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1. Assignment: Differential Diagnosis for Skin Conditions Case Study
Assignment: Differential Diagnosis for Skin Conditions Case Study ON Assignment:
Differential Diagnosis for Skin Conditions Case StudyProperly 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. Assignment: Differential Diagnosis for Skin Conditions Case StudyIn 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 PREPAREConsider 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 for one evidence-based practice, peer-
reviewed article based on the skin condition you chose for this 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.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.For Week 4 the pictures you need
to create the story to your diagnosis and list your differentials. Remember to include the
pertinent positives and pertinent negatives with your primary diagnosis and differentials.
The pertinent positive and pertinent negatives are your hands on exam findings that rule in
or rule out a diagnosis. For example chickenpox is itchy – that’s a pertinent positive and
pertinent negative not raised or flat rash.You want to approach your hands on exam in
advanced health assessment as what are the pertinent hands on findings that leads you to
the diagnosis.Common things occur commonly and sometimes in uncommon circumstances
so we need to be proficient with our hands on exam
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976d837a5460d0e1Unformatted Attachment PreviewWeek 4 Lab Assignment: Differential

2. Diagnosis for Skin Conditions 1: Page 1 of 5 Week 4 Lab Assignment: Differential Diagnosis
for Skin Conditions 2: Page 2 of 5 Week 4 Lab Assignment: Differential Diagnosis for Skin
Conditions 3. Page 3 of 5 Week 4 Lab Assignment: Differential Diagnosis for Skin Conditions
4. Page 4 of 5 Week 4 Lab Assignment: Differential Diagnosis for Skin Conditions 5. Page 5 of
5 Comprehensive SOAP Exemplar Purpose: To demonstrate what each section of the SOAP
note should include. Remember that Nurse Practitioners treat patients in a holistic manner
and your SOAP note should reflect that premise. Patient Initials: _______ Age: _______ Gender:
_______ SUBJECTIVE DATA: Chief Complaint (CC): Coughing up phlegm and fever History of
Present Illness (HPI): Sara Jones is a 65 year old Caucasian female who presents today with
a productive cough x 3 weeks and fever for the last three days. She reported that the “cold
feels like it is descending into her chest”. The cough is nagging and productive. She brought
in a few paper towels with expectorated phlegm – yellow/brown in color. She has
associated symptoms of dyspnea of exertion and fever.Her Tmax was reported to be 102.4,
last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks,
but returns after the medication wears off. She rated the severity of her symptom
discomfort at 4/10. Medications: 1.) Lisinopril 10mg daily 2.) Combivent 2 puffs every 6
hours as needed 3.) Serovent daily 4.) Salmeterol daily 5.) Over the counter Ibuprofen
200mg -2 PO as needed 6.) Over the counter Benefiber 7.) Flonase 1 spray each night as
needed for allergic rhinitis symptoms Allergies: Sulfa drugs – rash Past Medical History
(PMH): 1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d
with outpatient antibiotics and an hand held nebulizer treatments. 2.) Hypertension – well
controlled 3.) Gastroesophageal reflux (GERD) – quiet on no medication 4.) Osteopenia 5.)
Allergic rhinitis Past Surgical History (PSH): 1.) Cholecystectomy 1994 2.) Total abdominal
hysterectomy (TAH) 1998 © 2019 Walden University Page 1 of 4 Sexual/Reproductive
History: Heterosexual G1P1A0 Non-menstrating – TAH 1998 Personal/Social History: She
has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History: Her immunizations are up to date. She received the influenza vaccine
last November and the Pneumococcal vaccine at the same time. Significant Family History:
Two brothers – one with diabetes, dx at age 65 and the other with prostate CA, dx at age 62.
She has 1 daughter, in her 50’s, healthy, living in nearby neighborhood. Lifestyle: She is a
retired; widowed x 8 years; lives in the city, moderate crime area, with good public
transportation. She college graduate, owns her home and receives a pension of $50,000
annually – financially stable. She has a primary care nurse practitioner provider and goes
for annual and routine care twice annually and as needed for episodic care. She has medical
insurance but often asks for drug samples for cost savings. Assignment: Differential
Diagnosis for Skin Conditions Case StudyShe has a healthy diet and eating pattern. There are
resources and community groups in her area at the senior center and she attends regularly.
