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Differential Diagnosis for Skin Conditions NURS6512 Week 4

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

soap note template.docx

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.

CLICK HERE TO ORDER PAPERS

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.

Learning Resources

Required Readings (click to expand/reduce)

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. Differential Diagnosis for Skin Conditions NURS6512 Week 4

  • Chapter 9, “Skin, Hair, and Nails”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.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.

This section explains the procedural knowledge needed prior to performing various dermatological procedures.

Chapter 1, “Punch Biopsy”

Chapter 2, “Skin Biopsy”

Chapter 10, “Nail Removal”

Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”

Chapter 16, “Skin Tag (Acrochordon) Removal”

Chapter 22, “Suture Insertion”

Chapter 24, “Suture Removal”

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 28, “Rashes and Skin Lesions”
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 Student Checklist and the Key Points when you conduct your assessment of the skin, hair, and nails in this Week’s Lab Assignment.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Student checklist. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

  • Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1 and 3)

VisualDx. (n.d.). Clinical decision support. Retrieved June 11, 2019, 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.

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) Differential Diagnosis for Skin Conditions NURS6512 Week 4

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 Historymedia 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 Orientationmedia 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.

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.

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 participate in this 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 Examinationonline media.

Optional Lab Assignment

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

What’s Coming Up in Week 5?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you examine how to properly assess the head, neck, eyes, ears, nose, and throat in order to form accurate diagnoses as you complete your Case Study Assignment of the Skin, Hair, Nails, and HEENT. You will once again complete a DCE related to a Focused Exam for cough. Make sure to plan ahead with your Please plan your time accordingly.

Week 5 Required Media

Photo Credit: [fergregory]/[iStock / Getty Images Plus]/Getty Images

Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Case Study Assignment. There are several videos of various lengths. Please plan ahead to ensure you have time to view these videos and animations to complete your Assignment on time.

Next Week

To go to the next week:

Week 5

Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat (Differential Diagnosis for Skin Conditions NURS6512 Week 4)

Emily, age 15, is brought to your clinic complaining of chills, aches, and a sore throat. Without any testing, consider all of the possible diagnoses. It could be a cold, the flu, bronchitis, or even something more serious, such as meningitis or mononucleosis. Assessing the actual cause will involve much more than simple visual inspection. Some conditions are so subtle that they require the use of special instruments and tests in addition to a trained eye and ear.

This week, you will explore how to assess the head, neck, eyes, ears, nose, and throat. Whether dealing with a detached retina, sinusitis, meningitis, or even cough, advanced practice nurses need to know the proper assessment techniques in order to form accurate diagnoses.

Learning Objectives

Students will:

  • Apply assessment skills to diagnose eye, ear, and throat conditions
  • Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the head, neck, eyes, ears, nose, and throat

Learning Resources

Required Readings (click to expand/reduce)

 

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.

 

  • Chapter 11, “Head and Neck”

    This chapter reviews the anatomy and physiology of the head and neck. The authors also describe the procedures for conducting a physical examination of the head and neck.

 

  • Chapter 12, “Eyes”

    In this chapter, the authors describe the anatomy and function of the eyes. In addition, the authors explain the steps involved in conducting a physical examination of the eyes.

 

  • Chapter 13, “Ears, Nose, and Throat”

    The authors of this chapter detail the proper procedures for conducting a physical exam of the ears, nose, and throat. The chapter also provides pictures and descriptions of common abnormalities in the ears, nose, and throat.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 15, “Earache”
This chapter covers the main questions that need to be asked about the patient’s condition prior to the physical examination as well as how these questions lead to a focused physical examination.

Chapter 21, “Hoarseness”
This chapter focuses on the most common causes of hoarseness. It provides strategies for evaluating the patient, both through questions and through physical exams.

Chapter 25, “Nasal Symptoms and Sinus Congestion”

 

In this chapter, the authors highlight the key questions to ask about the patients symptoms, the key parts of the physical examination, and potential laboratory work that might be needed to provide an accurate diagnosis of nasal and sinus conditions.

Chapter 30, “Red Eye”

 

The focus of this chapter is on how to determine the cause of red eyes in a patient, including key symptoms to consider and possible diagnoses.

Chapter 32, “Sore Throat”

 

A sore throat is one most common concerns patients describe. This chapter includes questions to ask when taking the patient’s history, things to look for while conducting the physical exam, and possible causes for the sore throat.

Chapter 38, “Vision Loss”
This chapter highlights the causes of vision loss and how the causes of the condition can be diagnosed.

 

Note: Download the six documents (Student Checklists and Key Points) below, and use them as you practice conducting assessments of the head, neck, eyes, ears, nose, and throat.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Head and neck: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., & Solomon, B. S., & Stewart, R. W. (2019). Head and neck: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Eyes: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Eyes: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Ears, nose, and throat: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Ears, nose, and throat: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.

 

 

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

 

  • Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1, 3, 4, and 5)

Bedell, H. E., & Stevenson, S. B. (2013). Eye movement testing in clinical examination. Vision Research 90, 32–37. doi:10.1016/j.visres.2013.02.001. Retrieved from https://www.sciencedirect.com/science/article/pii/S0042698913000217

Rubin, G. S. (2013). Measuring reading performance. Vision Research, 90, 43–51. doi:10.1016/j.visres.2013.02.015. Retrieved from http://www.sciencedirect.com/science/article/pii/S0042698913000436 

 

Harmes, K. M., Blackwood, R. A., Burrows, H. L., Cooke, J. M., Harrison, R. V., & Passamani, P. P. (2013). Otitis media: Diagnosis and treatment. American Family Physicians, 88(7), 435–440.

