18 Sep 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 t
- 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 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.
Skin Comprehensive SOAP Note Template
Patient Initials: _______ Age: _______ Gender: _______
Chief Complaint (CC):
History of Present Illness (HPI):
Past Medical History (PMH):
Past Surgical History (PSH):
Significant Family History:
Review of Systems:
Diagnostic / Lab Tests and results:
Differential diagnosis 1:
Differential diagnosis 2:
Differential diagnosis 3:
Differential diagnosis 4:
Differential diagnosis 5:
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Rubric for grading and Reference lists
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 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.
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. = 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.
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. = 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.
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. = 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.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation. = Uses correct grammar, spelling, and punctuation with no errors.
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. = Uses correct APA format with no errors.
· Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel's guide to physical examination: An interprofessional approach (10th 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.
· 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” Download 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.
· 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. (2021). Clinical decision supportLinks to an external site.: For professionals. Retrieved July 16, 2021, from http://www.skinsight.com/professionals This interactive website allows you to explore skin conditions according to age, gender, and area of the body.
· Bonifant, H., & Holloway, S. (2019). A review of the effects of ageing on skin integrity and wound healingLinks to an external site.. British Journal of Community Nursing, 24(Sup3), S28–S33. https://doi.org/10.12968/bjcn.2019.24.sup3.s28
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
· Shadow Health. (2021). Welcome to your introduction to Shadow HealthLinks to an external site. . https://link.shadowhealth.com/Student-Orientation-Video
· Shadow Health. (n.d.). Shadow Health help deskLinks to an external site.. Retrieved from https://support.shadowhealth.com/hc/en-us
· Shadow Health. (2021). Walden University quick start guide: NURS 6512 NP students. Download Walden University quick start guide: NURS 6512 NP students. https://link.shadowhealth.com/Walden-NURS-6512-Student-Guide
· Document: Shadow Health Nursing Documentation Tutorial Download Shadow Health Nursing Documentation Tutorial(Word document)
· Document: DCE (Shadow Health) Documentation Template for Health History Download DCE (Shadow Health) Documentation Template for Health History(Word document) Use this template to complete your Assignment 2 for this week.
Lab Assignment: Differential Diagnosis for Skin Conditions
Lab Assignment: Differential Diagnosis for Skin Conditions
Purpose: This paper aims to perform a differential diagnosis of a skin condition depicted in
graphic no. 4. Through objective assessment, the paper records observations and analyses them
to come up with a differential diagnosis as per the SOAP format.
Week 4: Skin Comprehensive SOAP Note
Patient Initials: __H.K___Age: __45_____Gender __M____
Chief Complaint (CC): Redness, pain, and swelling of the skin on the left leg, fever.
History of Present Illness (HPI): H.K. is a 45-year-old Caucasian male who reports fever and
severe soreness, swelling, and redness of the skin on the left leg. The patient also complains of
fever before the discovery of erythema on the leg, which spread over a larger skin area with time.
The patient also reported hitting his leg on a hard surface during his regular plumbing work
schedule. The accident did not lead to an open wound immediately, and there was no bruising or
broken skin. Also, he did not take any medications for the fever but applied first aid by placing
ice on the hit area once the pain progressed. The patient denied any use of painkillers or
application of any form of cream.
i. Inderal 120 mg extended release, orally, daily
ii. Losartan 100 mg, orally, daily
iii. Bumex 3 mg, twice a day
iv. Protonix 20 mg, orally, daily
v. Coreg 25 mg, orally, twice a day
vi. Hydralazine 100 mg, thrice a day
vii. Lantus 12 units taken subcutaneously
viii. Citalopram 40 mg, orally, every day
vi. Insulin a part, administered bedtime subcutaneously after every meal
vii. Lipitor 80 mg, orally, every day
The patient reports an allergic response to Tetracycline Adhesive.