She enjoys bingo. She has a good system composed of family and friends. Review of
Systems: General: + fatigue since the illness started; + fever, no chills or night sweats; no
recent weight gains of losses of significance. HEENT: no changes in vision or hearing; she
does wear glasses and her last eye exam was 1 ½ years ago. She reported no history of
glaucoma, diplopia, floaters, excessive tearing or photophobia. She does have bilateral small
cataracts that are being followed by her ophthalmologist. She has had no recent ear

3. infections, tinnitus, or discharge from the ears. She reported her sense of smell is intact. She
has not had any episodes of epistaxis. She does not have a history of nasal polyps or recent
sinus infection. She has history of allergic rhinitis that is seasonal. Her last dental exam was
3/2014. She denied ulceration, lesions, gingivitis, gum bleeding, and has no dental
appliances. She has had no difficulty chewing or swallowing. © 2019 Walden University
Page 2 of 4 Neck: no pain, injury, or history of disc disease or compression. Her last Bone
Mineral density (BMD) test was 2013 and showed mild osteopenia, she said. Breasts: No
reports of breast changes. No history of lesions, masses or rashes. No history of abnormal
mammograms. Respiratory: + cough and sputum production (see HPI); denied hemoptysis,
no difficulty breathing at rest; + dyspnea on exertion; she has history of COPD and
community acquired pneumonia 2012. Last PPD was 2013. Last CXR – 1 month ago. CV: no
chest discomfort, palpitations, history of murmur; no history of arrhythmias, orthopnea,
paroxysmal nocturnal dyspnea, edema, or claudication. Date of last ECG/cardiac work up is
unknown by patient. GI: No nausea or vomiting, reflux controlled, No abd pain, no changes
in bowel/bladder pattern. She uses fiber as a daily laxative to prevent constipation. GU: no
change in her urinary pattern, dysuria, or incontinence. She is heterosexual. She has had a
total abd hysterectomy. No history of STD’s or HPV. She has not been sexually active since
the death of her husband. MS: she has no arthralgia/myalgia, no arthritis, gout or limitation
in her range of motion by report. No history of trauma or fractures. Psych: no history of
anxiety or depression. No sleep disturbance, delusions or mental health history. She denied
suicidal/homicidal history. Neuro: no syncopal episodes or dizziness, no paresthesia, head
aches. No change in memory or thinking patterns; no twitches or abnormal movements; no
history of gait disturbance or problems with coordination. No falls or seizure history.
Assignment: Differential Diagnosis for Skin Conditions Case
StudyIntegument/Heme/Lymph: no rashes, itching, or bruising. She uses lotion to prevent
dry skin. She has no history of skin cancer or lesion removal. She has no bleeding disorders,
clotting difficulties or history of transfusions. Endocrine: no endocrine symptoms or
hormone therapies. Allergic/Immunologic: this has hx of allergic rhinitis, but no known
immune deficiencies. Her last HIV test was 10 years ago. OBJECTIVE DATA Physical Exam:
© 2019 Walden University Page 3 of 4 Vital signs: B/P 110/72, left arm, sitting, regular cuff;
P 70 and regular; T 98.3 Orally; RR 16; non-labored; Wt: 115 lbs; Ht: 5’2; BMI 21 General:
A&O x3, NAD, appears mildly uncomfortable HEENT: PERRLA, EOMI, oronasopharynx is
clear Neck: Carotids no bruit, jvd or tmegally Chest/Lungs: CTA AP&L Heart/Peripheral
Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial ABD:
benign, nabs x 4, no organomegaly; mild suprapubic tenderness – diffuse – no rebound
Genital/Rectal: external genitalia intact, no cervical motion tenderness, no adnexal masses.
Musculoskeletal: symmetric muscle development – some age related atrophy; muscle
strengths 5/5 all groups. Neuro: CN II – XII grossly intact, DTR’s intact Skin/Lymph Nodes:
No edema, clubbing, or cyanosis; no palpable nodes ASSESSMENT: Lab Tests and Results:
CBC – WBC 15,000 with + left shift SAO2 – 98% Diagnostics: Lab: Radiology: CXR –
cardiomegaly with air trapping and increased AP diameter ECG Normal sinus rhythm
Differential Diagnosis (DDx): 1.) Acute Bronchitis 2.) Pulmonary Embolis 3.) Lung Cancer
Diagnoses/Client Problems: 1.) COPD 2.) HTN, controlled 3.) Tobacco abuse – 40 pack year

4. history 4.) Allergy to sulfa drugs – rash 5.) GERD – quiet on no current medication PLAN:
[This section is not required for the assignments in this course, but will be required for
future courses.] © 2019 Walden University Page 4 of 4 Comprehensive SOAP Template
Patient Initials: _______ Age: _______ Gender: _______ Note: The mnemonic below is included for
your reference and should be removed before the submission of your final note. O = onset of
symptom (acute/gradual) L= location D= duration (recent/chronic) C= character A=
associated symptoms/aggravating factors R= relieving factors T= treatments previously
tried – response? Why discontinued? S= severity SUBJECTIVE DATA: Include what the
patient tells you, but organize the information. Chief Complaint (CC): In just a few words,
explain why the patient came to the clinic. History of Present Illness (HPI): This is the
symptom analysis section of your note. Thorough documentation in this section is essential
for patient care, coding, and billing analysis. Paint a picture of what is wrong with the
patient. You need to start EVERY HPI with age, race, and gender (i.e. 34-year-old AA male).
