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 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 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.
Download the SOAP Template found in this week’s Learning Resources.
To complete:
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. FILES ATTACHED WITH WHAT YOU NEED
usw1_nurs_6512_comprehensivesoaptemplate.doc
usw1_nurs_6512_week04_skinconditions.doc
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Comprehensive SOAP Template
This template is for a full history and physical. For this course include only areas that
are related to the case.
Patient Initials: _______
Age: _______
Gender: _______
Note: The mnemonic below is included for your reference and should be removed
before the submission of your final note.
L =location
O= onset
C= character
A= associated signs and symptoms
T= timing
E= exacerbating/relieving factors
S= severity
SUBJECTIVE DATA: Include what the patient tells you, but organize the information.
Chief Complaint (CC): In just a few words, explain why the patient came to the
clinic.
History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough
documentation in this section is essential for patient care, coding, and billing analysis. Paint a
picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and
gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal
symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI
might look like the following example:
Location: head
Onset: 3 days ago
Character: pounding, pressure around the eyes and temples
Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia
Timing: after being on the computer all day at work
Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not
completely better
Severity: 7/10 pain scale
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Medications: Include over-the-counter, vitamin, and herbal supplements. List
each one by name with dosage and frequency.
Allergies: Include specific reactions to medications, foods, insects, and
environmental factors. Identify if it is an allergy or intolerance.
Past Medical History (PMH): Include illnesses (also childhood illnesses),
hospitalizations.
Past Surgical History (PSH): Include dates, indications, and types of
operations.
Sexual/Reproductive History: If applicable, include obstetric history, menstrual
history, methods of contraception, sexual function, and risky sexual behaviors.
Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s
interests, ADL’s and IADL’s if applicable, and exercise and eating habits.
Immunization History: Include last Tdap, Flu, pneumonia, etc.
Significant Family History: Include history of parents, grandparents, siblings,
and children.
Lifestyle: Include cultural factors, economic factors, safety, and support systems
and sexual preference.
Review of Systems: From head-to-toe, include each system that covers the
Chief Complaint, History of Present Illness, and History (this includes the
systems that address any previous diagnoses). Remember that the information
you include in this section is based on what the patient tells you so ensure that
you include all essentials in your case (refer to Chapter 2 of the Sullivan text).
General: Include any recent weight changes, weakness, fatigue, or fever,
but do not restate HPI data here.
HEENT:
Neck:
Breasts:
Respiratory:
Cardiovascular/Peripheral Vascular:
Gastrointestinal:
Genitourinary:
Musculoskeletal:
Psychiatric:
Neurological:
Skin:
Hematologic:
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Endocrine:
Allergic/Immunologic:
OBJECTIVE DATA: From head-to-toe, include what you see, hear, and feel when
doing your physical exam. You only need to examine the systems that are pertinent to
the CC, HPI, and History unless you are doing a total H&P- only in this course. Do not
use “WNL” or “normal.” You must describe what you see.
Physical Exam:
Vital signs: Include vital signs, ht, wt, and BMI.
General: Include general state of health, posture, motor activity, and gait. This
may also include dress, grooming, hygiene, odors of body or breath, facial
expression, manner, level of consciousness, and affect and reactions to people
and things.
HEENT:
Neck:
Chest
Lungs:
Heart
Peripheral Vascular: Abdomen:
Genital/Rectal:
Musculoskeletal:
Neurological:
Skin:
Include any labs, x-rays, or other diagnostics that are needed to develop the differential
diagnoses.
ASSESSMENT: List your priority diagnosis (es). For each priority diagnosis, list at least
three differential diagnoses, each of which must be supported with evidence and
guidelines. For holistic care, you need to include previous diagnoses and indicate
whether these are controlled or not controlled. These should also be included in your
treatment plan.
PLAN: This section is not required for the assignments in this course (NURS 6512) but
will be required for future courses.
REFLECTION: This section is not required for the assignments in this course (NURS
6512) but will be required for future courses. Reflect on your clinical experience, and
consider the following questions: What did you learn from this experience? What would
you do differently? Do you agree with your preceptor based on the evidence?
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