Past Medical History:
iii. Morbid obesity Diabetes Mellitus
iv. Gastro-esophageal reflux disease (GERD)
Past Surgical History (PSH):
i. Right shoulder arthroscopy
ii. Laser eye surgery in 2018
Sexual/Reproductive History: heterosexual, sexually active.
Personal/Social History: The patient reports smoking cigarettes about five years ago but
managed to quit. He takes alcohol-based drinks with a friend, especially on weekends. He denied
the use of any narcotic drugs throughout his life. His hobbies include playing chess, and
draughts, riding m motorcycle, participating in humanitarian aid and charitable events, and going
for morning runs.
The patient reported exercising on a daily bases through morning runs and avoiding starch and
sugary foods due to the morbid obesity and diabetes history.
Immunization History: The patient reported receiving all pre-requisite immunizations,
including Covid-19 vaccinations and booster shots.
Significant Family History: The maternal grandfather has a history of hyperlipidemia, while the
father has hypertension. The patient is a singleton with both parents.
Review of Systems:
General: The patient reported frequent fever, soreness, redness, swelling, and pain of the
erythema on the left leg.
HEENT: The patient did not report any blurry vision. He wears spectacles due to short-
sightedness. The patient denied any ear discharge or pain and any running nose in the last month.
Respiratory: The patient denied any shortness of breath, coughing, or congestion. The patient
denied any chest pain but has a history of smoking. The patient did not report any withdrawal
symptoms from smoking. The patient has a history of pneumonia but denied tuberculosis.
Cardiovascular/Peripheral Vascular: The patient has a history of hypertension and
hyperlipidemia. He denied any chest pain or palpitations but reported soreness, redness, swelling,
and pain in the lower left limb.
Gastrointestinal: The patient denied any abdominal discomfort or pain.
Genitourinary: There were no medical records of dysuria, hematuria, or any other kidney
Musculoskeletal: The patient reported pain in the lower part of the left leg. He did not report
any joint, arm, or leg weakness. He also denied joint swelling and arthritis.
Neurological: The patient denied any focal motor anomalies, stroke, paresthesia, or seizures.
Psychiatric: The patient reported depression and anxiety but denied phobias, nightmares,
nervousness, hallucinations, delusions, and suicidal or homicidal ideation.
Skin/hair/nails: The patient reported swelling, soreness, redness, pain in the skin of the left
lower leg, and erythema.
Body Temp: 38
Weight: 112kg (247 lbs)
Height: 6' 3.7"
Pulse rate: 68
RR: 18 (non-labored)
BMI: 31.4 kg/m²
General: A well-dressed man with a normal temperate, kind, face comforted and sensitive to
anyone trying to touch the leg.
HEENT: The extraocular muscles were intact (EOMI), the patient had normal eyelids, pupils
that were equal, round, and reactive to light (PERRL) normal lids, pupils are equal, round and
react to light, normocephalic, pink conjunctiva, normal distribution of hair, and a clear sclera.
The patient denied any soreness, discomfort, or pain of the year.
Neck: an assessment of the trachea revealed no signs of lymphadenopathy or chiromegaly. The
trachea had a moist mucous membrane.
Chest/Lungs: The patient did not report any wheezing, rubs, or crackling, and both lungs were
free of auscultation. The patient also presented normal fremitus, symmetric chest expansion, and
resonance on percussion.
Heart/Peripheral Vascular: The patient has a normal heart rate and rhythm and has no signs of
cyanosis or pallor. Also, the patient has a normal S1 and S2. The patient has +2 left leg edema,
+2 capillary refill in the lower extremity, and +1 right leg edema. The patient also has no S3 or
Abdomen: The patient reports abnormal bowel sounds and denied any abdominal sounds. The
were no signs of bruits or organomegaly.
Genital/Rectal: The patient is circumcised and did not have any penile lesions, testicular lumps,
or penile discharge. The rectal examination revealed no lesions, masses, or tenderness.
Musculoskeletal: There were no signs of Scoliosis and kyphosis, and the patient denied any
joint swelling or stiffness.
