NURA 6512 Assignment Differential Diagnosis for Skin Conditions

Walden University NURA 6512 Assignment Differential Diagnosis for Skin Conditions-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURA 6512 Assignment Differential Diagnosis for Skin Conditions assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURA 6512 Assignment Differential Diagnosis for Skin Conditions                     

Whether one passes or fails an academic assignment such as the Walden University NURA 6512 Assignment Differential Diagnosis for Skin Conditions depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURA 6512 Assignment Differential Diagnosis for Skin Conditions                     

The introduction for the Walden University NURA 6512 Assignment Differential Diagnosis for Skin Conditions is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURA 6512 Assignment Differential Diagnosis for Skin Conditions                     

After the introduction, move into the main part of the NURA 6512 Assignment Differential Diagnosis for Skin Conditions assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURA 6512 Assignment Differential Diagnosis for Skin Conditions                     

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURA 6512 Assignment Differential Diagnosis for Skin Conditions                     

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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NURA 6512 Assignment Differential Diagnosis for Skin Conditions

NURA 6512 Assignment Differential Diagnosis for Skin Conditions

Assessment

Tinea Barbae

Tinea barbae is an infection of the superficial dermatophyte that occurs on the bearded areas of the face and neck. It occurs almost solely in older adolescents and adult males (Kuruvella & Pandey, 2021). It most often affects farmers due to contact with an infected animal since a zoophilic organism causes it. Tinea barbae presents with a characteristic lesion, an inflammatory red nodule with pustules, and draining sinuses on the surface (Kuruvella & Pandey, 2021). The beard hairs are usually loose or broken, and removing the hair is easy and painless.

The pus-filled white masses affect the hair root and follicle (Singh et al., 2017). Tinea barbae is a priority differential diagnosis based on the patient’s findings of inflamed and red lumpy areas on the lower beards and red pustules with crusting around the beard hairs. Besides, the patient’s beard hairs are broken and easily plucked. The patient could have contracted the infection from an infected animal at the ranch. A direct microscopy culture will help in confirming the diagnosis.

Bacterial Folliculitis

Bacterial folliculitis is an inflammation of the hair follicle caused by infection, physical injury, or chemical irritation. It is primarily caused by Staphylococcus aureus (Jappa & Sameer, 2018). Bacterial folliculitis mostly occurs in skin areas exposed to occlusion, rubbing, and sweating, including the face, neck, axillae, and buttocks (Lin et al., 2018). Persons with superficial folliculitis usually have an acute onset that occurs with pruritus or mild discomfort.

Deep folliculitis typically has longer-standing lesions, and patients frequently report pain and, at times, suppurative drainage. Recurrent lesions can cause scarring and permanent hair loss. Superficial folliculitis presents with many small papules and pustules on an erythematous base pierced by a central hair, although the hair is not always visualized (Jappa & Sameer, 2018). Folliculitis is a differential diagnosis based on patient symptoms of pruritus and mild pain on the beard and pustules and crusting on an erythematous base.

Pseudofolliculitis Barbae:

Pseudofolliculitis barbae is a form of folliculitis involving the beard area. It is caused by infection with Staphylococcus aureus. It is a chronic inflammatory condition of follicular and perifollicular skin (Ogunbiyi, 2019). I presents with pustules, papules, and post-inflammatory hyperpigmentation. It occurs mostly in males of African and Asian descent. Patients report experiencing a painful eruption of acne after shaving (Ogunbiyi, 2019). It presents with an erythematous papule having a hair shaft in its center. The patient’s symptoms consistent with pseudofolliculitis barbae include pustules and erythematous at the beard area.

Reflection

The clinical experience has enlightened me on dermatological conditions affecting the beard area. I have learned that various bacteria or fungal infections can cause the conditions. Besides, I learned that the clinician should be keen during the examination to differentiate if a patient has papules (pimples with no visible pus) or pustules (pus-filled pimples), which helps differentiate the dermatological condition. If I were to repeat the assessment, I would perform a culture to identify the specific causative microbe.