 

Otolaryngology Houston. (2014). Imaging of maxillary sinusitis (X-ray, CT, and MRI). Retrieved from http://www.ghorayeb.com/ImagingMaxillarySinusitis.html

 

This website provides medical images of sinusitis, including X-rays, CT scans, and MRIs (magnetic resonance imaging).

Document: Episodic/Focused SOAP Note Exemplar (Word document)

Document: Episodic/Focused SOAP Note Template (Word document)

Document: Midterm Exam Review (Word document)

 

Shadow Health Support and Orientation Resources

Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY

Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us

Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)

Document: Student Acknowledgement Form (Word document)

Note: You will sign and date this form each time you complete your DCE Assignment in Shadow Health to acknowledge your commitment to Walden University’s Code of Conduct.

Document: DCE (Shadow Health) Documentation Template for Focused Exam: Cough (Word document)

Use this template to complete your Assignment 2 for this week.

 

Optional Resource

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical. Differential Diagnosis for Skin Conditions NURS6512 Week 4

 

  • Chapter 7, “The Head and Neck” (pp. 178–301)

 

This chapter describes head and neck examinations that can be made with general clinical resources. Also, the authors detail syndromes of common head and neck conditions.

Required Media (click to expand/reduce)

 

Online media for Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 10, 11, and 12 that relate to the assessment of the head, neck, eyes, ears, nose, and throat. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.

University of Iowa Ophthalmology. (2016, December 19). Fluorescein staining of the cornea. Retrieved from https://vimeo.com/198695974

Credit Line: University of Iowa Ophthalmology. (n.d.). Fluorescein staining of the cornea [Video file]. Retrieved from ​https://vimeo.com/198695974. The author(s) and publishers acknowledge the University of Iowa and EyeRounds.org for permission to reproduce this copyrighted material.

 

Note: Approximate length of this media program is 25 seconds.

 

Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat

Photo Credit: Getty Images/Blend Images

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.

Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.

In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

To Prepare

 

  • By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
  • Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.

With regard to the case study you were assigned:

  • Review this week’s Learning Resources and consider the insights they provide.
  • Consider what history would be necessary to collect from the patient.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
  • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each. Differential Diagnosis for Skin Conditions NURS6512 Week 4

By Day 6 of Week 5

Submit your 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 “WK5Assgn1+last name+first initial.(extension)” as the name.
  • Click the Week 5 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 5 Assignment 1  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 Find the document you saved as “WK5Assgn1+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 Submitbutton to complete your submission.

Grading Criteria

To access your rubric:

Week 5 Assignment 1 Rubric

 

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 5 Assignment 1 draft and review the originality report.

 

Submit Your Assignment by Day 6 of Week 5

To participate in this Assignment:

Week 5 Assignment 1

 

Assignment 2: Digital Clinical Experience: Focused Exam: Cough

In this DCE Assignment, you will conduct a focused exam related to cough in your DCE using the simulation tool, Shadow Health. You will determine what history should be collected from the patient, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

Photo Credit: Getty Images

To Prepare

  • Review this week’s Learning Resources and consider the insights they provide related to ears, nose, and throat.
  • Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation within the Shadow Health platform. Review the examples also provided.
  • Review the DCE (Shadow Health) Documentation Template for Focused Exam: Cough 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 Week 5 Focused Exam: Cough Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis? Differential Diagnosis for Skin Conditions NURS6512 Week 4

Focused Exam: Cough Assignment:

Complete the following in Shadow Health:

  • Respiratory Concept Lab (Recommended but not required)
  • Episodic/Focused Note for Focused Exam: Cough

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 5 Day 7 deadline.

Submission and Grading Information

By Day 7 of Week 5

  • Complete your Focused Exam: Cough DCE Assignment 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.
  • Downloadsigndate, and submityour Student Acknowledgement Form found in the Learning Resources for this week. Differential Diagnosis for Skin Conditions NURS6512 Week 4

Grading Criteria

To access your rubric:

Week 5 Assignment 2 DCE Rubric

 

Submit Your Assignment by Day 7 of Week 5

To submit your Lab Pass:

Week 5 Lab Pass

To participate in this Assignment:

Week 5 Documentation Notes for Assignment 2

To Submit your Student Acknowledgement Form:

Submit your Week 5 Assignment 2 DCE Student Acknowledgement Form

 

What’s Coming Up in Week 6?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will evaluate abnormal findings in the area of the abdomen and the gastrointestinal system. In addition, you will appraise health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system as you complete your Lab Assignment in assessing the abdomen in a SOAP note format. You will also take your Midterm Exam, which covers the topics in Weeks 1–6. Please review the previous weekly content and resources to help you prepare for your exam. Plan your time accordingly.

Week 6 Required Media

Photo Credit: [fergregory]/[iStock / Getty Images Plus]/Getty Images

Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Lab Assignment. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Assignment on time.  Differential Diagnosis for Skin Conditions NURS6512 Week 4

Next Week

To go to the next week:

Week 6

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