Neurological: The patient had normal speech and a normal sensation that was oriented to person,
time, and place.
Skin: There were signs of more left lower extremity edema in comparison with the right lower
extremity. The were no signs of skin, open wound, or discharge. There was erythema in the left
lower limb along the mid-shin and its anterior region. However, there were no ulcerations. There
was also a slight abrasion on the left shin. A bilaterally palpable arterial pulse revealed a warmer
and tender lower left extremity in comparison to the lower right extremity.
Diagnostic/Lab Tests and Results:
1. CBC test revealed leukocytosis with >13000 leukocytes/µL
2. Skin biopsy
3. CRP test revealed higher than normal results at 115 mg/L
Differential Diagnosis 1: Cellulitis.
Cellulitis, commonly referred to as streptococci, is a skin infection that affects
subcutaneous skin layers and causes severe pain in the affected areas (Patel et al., 2018). The
skin condition is caused by an unknown streptococcus. The condition occurs when pathogens
enter the subcutaneous layers through broken skin. The condition is also difficult to diagnose and
distinguish from other skin conditions, which manifest in very similar ways. The disease
manifests in a subcutaneous region with an inferior boundary, mostly in the lower extremities.
However, the disease can also occur in the upper extremities if a patient is administered
an intravenous drug. The disease is accompanied by inflammatory signs, consisting of fever,
swelling, tenderness, and pain in the infected area. From graphic 4, the patient has red and
slightly swollen skin on the lower extremity, with visible sores. The accident that led to hitting
the leg on a surface may have caused the streptococcus to penetrate the skin and cause Cellulitis.
Differential Diagnosis 2: Erysipelas
Erysipelas is a skin infection of the dermis, which mainly manifests in the lower limbs or
face. The disease's symptoms include skin tenderness, a well-delineated and raised erythema,
fever, and malaise. The disease is caused by Streptococcus Pyogenes, a bacterium that is also
referred to as hemolytic streptococci (Brindle et al., 2020). The bacteria enter the skin through a
scratch of the skin or through an insect bite. The disease has very similar signs and symptoms to
Cellulitis, but it is usually more demarcated and raised. Signs of the symptoms include a red
plaque, a raised edge, swollenness, tenderness, and warmth of the skin on the affected area.
Differential diagnosis 3: Necrotizing
The disease is a severe skin infection affecting the subcutaneous later and skin facia and
is prevalent in the lower skin areas (Puntis, 2018). The disease spreads fast and often calls for
emergency surgery. Its symptoms include fever, swelling, tenderness, and pain in the infected
area, which are very close to those of Cellulitis. The symptoms keep on changing with time,
unlike Cellulitis, whose symptoms are very specific. In the later stages, the disease manifests in
the form of gas gangrene and necrosis. From graphic number four, the patient has tenderness of
the skin, red ores, and swelling, but lacks any signs of gas gangrenes, thus disqualifying the
Differential Diagnosis 4: Erythema nodosum
Erythema nodosum is a skin infection commonly located at the lower extremities and
manifests in the form of erythematous and nodular eruption (Gilchrist & Patterson, 2010). The
disease is considered a reaction caused by hypersensitivity to immune depositions by vessels
located in the panniculus adiposis. It is also comorbid with other systemic diseases and certain
Differential diagnosis 5: Contact Dermatitis
The disease is an itchy rash caused by contact with a substance that causes an allergic
reaction to the skin. Such substances include plants, cosmetics, jewelry, and fragrances. Signs
and symptoms include swelling, warmth, or tenderness of the skin on the affected region, an
itchy rash, blisters, and leathery patches (Marty & Cheng, 2005).
Primary Diagnoses: While many skin diseases manifest with similar symptoms, there are
distinguishing features that set apart a specific disease. Considering that the person hit his leg
on a blunt object which did not cause broken skin, but the disease emerged after the accident,
it is most likely that bacteria entered the skin during the impact, thus implying a high
likelihood of Cellulitis. Also, the disease affected the subcutaneous tissue, whic
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