References

Jappa, L. S., & Sameer, R. K. (2018). A clinical and bacteriological study of bacterial folliculitis. Panacea Journal of Medical Sciences, 8(2), 54-58. https://doi.org/10.18231/2348-7682.2018.0014

Kuruvella, T., & Pandey, S. (2021). Tinea Barbae. StatPearls [Internet].

Lin, H. S., Lin, P. T., Tsai, Y. S., Wang, S. H., & Chi, C. C. (2018). Interventions for bacterial folliculitis and boils (furuncles and carbuncles). The Cochrane Database of Systematic Reviews, 2018(8), CD013099. https://doi.org/10.1002/14651858.CD013099

Ogunbiyi, A. (2019). Pseudofolliculitis barbae; current treatment options. Clinical, cosmetic and investigational dermatology, 12, 241–247. https://doi.org/10.2147/CCID.S149250

Singh, S., Sondhi, P., Yadav, S., & Ali, F. (2017). Tinea barbae presenting as kerion. Indian journal of dermatology, venereology, and leprology, 83(6). https://doi.org/10.4103/ijdvl.IJDVL_1104_16

SUBJECTIVE DATA:

Chief Complaint (CC): Presence of a rash that has blisters that starts from the chest radiating to the armpit and also on the patient’s back

History of Present Illness (HPI): William Mendel is a 30 year old Black African American who has a rash that is similar to blisters that has covered his chest and back radiating to the armpit. He states the onset of the onset of the rash was a week ago and at the site he has an itching sensation as well as him experiencing a burning pain and some tingling. He informs that the pain is at 8/10 and at palpation it’s at 10/10.

Medications:

• Paracetamol over the counter two tablets every 6 hours for pain.
• Diphenhydramine over the counter 25 mg 1 tablet thrice daily for the itching.
• Hydrocortisone over the counter that is topical used when needed to also deal with the itching.
• Flomax 0.4mg

Allergies:

The patient has no known food or drug allergies.

Past Medical History (PMH):

1.) Gallstones

2.) Varicella Zoster Virus

3.) Chlamydia

Past Surgical History (PSH):

• Kidney transplant 2008

Sexual/Reproductive History:

Heterosexual

Personal/Social History:

Patient is a tee-tootler and a non-smoker. He also denies abusing any drugs. He enjoys outdoor activities and visiting the countryside. He also engages in swimming from time to time at the local river.

Immunization History:

Covid-19 Vaccine #2 4/8/2021 #2 8/10/2021 AstraZeneca

All his other vaccinations are up to date as per EPI guidelines

Significant Family History:

His parents are both dead due to natural reasons. He has three siblings who are alive. The sister however is diagnosed with asthma. The other two brother experience allergies during specific seasons such as in the spring.

Lifestyle:

The patient is newly married with only a few months having gone by. He is a business man in the import and exports sector. He however has a work- life stable lifestyle and as stated enjoys engaging in outdoor activities. He used to be a professional swimmer however he changed that and swims leisurely for now.

Review of Systems:

General: He denies experiencing any fatigue, loss of appetite or a fever. His complaint is the pain at the site of the rash.

HEENT: He also states he has had any head injury previously thus no visual issues.

He has an excessive wax issue which he has seen an ENT specialist and is managing it. He however has no hearing loss issues, pain or tinnitus. For his nose he reports to nosebleed in extremely cold weather that is associated with the flu he gets in such environments. He denies any soreness of the throat, history of a cough or even a dry mouth.

Neck: There are no pain complaints or discomfort. There are also no distended jugular veins or swollen lymph nodes.

Breasts: There’s no discomfort tenderness nor drainage.

Respiratory: No dyspnea nor shortness of breath neither is there coughing or pain associated.

CV: No reports of dyspnea, palpitations, or chest pain when exerting oneself. Edema, syncope, rheumatic, claudication, or thrombophlebitis histories are not present. Electrocardiograms that were abnormal or negative for hypertension.

