Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions
Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions
Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions
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Assignment 1: Differential Diagnosis of Skin Disorders
Patient Data:
R.S., a fifty-year-old man
Subjective CC: For the last five days, I’ve had nasal congestion and itching.
R.S. is a 50-year-old male who presented to the unit complaining of nasal congestion, rhinorrhea, sneezing, itchy nose, postnasal discharge, and itchy ears and nose for the previous five days.
The patient stated that he used Mucinex to assist with breathing, but it has been associated with limited effectiveness.
The patient denied any prior experience with pain or headaches.
Medications: The patient is currently taking one Mucinex over-the-counter tablet orally daily.
Allergies: The patient denied having ever been allergic to any medication or food.
The patient stated that he or she had a history of seasonal allergies.
PMHx: The patient denied having been hospitalized, undergoing surgery, or receiving blood transfusions.
The client’s immunization record is current.
The patient is married and has two children.
In 2012, the patient ceased smoking.
He occasionally consumes alcoholic beverages.
His highest educational attainment is a university degree.
He holds a bachelor’s degree in business administration and is currently employed as a manager at a local supermarket.
He stated that he engages in physical activity.
He stated that the disease’s symptoms had significantly disrupted his sleeping patterns.
Family Hx: Both of the patient’s parents are still alive.
In 2016, his father was diagnosed with diabetes and has been receiving treatment.
In 2020, his mother was diagnosed with hypertension and is currently receiving treatment.
The patient is the second child in a three-child family.
All of his siblings are still alive and well.
ROSsGeneral:
The patient appeared to be appropriately attired for the occasion.
He was time, place, and self-aware.
He denied having a fever, being fatigued, or having chills.
The patient expressed fatigue as a result of insufficient sleep caused by the health problem’s symptoms.
HEENT: The patient asserted that he had no headaches.
His eyes are itchy and red, according to the patient.
The vision remained unchanged.
The tympanic membranes are intact, and there are no signs of ear drainage or hearing changes.
The patient complained of nasal congestion, itching, and a pale, swollen nasal mucosa.
Clear nasal drainage was present, along with slightly enlarged nasal turbinates.
Tonsillitis was not present.
The throat was erythematous to a degree.
Neck: The trachea was perfectly straight and free of deviation or lymphadenopathy.
Skin: The patient denied having a rash, changing the color of her skin, or itching.
Cardiovascular: No chest pain, palpitations, discomfort, or edema were reported by the patient.
Respiratory: The patient denied experiencing shortness of breath, coughing, or breathing difficulty.
Musculoskeletal: The patient denied experiencing pain in his joints or muscles.
The client denied having lymphadenopathy.
Allergies: The client stated that she was unaware of any known food or drug allergies.
He stated that he had seasonal allergies.
Objective
HEENT: The patient reports itchy eyes.
The eyes appear to be bloodshot.
The tympanic membranes are intact and without drainage.
Congested nasal passages, boggy, pale mucosa, and inflamed nasal turbinates.
There is evidence of thin, clear secretion drainage.
On the throat, there is mild erythema but no tonsillitis or bleeding.
Diagnostic Findings
The skin test indicated that pollen elicited a positive response.
The patient was diagnosed with allergic rhinitis.
Allergic rhinitis is an upper respiratory tract condition caused by an individual’s exposure to an allergen.
Sneezing, rhinorrhea, itchy nose and eyes, nasal congestion, and sore throat are just some of the symptoms that patients experience.
Diagnostic studies are not recommended in allergic rhinitis because they are not cost effective.
Healthcare providers can diagnose patients with the condition through history taking and physical examination.
However, it is critical to conduct tests such as skin tests to ascertain whether a patient has allergic rhinitis in the absence of a history of allergic reactions.
Diagnosis Differential
Rhinitis Allergica:
The patient’s first differential diagnosis is allergic rhinitis.
As mentioned previously, allergic rhinitis is a chronic respiratory condition caused by an individual’s exposure to an allergen.
Sneezing, nasal congestion, rhinorrhea, and itchy eyes are all symptoms of allergic rhinitis.
The symptoms developed as a result of IgE-mediated responses to the allergens (Okubo et al., 2020).
Due to the patient’s positive skin test, allergic rhinitis is the primary diagnosis.
Rhinitis that is not allergic:
The client may also have non-allergic rhinitis.
Patients present with a variety of symptoms, including nasal congestion, rhinorrhea, sneezing, and itchy eyes.
Patients, on the other hand, have no history of allergic reactions to allergens (Zheng Ming et al., n.d.).
This is the most conservative diagnosis for the client in the case study, as he has a history of seasonal allergies.
Sinusitis: Sinusitis is an inflammatory condition affecting the paranasal sinuses.
Sinusitis is caused by fungal, viral, or bacterial infections, as well as allergic reactions.
Sinusitis patients experience nasal congestion, headaches, rhinorrhea, fever, and facial pain (Little et al., 2018).
Sinusitis, on the other hand, is the least likely condition, as it lacks the signs and symptoms associated with infections.
Flu/common cold: The other possible diagnosis is a common cold.
The common cold is a viral infection that affects the upper respiratory tract.
It may affect the sinuses, larynx, or pharynx.
Patients may experience nasal drainage, malaise, fever, and headaches, among other symptoms.
It is, however, the least likely scenario due to the absence of infection-related signs and symptoms (Sadeghirad et al., 2017).
