Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions Photo Credit: Getty Images/iStockphoto Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause. In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition. To Prepare Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment. Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies? Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected. Consider which of the conditions is most likely to be the correct diagnosis, and why. Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment. Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note. Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment. The Lab Assignment Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week's Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case. Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of  three to five  possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources. 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 .

1. Assignment 1: Lab Assignment: Differential Diagnosis for Skin
Conditions
Photo Credit: Getty Images/iStockphoto
Properly identifying the cause and type of a patient’s skin
condition involves a process of elimination known as
differential diagnosis. Using this process, a health professional
can take a given set of physical abnormalities, vital signs,
health assessment findings, and patient descriptions of
symptoms, and incrementally narrow them down until one
diagnosis is determined as the most likely cause.
In this Lab Assignment, you will examine several visual
representations of various skin conditions, describe your
observations, and use the techniques of differential diagnosis to
determine the most likely condition.
To Prepare
Review the Skin Conditions document provided in this week’s
Learning Resources, and select one condition to closely
examine for this Lab Assignment.
Consider the abnormal physical characteristics you observe in
the graphic you selected. How would you describe the
characteristics using clinical terminologies?
Explore different conditions that could be the cause of the skin
abnormalities in the graphics you selected.
Consider which of the conditions is most likely to be the correct
diagnosis, and why.

2. 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.

3. 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.

4. 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.

5. 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

6. This interactive website allows you to explore skin conditions
according to age, gender, and area of the body.
Clothier, A. (2014). Assessing and managing skin tears in older
people.
Nurse Prescribing, 12
(6), 278–282.
Document
: Skin Conditions (Word document)
This document contains five images of different skin conditions.
You will use this information in this week’s Discussion.
Document
: Comprehensive SOAP Exemplar (Word document)
Document
: Comprehensive SOAP Template (Word document)
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow
Health orientation as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation
[Video file]. Retrieved from
https://www.youtube.com/watch?v=Rfd_8pTJBkY
Document: Shadow Health Support and Orientation Resources
(PDF)

7. Shadow Health. (n.d.). Shadow Health help desk. Retrieved
from https://support.shadowhealth.com/hc/en-us
Document
: Shadow Health. (2014). Useful tips and tricks (Version 2)
(PDF)
Document
: Shadow Health Nursing Documentation Tutorial (Word
document)
Document
: Student Acknowledgement Form (Word document)
Note
: You will sign and date this form each time you complete your
DCE Assignment in Shadow Health to acknowledge your
commitment to Walden University’s Code of Conduct.
Document
: DCE (Shadow Health) Documentation Template for Health
History (Word document)
Use this template to complete your Assignment 2 for this week.
Optional Resources
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014).
DeGowin’s diagnostic examination
(10th ed.). New York, NY: McGraw Hill Medical.
Chapter 6, “The Skin and Nails”

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

9. topical skin adhesive
. Retrieved from
https://web.archive.org/web/20150926002534/http://academicde
partments.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://academicde
partments.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).
Accessible player --Downloads--Download Video
w/CCDownload AudioDownload Transcript
Skin, Hair, and Nails - Week 4

10. (19m)
Accessible player --Downloads--Download Video
w/CCDownload AudioDownload Transcript
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=stu
dent .
To Register to View the Content
Go to
https://evolve.elsevier.com/cs/product/9780323172660?role=stu
dent
Enter the name of the textbook, Seidel's Guide to Physical
Examination (name of text without the edition number) in the
Search textbox.
Complete the registration process.

11. To View the Content for this Text
Go to
https://evolve.elsevier.com/
Click on Student Site.
Type in your username and password.
Click on the Login button.
Click on the plus sign icon for Resources on the left side of the
screen.
Click on the name of the textbook for this course.
Expand the menu on the left to locate all the chapters.
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

12. 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=PL9U
KTUFtRDcNq4--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

13. Note
: Approximate length of this media program is 5 minutes.
Welcome to week 4
We are entering week 4. Students have 2 assignments due this
week. You will choose a lesion to document the SOAP note and
secondly, this week is our first Shadow Health Assignment.
There are several student tips, how to upload the lab pass, etc.
located in the course. Regarding the SOAP notes, there is not
enough information. I advise you to make up the information
that is not there (ie. Health hx, social hx, etc). This will allow
you to critically think as you develop the notes.
You need to know that the DCE score is not the only score that
counts as your grade, it is only a portion of the grade. You must
complete the documentation portion. Also, we have noted that
in SH, the ROS is not located in the documentation portion but
is located in the subjective data collection portion. Remember
to document as the SOAP order. I advise you to review my
SOAP document send last week for guidance.
Last week we engulfed in great conversation on the risks of our
findings about growth, measurements, and nutrition of children
and their families. As practitioners, it’s important to
communicate professionally, ask the right questions, and guide
families as they strive to have healthier and happy lives. This
week we will begin to review assessments of body systems.
Skin, Hair, and Nails will be covered. I encourage you to
perform the assessment of Skin, Hair, and Nails so that you may
be proficient with it for the overall assessment. You are able to
access the check lists by enrolling into the evolve website in
your resources.

14. You first assignment for this week is to be written in a SOAP
Note format (NO NARRATIVES). There is a template/sample
for you to follow posted in your announcements at the
beginning of the semester. You will need to put in the missing
information in the note (some may be made up ie meds, hx,
parts of the ROS and PE). In the Assessment/Plan, you will
document your differential diagnoses as per the assignment. I
will comment on your notes and if needed, send you an email if
I need to help you with them more.
Assignment 1:
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.