GI: Denies experiencing any diarrhea, constipation, diarrhea, nausea, or vomiting. Bowel patterns are normal every three days. No history of dyspepsia, food intolerance, rectal hemorrhage, hemorrhoids, or any of those things.

The patient’s gallbladder has previously been sick.

GU: no hematuria, penile pain or discharge, dysuria, testicular pain, or a history of hernias or UTI. The patient has a history of nocturia, frequent urination, a perception of incomplete bladder emptying, a strong need to urinate, and dribbling after urine. Abnormal patterns of ejaculation. Absence of STD history.

MS: He doesn’t have any complains of muscle or arthritis discomfort. Last year, I slipped and fell in the snow, but I wasn’t hurt or broke. Positive Range of motion in the upper and lower extremities, Trendelenburg gait

PSYCH: Disavows any feelings of sadness, suicidal or homicidal thoughts, anxiety, nightmares, hallucinations, or insomnia. Has a fear of clowns.

NEURO: Negative for headaches, tremors, numbness, weakness, or tingling. There were no vertigo, nausea, blackouts, seizures, or alterations in memory.

INTEGUMENT/HEME/LYMPH: Cluster and scattered rashes on the front and back of the chest. There are no further skin abnormalities.

ENDOCRINE: This region is normal. Currently no hormone therapy.

ALLERGIES/ IMMUNOLOGICAL: No known food or drug allergies and neither environmental nor immunological deficiencies.

OBJECTIVE DATA

PHYSICAL EXAM: B/P 156/90, left arm in a sitting position, regular adult cuff; P 82 and regular; T 98.9 orally; RR 18 and non-labored; PHYSICAL EXAM; Weight: 147 lbs., height: 5’6

General: Well-fed, alert, and talkative. Seems uneasy and is protecting the right upper torso.

HEENT: His head had no visual abnormalities. Neither a history of injuries nor headache symptoms.

Ten years ago, the patient underwent bilateral Lasik surgery, and there was no conjunctivitis. Hearing is not a problem, the ear canal is clear, and the tympanic membranes are pink with obvious land masks. No polyps or post-nasal drip were found. There is no throat inflammation, pain, or redness to speak of. Pink and wet oral mucosa is seen. The size and form of the tonsils are normal.

Lungs and chest: Symmetrical chest. No crackling or wheezing, just clean, equal lung sounds on auscultation throughout the entire lung area. Even and unlabored breathing is being done.

Heart/Peripheral Vascular: Systolic blood pressure in the 150s, slightly raised. Normal heartbeat and rhythm with S1 and S2 sounds absent of gallops or murmurs.

ABD: Abdomen soft, non-tender, and non-dilated with active bowel sounds present in all quadrants.

Genital/Rectal: External circumcision of the genitalia with no sores or scars.

No evidence of a hemorrhage.

Musculoskeletal: AROM to the upper and lower extremities is musculoskeletal. No prior fractures or trauma.

Right hip cannot be totally abducted.

Neuro: Responds to quarry age-appropriately. No unusual sensory or weak points were found.

Skin and lymph nodes: An open, fluid-filled blister is visible on the chest.

ASSESSMENT

LAB TESTS AND RESULTS:

SPO2: 94% with ambient air.

CBC: WBC: 8,000; RBC: 13

Polymerase Chain Reaction (PCR): 243.8

Differential Diagnosis:

Shingles;

Eczema;

Contact Dermatitis

DIAGNOSIS/CLIENT PROBLEM

Because the characteristic rash frequently does not emerge until after the discomfort begins, diagnosing shingles in its early stages can be challenging. Depending on the area of your body that is affected, additional causes such as an appendix infection (appendicitis), a gallbladder infection (cholecystitis), a slipped disk, or even a heart attack, may first be assumed.

Many persons who have shingles initially speculate that they may have an eczematous skin condition that is not communicable. They might believe they don’t need to see a doctor about it as a result, which could delay the diagnosis.