Sore throat: Another possible diagnosis for the patient is sore throat.
When patients swallow, they experience pain in the pharynx.
Sore throats are frequently caused by viral infections.
The patient, on the other hand, is least bothered by a sore throat due to the absence of infection-related signs and symptoms (Mahalingam et al., 2020).
Assignment 1: Lab Assignment: Differential
Diagnosis for Skin Conditions
Photo Credit: Getty Images/iStockphoto
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.
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
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 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)
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well
as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file].
Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Document: Shadow Health Support and Orientation Resources (PDF)
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: Shadow Health Nursing Documentation Tutorial (Word document)
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 Health History
(Word document)
Use this template to complete your Assignment 2 for this week.
Optional Resources
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic
examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 6, “The Skin and Nails”
In this chapter, the authors provide guidelines and procedures to aid in the
diagnosis of skin and nail disorders. The chapter supplies descriptions and
pictures of common skin and nail conditions.
Ethicon, Inc. (n.d.-a). Absorbable synthetic suture material. Retrieved from
https://web.archive.org/web/20170215015223/http://academicdepartments.musc.e
du/surgery/education/resident_info/supplement/suture_manuals/absorbable_suture
_chart.pdf
Ethicon, Inc. (2006). Dermabond topical skin adhesive application technique.
Retrieved from
https://web.archive.org/web/20150921174121/http://academicdepartments.musc.e
du/surgery/education/resident_info/supplement/suture_manuals/db_application_p
oster.pdf
Ethicon, Inc. (2001). Ethicon needle sales types. Retrieved from
https://web.archive.org/web/20150921171922/http://academicdepartments.musc.e
du/surgery/education/resident_info/supplement/suture_manuals/needle_template.
pdf
Ethicon, Inc. (n.d.-b). Ethicon sutures. Retrieved from
https://web.archive.org/web/20150921202525/http://academicdepartments.musc.e
du/surgery/education/resident_info/supplement/suture_manuals/suture_chart_ethi
con.pdf
Ethicon, Inc. (2002). How to care for your wound after it's treated with
Dermabond topical skin adhesive. Retrieved from
https://web.archive.org/web/20150926002534/http://academicdepartments.musc.e
du/surgery/education/resident_info/supplement/suture_manuals/db_wound_care.p
df
Ethicon, Inc. (2005). Knot tying manual. Retrieved from
https://web.archive.org/web/20160915214422/http://academicdepartments.musc.e
du/surgery/education/resident_info/supplement/suture_manuals/knot_tying_manu
al.pdf
Ethicon, Inc. (n.d.-c). Wound closure manual. Retrieved from
http://www.uphs.upenn.edu/surgery/Education/facilities/measey/Wound_Closure
_Manual.pdf
Required Media (click to expand/reduce)
Module 3 Introduction
Dr. Tara Harris reviews the overall expectations for Module 3. Consider how you
will manage your time as you review your media and Learning Resources for
your Discussions, Case Study Lab Assignments, DCE Assignments, and your
Midterm exam (12m).
Skin, Hair, and Nails – Week 4 (19m)
Online media for Seidel's Guide to Physical Examination
In addition to this week's media, it is highly recommended that you access and view the
online resources included with the text, Seidel's Guide to Physical Examination. Focus on
the videos and animations in Chapter 8 that relate to the assessment of the skin, hair, and
nails.
Note: To access the online resources included with the text, you need to complete
the FREE online registration that is located at
https://evolve.elsevier.com/cs/product/9780323172660?role=student .
To Register to View the Content
1. Go to https://evolve.elsevier.com/cs/product/9780323172660?role=student
2. Enter the name of the textbook, Seidel's Guide to Physical Examination (name of
text without the edition number) in the Search textbox.
3. Complete the registration process.
To View the Content for this Text
1. Go to https://evolve.elsevier.com/
2. Click on Student Site.
3. Type in your username and password.
4. Click on the Login button.
5. Click on the plus sign icon for Resources on the left side of the screen.
6. Click on the name of the textbook for this course.
7. Expand the menu on the left to locate all the chapters.
8. Navigate to the desired content (checklists, videos, animations, etc.).
Note: Clicking on the URLs in the APA citations for the Resources from the
textbook will not link directly to the desired online content. Use the online menu
to navigate to the desired content.
Suturing Tutorials
The following suturing tutorials provide instruction on the basic interrupted suture, as
well as the vertical and horizontal mattress suturing techniques
Tulane Center for Advanced Medical Simulation & Team Training. (2010, July
8). Suturing technique [Video file]. Retrieved from
Note: Approximate length of this media program is 5 minutes.
Mikheil. (2014, April 22). Basic suturing: Simple, interrupted, vertical mattress,
horizontal mattress [Video file]. Retrieved from
Note: Approximate length of this media program is 9 minutes.
Incision and Drainage of an Abscess (a common procedure in primary care)
New England Journal of Medicine (NEJM). (2013, September 30). NEJM abscess
incision and drainage [Video file]. Retrieved from
-Vf2NYfUANEyObfeNm&index=8
Note: Approximate length of this media program is 10 minutes.
Dermablade Use for Shave Biopsies
Dermablade®. (2012, November 9). PersonnaBlades [Video file]. Retrieved from
Note: Approximate length of this media program is 5 minutes.
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