NURS 6512 Differential Diagnosis for Skin Conditions

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

 

This guide will demonstrate how to complete the Walden University NURS 6512 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 NURS 6512 Differential Diagnosis for Skin Conditions                     

 

Whether one passes or fails an academic assignment such as the Walden University NURS 6512 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 NURS 6512 Differential Diagnosis for Skin Conditions                     

The introduction for the Walden University NURS 6512 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 NURS 6512 Differential Diagnosis for Skin Conditions                     

 

After the introduction, move into the main part of the NURS 6512 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 NURS 6512 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 NURS 6512 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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Review of Systems:

General: The patient denied fatigue, fever, chills, night sweats, or recent changes in his body weight.

HEENT: The client denied changes in vision or hearing; he does wear glasses and his last eye exam was 8 months ago. He denied glaucoma, diplopia, floaters, excessive tearing, or photophobia. He denied recent ear infections, tinnitus, or discharge from the ears. He also denied changes in smell or epistaxis. His last dental exam was 1/2022. He denied ulceration, lesions, gingivitis, and gum bleeding, and has no dental appliances. He has had no difficulty chewing or swallowing.

Neck: R.R. denied neck stiffness, pain, or goiter

Breasts: R.R. denied breast changes, pain, or abnormal skin pigmentation  

Respiratory: R.R. denied cough, wheezing, shortness of breath, dyspnea, or nasal flaring.

CV: R.R. denied chest discomfort, palpitations, and a history of murmur, arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication.

GI: R.R. denied nausea or vomiting, abdominal pain, or changes in bowel/bladder pattern.

GU: R.R. denied a change in his urinary pattern, dysuria, or incontinence. He is heterosexual. No history of STDs or HPV. He is sexually active.

MS: He denies arthralgia/myalgia, arthritis, gout, or limitation in his range of motion.

Psych: R.R. denied a history of anxiety or depression. No sleep disturbance, delusions, or mental health history. He denied suicidal/homicidal history.

Neuro: R.R. denied syncope episodes or dizziness, paresthesia, headaches, change in memory or thinking patterns, twitches, or abnormal movements.

Integument/Heme/Lymph: The patient reports itchy, scaly, abnormal pigmentation on his chin. He denies rashes or bruising. He denies a history of skin cancer or lesion removal. He has no bleeding disorders, clotting difficulties, or history of transfusions.

Endocrine: R.R. denied polyuria/polyphagia/polydipsia. Denies fatigue, heat or cold intolerances, shedding of hair, unintentional weight gain, or weight loss.  

Allergic/Immunologic: R.R. denied any history of food, drug, or environmental allergies.

NURS6 512 Differential Diagnosis for Skin Conditions

NURS 6512 Differential Diagnosis for Skin Conditions

Patient Initials: G.B                Age: 28                                                    Gender: Male

Skin condition: Picture 3

SUBJECTIVE DATA:

Chief Complaint (CC): Patient complains of a red itchy rash on their beard.

History of Present Illness (HPI):

Gabriel Buckhannon a 28-year old white Caucasian male presents to the facility with complaints of a red itchy rash that has lasted a week. The itchiness is accompanied with discomfort at the region of the rash and also the area is red as well as swollen. The patient reports no pain initially however this can be aggravated on touch whereby it has been identified to be tender.

Medications:

• Metformin 500mg orally twice daily
• Over the counter topical clotrimazole applied twice daily
• Over the counter topical hydrocortisone applied four times in a day to deal with the itchy sensation

Allergies:

 Patient reports no drug, food or seasonal allergies

 

Past Medical History (PMH):

1.) Diabetes type 2

2.) Pharyngitis

3.) Acute otitis media

Past Surgical History (PSH):

• Patient has not had any previous surgical procedures

Sexual/Reproductive History:

Patient is sexually interested to females

Patient is at the time sexually active

Patient has 3 sexual partners

Personal/Social History:

Patient drinks alcohol consisting of wine once in a while.

Patient smokes cigarettes

Patient enjoys playing football

Patient does not use illicit drugs

Immunization History:

Patient took all his childhood vaccines

Patient is up to date with all expected vaccines

Patient has had a flu shot that year

Significant Family History:

There is a history of diabetes in the family

There is a history of hypertension in the family

There is a history of obesity in the family

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.

Patient reports due to his diabetes diagnosis he has made lifestyle changes that consist of regular exercise such as playing football, going on hikes and not taking sugary food.

Patient also reports not to drink as much alcohol as before and taking instead on occasion.

Patient also reports to have made dietary changes of taking diet soda, low carbohydrate food and he is also complying to the indicated treatment.

Review of Systems:

General: Patient reports discomfort at the area of the rash however no fatigue, fever or loss of appetite.

HEENT:

Patient reports no occurrences of headaches.

Patient reports no blurred vision.

Patient no problems in hearing.

Patient reports no change in sense of smell.

Patient does not report a sore throat.

Neck: Patient reports no difficulty in swallowing or any neck pain.

Breasts: Patient reports no pain at the breasts.

Respiratory: Patient reports no coughing, tightness of chest or dyspnea.

CV: Patient reports no pain at the chest, blue discoloration at the fingertips or edema.

GI: Patient reports no constipation, diarrhea or stool with blood.

 

GU: Patient reports no increase in frequency, pain while urinating or dribbling

MS: Patient reports no muscle or joint pain. Patient reports no back pain. Patient reports no weakness at the joints.

PSYCH: Patient reports not feeling depressed, anxious or having hallucinations.

 

NEURO: Patient reports having not fainted before, feeling dizzy or areas that are numb

INTEGUMENT/HEME/LYMPH:

Patient reports presence of a red inflamed rash on the beard. Patient reports hair loss at region of the rash. Patient reports itchiness at the area of the rash.

ENDOCRINE: Patient reports no heat or cold intolerance.

ALLERGIES/ IMMUNOLOGICAL: Patient reports no known food, drug or seasonal allergies

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.

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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.

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