Primary Diagnoses:

1.) Eczema

References

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.

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.

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

SUBJECTIVE DATA:

Chief Complaint (CC): “My left thumbnail has been having a vertical split at the center for the last three months”

History of Present Illness (HPI): AD is a 34-year-old white male who presents with a vertical split on his left thumbnail. He states that it started four months ago. He reports he tends to habitually rub the thumb’s nail fold using the tip of the second digit. He also states that he has frequented a manicurist in the last four months who have been pushing back his cuticle during the manicure. His nail has a crack that extends laterally and looks like the branches of a fir tree. He denies erythema or warmth and no other fingernails are affected. The finger is painless.

Medications: None

Allergies:  No known drug or food allergies.

Past Medical History (PMH):

1. Tonsilitis
2. Appendicitis

Past Surgical History (PSH):

1. Tonsillectomy
2. Appendectomy

Sexual/Reproductive History:

The patient is a heterosexual and he reports no reproductive issues or risky sexual behavior. He is married with one kid. He has no history of STIs.

Personal/Social History:

The patient is a real estate agent who lives with his wife and kid. Patient denies smoking, ETOH, or consuming any illicit substance. He states that he exercises three times a week and maintains a healthy diet.

Health Maintenance:

AD presents annually for a routine physical exam. He reports bloodwork 2 years ago at an annual exam.

Immunization History:

Immunizations up to date and had a flu vaccine two months ago. He had a Tdap in 2018.

Significant Family History:

Father alive 67 HTN, mother alive 60 healthy. He is the only sibling and he reports that his daughter is in good health with no significant health history.

Review of Systems:

General: The patient denies fever or chills, fatigue, or decreased appetite. He denies difficulty sleeping, night sweats, malaise, chills, or unexplained weight changes.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia, or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, and congestion. THROAT: Denies throat or neck pain, hoarseness, or difficulty swallowing.

Respiratory: The patient denies shortness of breath, cough, or hemoptysis.

Cardiovascular/Peripheral Vascular: The patient denies arrhythmia, chest pain, palpitations, heart murmur, or SOB.

Gastrointestinal: The patient denies abdominal pain or discomfort. He denies flatulence, nausea, vomiting, or diarrhea.

Genitourinary: Pt denies hematuria, dysuria, or change in urinary frequency. He denies difficulty starting/stopping a stream of urine or incontinence.

Musculoskeletal: Pt denies edema, weakness, or joint pain of extremities B/L.

Neurological: Denies headache and dizziness, LOC or history of tremors or seizures.

Psychiatric: Pt denies a history of anxiety or depression. He reports no sleep disturbance, delusions, or mental health history. He denied a suicidal/homicidal history.

Skin/hair/nails: The patient denies rash, petechiae, pruritus, or abnormal bruising/bleeding. He complains of a vertical split on his left thumbnail.

OBJECTIVE DATA:

Physical Exam:

Vital signs: Temp: 98.67 °F, Pulse: 85 and regular, BP: 118/79 mm hg left arm, sitting, regular cuff; RR 17 non-labored; Ht- 6’0”, Wt 170 lb, BMI 23.1.

General: AD is a well-groomed White male of well nutritional status who is cooperative and answers questions appropriately. Alert and oriented x 3.

HEENT: Normocephalic/atraumatic. Eyes: PERRLA. Conjunctiva pink with no scleral jaundice. Mouth: Moist mucosa, No lesions, inflammation, or exudate to the oral mucosa, tongue, or gum line. Ears: No lesions, scars, papules or nodules noted on the helix.

Neck: Supple and trachea midline. No thyromegaly

Chest/Lungs: Equal and bilateral chest rise, breathing unlabored with good respiratory effort no accessory muscle use. No tenderness on palpation of sternum, anterior or posterior thorax. resonant percussion over all lobes. Lung sounds clear on inspiration/expiration, anterior and posterior with no rhonchi, crackles, or wheezing with no areas of diminished breath sounds.

