4; her husband is with her and provides excellent support. She is dressed appropriately, follows instructions, and askes the right questions. Full activity level.
HEENT: Oropharynx clear, Normocephalic, Normal hearing, Oral mucosa moist.
Neck: Supple, Non-tender, No lymphadenopathy
Chest/Lungs: Lungs are clear to auscultation, Respirations are non-labored, breath sounds are equal, Symmetric chest wall expansion, No chest wall tenderness.
Heart/Peripheral Vascular: Normal rate, Regular rhythm, No murmur, No edema Abdomen: Soft, non-tender, Nondistended, normal bowel sounds, no organomegaly Musculoskeletal: Normal range of motion, Normal strength, No tenderness, No swelling Neurological: Alert, Orientated, No focal defects
Skin: Warm, Dry, Intact, No edema, No rash, Visual skin growth left axilla
ASSESSMENT:
DIFFERENTIAL DX:
- Cutaneous Tag/Skin Tag (Acrochordon)
- Squamous cell carcinoma of left axilla (history of multiple SCC)
- Seborrheic Keratoses
- Common warts
DIAGNOSIS/CLIENT PROBLEM:
Cutaneous tag/ skin tag (Acrochordon) are papillomas commonly found in the neck and axillae region of the middle-aged and elderly population (Ball et al., 2019). Acrochordon is the most likely diagnosis for Mrs. Acosta. Due to Mrs. Acosta’s history of non-melanoma skin cancers, we don’t want to rule out a Squamous cell carcinoma. Early detection of squamous cell carcinoma of the skin can be easily treated (Goh, Howle, Hughes, & Veness, 2009). It is essential to report any new changes or unusual skin growths (Goh et al., 2009). Mrs. Acosta’s skin growth is skin-colored, small 2cm, and fleshy. Skin tags are not traditionally painful but can be tender or irritated by touched or caught on clothing (Colyar, 2015). Skin tags tend to grow in skin folds but can appear anywhere on the body (Hay et al., 2011).
References for Differential Diagnosis for Skin Conditions NURS6512 Week 4
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Colyar, M. R. (2015). Advanced practice nursing procedures.
Goh, A., Howle, J., Hughes, M., & Veness, M. J. (2009). Managing patients with cutaneous squamous cell carcinoma metastatic to the axilla or groin lymph nodes. Australasian Journal of Dermatology, 51(2), 113-117. doi:10.1111/j.1440-0960.2009.00576.x
Hay, R. A., Kadry, D., Zeid, O. A., Safoury, O. E., Fawzy, M., Amin, I., & Rashed, L. (2011). Skin tags, leptin, metabolic syndrome, and change of the lifestyle. Indian Journal of Dermatology, Venereology, and Leprology, 77(5), 577. doi:10.4103/0378-
By Day 7 of Week 4
Submit your Lab Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK4Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 4 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 4 Assignment 1 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 “WK4Assgn1+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.
Grading Criteria
To access your rubric:
Week 4 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 4 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 7 of Week 4
To participate in this Assignment:
Week 4 Assignment 1
Skin Conditions to Select From
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 4 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 7 of Week 4
To participate in this Assignment:
Week 4 Assignment 1
Assignment 2: Digital Clinical Experience (DCE): Health History Assessment
In Week 3, you began your DCE: Health History Assessment. For this week, you will complete this Health History Assessment in your simulation tool, Shadow Health and finalize for submission.
Photo Credit: Sam Edwards / Caiaimage / Getty Images
To Prepare
- Review this week’s Learning Resources as well as the Taking a Health History media program in Week 3, and consider how you might incorporate these strategies. Download and review the Student Checklist: Health History Guide and the History Subjective Data Checklist, provided in this week’s Learning Resources, to guide you through the necessary components of the assessment.
- Review the DCE (Shadow Health) Documentation Template for Health History found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
- Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
- Review the Shadow Health Student Orientation media program and the Useful Tips and Tricks document provided in the week’s Learning Resources to guide you through Shadow Health.
- Review the Week 4 DCE Health History Assessment Rubric, provided in the Assignment submission area, for details on completing the Assignment.
Note: There are 2 parts to this assignment – the lab pass and the documentation. You must achieve a total score of 80% in order to pass this assignment. Carefully review the rubric and video presentation in order to fully understand the requirements of this assignment.
DCE Health History Assessment:
Complete the following in Shadow Health:
Orientation
- DCE Orientation (15 minutes)
- Conversation Concept Lab (50 minutes)
Health History
- Health History of Tina Jones (180 minutes)
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 4 Day 7 deadline.
Submission and Grading Information
By Day 7 of Week 4
- Complete your Health Assessment DCE assignments in Shadow Health via the Shadow Health link in Blackboard.
- Once you complete your assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding assignment in Blackboard for your faculty review.
- (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
- Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
- Download, sign, date, and submit your Student Acknowledgement Form found in the Learning Resources for this week.
- Note: You must pass this assignment with a minimum score of 80% in order to pass the class. Once submitted, there are not any opportunities to revise or repeat this assignment.
Grading Criteria
To access your rubric:
Week 4 Assignment 2 DCE Rubric
Submit Your Assignment by Day 7 of Week 4
To submit your Lab Pass:
Week 4 Lab Pass
To submit this required part of the Assignment:
Week 4 Documentation Notes for Assignment 2
To Submit your Student Acknowledgement Form:
Submit your Week 4 Assignment 2 DCE Student Acknowledgement Form
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 conducting various optional examinations on a volunteer “patient.”
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, 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.
To Prepare
- Arrange an appropriate time and setting with your volunteer “patient” to perform a skin, hair, and nails examination.
- Download and review the Skin, Hair, and Nails Student Checklist and Key Points, provided in this week’s Learning Resources, and review the Seidel’s Guide to Physical Examination online media.
Optional Lab Assignment
- Perform the skin, hair, and nails examination, covering all of the areas listed in the checklist.