Heart/Peripheral Vascular: RRR. S1 and S2 are normal. No murmurs or bruits were noted. Chest non-tender, no visible heaves, and JVO non-elevated.

Abdomen: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation

Genital/Rectal: No bladder distention, suprapubic pain, or CVA tenderness.

Musculoskeletal: 2+ radial and dorsalis pulses. No edema, cyanosis, or clubbing was noted. The patient has a full ROM with no pain, swelling, or tenderness.

Neurological: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

Skin/nails: Warm, dry, and intact. The patient has a feathered, central, longitudinal ridge with a fir tree pattern on his left thumb. He has transverse ridges, parallel and angled towards the nail fold. He also has macrolunulae.

ASSESSMENT:

Differential Diagnosis

1. Median nail dystrophy- Refers to a split in the midline of the nail that starts from the cuticle. It affects the thumbs mostly and presents with a longitudinal groove in the central portion of the nail plate that starts at the proximal nail fold (Ball et al., 2019). The groove has small grooves that connect to it in an oblique fashion resulting in an inverse “fir-tree” pattern (Khodaee et al., 2020). It is caused by a temporary defect in the matrix that interferes with nail formation. Harsh trauma to the nail and recurrent self-inflicted trauma is the major cause of the disorder. The patient reports habitually rubbing his thumb’s nail fold using his index finger and visiting a manicurist who pushes his cuticle during a manicure. The presentation and the patient’s report confirm the diagnosis.
2. Habit-tic deformity– It is also a form of nail dystrophy that is linked to habitual external trauma to the matrix. It affects the thumbs and presents as central depression and transverse, parallel ridging that runs from the nail fold to the distal edge of the nail (Sathyapriya et al., 2020). The transverse depression projects a “washboard” configuration. Some patients also report redness and swelling along the proximal nail fold (Dains et al., 2019). The diagnosis is ruled out because the current patient has a fir-tree pattern rather than transverse parallel ridges.
3. Trachyonychia- Refers to rough nails. It can present as either opaque or shiny. In an opaque trachyonychia, the nail plate has longitudinal ridges while the nails appear opaque, rough, and with a “sandpapered” appearance (Sathyapriya et al., 2020). Shiny trachyonychia on other hand has numerous small pits with longitudinal and parallel lines. The nails have a shiny appearance. The disorder affects all the nails. It is ruled out because the patient does not record any presentation that can be said to be sandpapered or shiny.
4. Subungual skin tumors- Refers to skin cancer that affects the skin under the nails. It results in brown-black discolorations of the nail bed that occurs as either a streak or irregular pigmentation (Sathyapriya et al., 2020). The discoloration usually progresses to thickening, splitting, or destruction of the nails. It is however accompanied by pain and inflammation. The current patient reports no pain or inflammation neither does he have any pigmentation ruling out the diagnosis.

Primary Diagnosis

• Median nail dystrophy

References

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.

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.

Khodaee, M., Kelley, N., & Newman, S. (2020). Median nail dystrophy. CMAJ, 192(50), E1810-E1810. https://doi.org/10.1503/cmaj.201002

Sathyapriya, B., Chandrakala, B., Heba, A., & AnubharathyV, G. S. (2020). Deformities, Dystrophies, and Discoloration of the Nails. European Journal of Molecular & Clinical Medicine, 7(5), 2020. https://www.ejmcm.com/article_4114_44f01b00119c36ca34c67eea5116ed45.pdf

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

Week 4: Assessment of the Skin, Hair, and Nails

Something as small and simple as a mole or a discolored toenail can offer meaningful clues about a patient’s health. Abnormalities in skin, hair, and nails can provide non-invasive external clues to internal disorders or even prove to be disorders themselves. Being able to evaluate such abnormalities of the skin, hair, and nails is a diagnostic benefit for any nurse conducting health assessments.
This week, you will explore how to assess the skin, hair, and nails, as well as how to evaluate abnormal skin findings.

Learning Objectives

Students will:
• Apply assessment skills to diagnose skin conditions
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the skin, hair, and nails
• Analyze dermatologic procedures to include skin biopsy, punch biopsy, suture insertion and removal, nail removal, skin lesion removal

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 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: 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.edu/surgery/education/resident_info/supplement/suture_manuals/absorbable_suture_chart.pdf

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURA 6512 Assignment Differential Diagnosis for Skin Conditions

Ethicon, Inc. (2006). Dermabond topical skin adhesive application technique. Retrieved from https://web.archive.org/web/20150921174121/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_application_poster.pdf

Ethicon, Inc. (2001). Ethicon needle sales types. Retrieved from https://web.archive.org/web/20150921171922/http://academicdepartments.musc.edu/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.edu/surgery/education/resident_info/supplement/suture_manuals/suture_chart_ethicon.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.edu/surgery/education/resident_info/supplement/suture_manuals/db_wound_care.pdf

Ethicon, Inc. (2005). Knot tying manual. Retrieved from https://web.archive.org/web/20160915214422/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/knot_tying_manual.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 https://www.youtube.com/watch?v=c-LDmCVtL0o
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 https://www.youtube.com/watch?v=MFP90aQvEVM
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 https://www.youtube.com/watch?v=MwgNdrA18fM&list=PL9UKTUFtRDcNq4–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 https://www.youtube.com/watch?v=D8u1Y18L9DQ
Note: Approximate length of this media program is 5 minutes.

SUBJECTIVE DATA:

Chief Complaint (CC): “Stretch marks.” (Image 2)

History of Present Illness (HPI): W.T. is a 26-year-old AA female presenting to the dermatologic clinic with complaints of stretch marks. She is concerned about her appearance and wishes to know if there is any cream she can use to reduce the appearance of stretch marks. She is pregnant, and the gestation by date (GBD) is 32 weeks. The stretch marks began appearing when she was about 22 weeks pregnant, and they have increased in number and size as the pregnancy progressed. She reports having used cocoa butter, shea butter lotions, and various stretch marks creams, but they have been ineffective.

Medications: Iron and Folic acid Supplements

Allergies: Allergic to Penicillin- causes a rash.

Past Medical History (PMH): No chronic illnesses.

Past Surgical History (PSH): Tonsillectomy at 6 years.

Sexual/Reproductive History: Para 0+0, Gravida-1; No history of STIs or gynecological disorders. Had UTI at 16 weeks GBD but was successfully treated with Nitrofurantoin. She was previously on IUD.

Personal/Social History: W.T. is married and lives with her husband in Baltimore, MD. She has a Diploma in Secretarial studies and works as a corporate secretary. Her hobbies are baking and traveling. She reports having about six small meals and about 3L of water daily. She used to smoke ½ PPD and drink 2-3 glasses of vodka on her off days before getting pregnant. She denies currently taking alcohol, smoking, or using any drug substances. The patient states that her husband and elder sister are her support system.

Health Maintenance: The patient reports attending antenatal checkups and adheres to the daily Iron and Folic Acid supplements.

Immunization History: Her immunization status is up to date. She had a TT2 booster in the last antenatal visit. The last Flu shot was 8 months ago.

Significant Family History: The maternal grandmother has Rheumatoid arthritis and HTN. The father was recently diagnosed with diabetes. Her siblings are alive and well.

Review of Systems:

General: Denies fever, generalized weakness, or chills.

HEENT: Denies eye redness, excessive tearing, blurred vision, nasal secretions, or swallowing difficulties.

Respiratory: Denies breathing difficulties, wheezing, or coughing.

Cardiovascular/Peripheral Vascular: Denies edema, chest tightness, palpitations, or exertional dyspnea.

Gastrointestinal: Reports occasional nausea and vomiting. Denies abdominal pain, heartburn, diarrhea, or constipation.

Genitourinary: Reports urine frequency and increased PV discharge. Denies foul-smelling discharge, lower abdominal pain, or urinary urgency.

Musculoskeletal: Denies back pain, joint stiffness, or pain.

Neurological: Negative for headaches, dizziness, or muscle weakness.

Psychiatric: Negative for psychotic, mood, or anxiety symptoms.

Skin/hair/nails: Reports stretch marks. Denies itching, burning sensation, rashes, bruising, or brittle nails

OBJECTIVE DATA:

Physical Exam:

Vital signs: BP-122/78; HR-80; RR-16; Temp-98.4; HT-5’4; WT- 154 lbs.

General: AA female client in no distress. She is alert and oriented x3.

HEENT: Head is symmetrical; Eyes: Sclera is white; Conjunctiva is pink; PERRLA; Ears: Intact and shiny TMs

Neck: Symmetrical and Supple. Thyroid gland normal on palpation.

Chest/Lungs: Uniform chest expansion. Smooth respirations; Lungs clear on auscultation.

Heart/Peripheral Vascular: No edema or neck vein distension. Regular heart rate and rhythm; S1 and S2 present; No murmurs.

Abdomen: Gravid abdomen; The abdominal skin is stretched with marked striae. Linea nigra present; Normoactive BS; FHR-142b/min; Gravid mass on palpation; No tenderness on palpation; No organomegaly.

Genital/Rectal: Normal female genitalia. Intact anal sphincter.

Musculoskeletal: Active ROM; No joint deformities.

Neurological: Clear speech; CNs are intact; Muscle strength- 5/5; Upright posture; Steady gait.

Skin: Flat dark streaks on the abdomen. The dark streaks are raised, 1-10 mm wide, and the length varies at 1-5 cm. A dark vertical line runs from the diaphragm to the pubic area

Diagnostic results: No tests were ordered.

ASSESSMENT:

Striae gravidarum: Striae gravidarum are stretch marks that appear during pregnancy. They are caused by thin tears in the dermal collagen. They appear as flat red or hypopigmented stripes that become raised, longer, wider, and violet-red (Abbas et al., 2018). The patient has dark flat streaks on the abdomen that first occurred during pregnancy, which align with Striae gravidarum.

Anetoderma: It is characterized by flaccid, well-circumscribed areas of slack skin. Sac-like protrusions can sometimes be observed in some lesions. It is attributed to the loss of elastic fibers within the dermis (Genta et al., 2020). Histopathology is necessary to confirm or rule out Anetoderma to determine if elastic tissue is lost in the dermis.

Lichen sclerosus: This is a rare autoimmune skin condition characterized by skin atrophy and hypopigmentation. It commonly affects genital skin. It typically begins as a sharply demarcated erythema that progresses into thin, hypopigmented, ivory-white, and sclerotic plaques. The plaques are surrounded by a purple, red, or violet border (Singh & Ghatage, 2020). The hypopigmented streaks make this a differential diagnosis. However, the patient has no plaques, and the streaks are not in the genital area ruling Lichen sclerosus as the primary diagnosis.

Elastotic striae: This is a rare skin condition that manifests as asymptomatic atrophic yellow lines on the thighs, mid or lower back, arms, or breasts. It manifests clinically with asymptomatic, numerous, yellowish, elevated, irregularly indurated, striae-like lines or bands spread horizontally across the lower and middle part of the posterior trunk (Palaniappan et al., 2023). The patient has raised irregular streaks, but they are not in the posterior trunk, making this an unlikely primary diagnosis.

Scarring: Scars present as raised, firm nodules or plaques, usually at sites of previous trauma (Barone et al., 2021). However, the patient has no history of abdominal trauma, which rules out scarring as the cause of the hypopigmented streaks.

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

Abbas, A. M., Kamel, F. M., & Salman, S. A. (2018). Clinical significance and treatment of striae gravidarum during pregnancy: a review article. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(1), 368. doi:10.18203/2320-1770.ijrcog20185454

Barone, N., Safran, T., Vorstenbosch, J., Davison, P. G., Cugno, S., & Murphy, A. M. (2021). Current Advances in Hypertrophic Scar and Keloid Management. Seminars in plastic surgery, 35(3), 145–152. https://doi.org/10.1055/s-0041-1731461Lokhande, A. J., & Mysore, V. (2019). Striae Distensae Treatment Review and Update. Indian dermatology online journal, 10(4), 380–395. https://doi.org/10.4103/idoj.IDOJ_336_18

Genta, M. P., Abreu, M. A. M. M., & Nai, G. A. (2020). Anetoderma: an alert for antiphospholipid antibody syndrome. Anais brasileiros de dermatologia, 95(1), 123–125. https://doi.org/10.1016/j.abd.2019.04.010

Palaniappan, V., Selvaarasan, J., Murthy, A. B., & Karthikeyan, K. (2023). Linear focal elastosis. Clinical and Experimental Dermatology, 48(3), 175-180. https://doi.org/10.1093/ced/llac071

Singh, N., & Ghatage, P. (2020). Etiology, Clinical Features, and Diagnosis of Vulvar Lichen Sclerosus: A Scoping Review. Obstetrics and gynecology international, 2020, 7480754. https://doi.org/10.1155/2020/7480754

Rubric Detail

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Content
Name: NURS_6512_Week_4_Assignment_1_Rubric
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Excellent Good Fair Poor

Using the SOAP (Subjective, Objective, Assessment, and Plan) note format:
· Create documentation, following SOAP format, of your assignment to choose one skin condition graphic (identify by number in your Chief Complaint). · Use clinical terminologies to explain the physical characteristics featured in the graphic. Points Range: 30 (30%) – 35 (35%)
The response clearly, accurately, and thoroughly follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response clearly and thoroughly explains all physical characteristics featured in the graphic using accurate terminologies.

Points Range: 24 (24%) – 29 (29%)

The response accurately follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response explains most physical characteristics featured in the graphic using accurate terminologies. Points Range: 18 (18%) – 23 (23%)
The response follows the SOAP format, with vagueness and some inaccuracy in documenting one skin condition graphic, and accurately identifies the graphic by number in the Chief Complaint. The response explains some physical characteristics featured in the graphic using mostly accurate terminologies.

Points Range: 0 (0%) – 17 (17%)

The response inaccurately follows the SOAP format or is missing documentation for one skin condition graphic and is missing or inaccurately identifies the graphic by number in the Chief Complaint. The response explains some or few physical characteristics featured in the graphic using terminologies with multiple inaccuracies.
· Formulate a different diagnosis of three to five possible considerations for the skin graphic. · Determine which is most likely to be the correct diagnosis, and explain your reasoning using at least three different references from current evidence-based literature.

Points Range: 45 (45%) – 50 (50%)

The response clearly, thoroughly, and accurately formulates a different diagnosis of five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained clearly, accurately, and thoroughly using three or more different references from current evidence-based literature.

Points Range: 39 (39%) – 44 (44%)

The response accurately formulates a different diagnosis of three to five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained accurately using at least three different references from current evidence-based literature.

Points Range: 33 (33%) – 38 (38%)

The response vaguely or with some inaccuracy formulates a different diagnosis of three possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained vaguely and with some inaccuracy using three different references from current evidence-based literature.

Points Range: 0 (0%) – 32 (32%)

The response formulates inaccurately, incompletely, or is missing a different diagnosis of possible considerations for the skin graphic, with two or fewer possible considerations provided. The response vaguely, inaccurately, or incompletely determines the most likely correct diagnosis with reasoning that is missing or explained using two or fewer different references from current evidence-based literature.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

Points Range: 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

Points Range: 4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

Points Range: 3 (3%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. Points Range: 0 (0%) – 2 (2%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors. Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors. Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors. Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) APA format errors.
Total Points: 100
Name: NURS_6512_Week_4_Assignment_1_Rubric