You must include the 7 attributes of each principal symptom: 1. Location 2. Quality 3.
Quantity or severity 4. Timing, including onset, duration, and frequency 5. Setting in which
it occurs 6. Factors that have aggravated or relieved the symptom 7. Associated
manifestations Medications: Include over the counter, vitamin, and herbal supplements. List
each one by name with dosage and frequency. Allergies: Include specific reactions to
medications, foods, insects, and environmental factors. Past Medical History (PMH): Include
illnesses (also childhood illnesses), hospitalizations, and risky sexual behaviors. Past
Surgical History (PSH): Include dates, indications, and types of operations. © 2019 Walden
University Page 1 of 3 Sexual/Reproductive History: If applicable, include obstetric history,
menstrual history, methods of contraception, and sexual function. Personal/Social History:
Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable,
and exercise and eating habits. Immunization History: Include last Tdp, Flu, pneumonia, etc.
Significant Family History: Include history of parents, Grandparents, siblings, and children.
Lifestyle: Include cultural factors, economic factors, safety, and systems. Review of
Systems: From head-to-toe, include each system that covers the Chief Complaint, History of
Present Illness, and History (this includes the systems that address any previous
diagnoses). Remember that the information you include in this section is based on what the
patient tells you. You do not need to do them all unless you are doing a total H&P. To ensure
that you include all essentials in your case, refer to Chapter 2 of the Sullivan text. General:
Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data
here. HEENT: Neck: Breasts: Respiratory: Cardiovascular/Peripheral Vascular:
Gastrointestinal: Genitourinary: Musculoskeletal: Psychiatric: Neurological: Skin: Include
rashes, lumps, sores, itching, dryness, changes, etc. Hematologic: Endocrine:
Allergic/Immunologic: OBJECTIVE DATA: From head-to-toe, include what you see, hear, and
feel when doing your physical exam. You only need to examine the systems that are
pertinent to the CC, HPI, and History unless you are doing a total H&P. Do not use WNL or
normal. You must describe what you see. Physical Exam: Vital signs: Include vital signs, ht,
wt, and BMI. © 2019 Walden University Page 2 of 3 General: Include general state of health,
posture, motor activity, and gait. This may also include dress, grooming, hygiene, odors of
body or breath, facial expression, manner, level of conscience, and affect and reactions to

5. people and things. HEENT: Neck: Chest/Lungs: Always include this in your PE.
Heart/Peripheral Vascular: Always include the heart in your PE. Abdomen: Genital/Rectal:
Musculoskeletal: Neurological: Skin: ASSESSMENT: List your priority diagnosis(es). For
each priority diagnosis, list at least 3 differential diagnoses, each of which must be ed with
evidence and guidelines. Include any labs, x-rays, or other diagnostics that are needed to
develop the differential diagnoses. For holistic care, you need to include previous diagnoses
and indicate whether these are controlled or not controlled. These should also be included
in your treatment plan. PLAN: This section is not required for the assignments in this course
(NURS 6512), but will be required for future courses. Treatment Plan: If applicable, include
both pharmacological and nonpharmacological strategies, alternative therapies, follow-up
recommendations, referrals, consultations, and any additional labs, x-ray, or other
diagnostics. the treatment plan with evidence and guidelines. Health Promotion: Include
exercise, diet, and safety recommendations, as well as any other health promotion
strategies for the patient/family. the health promotion recommendations and strategies
with evidence and guidelines. Disease Prevention: As appropriate for the patient’s age,
include disease prevention recommendations and strategies such as fasting lipid profile,
mammography, colonoscopy, immunizations, etc. the disease prevention
recommendations and strategies with evidence and guidelines. REFLECTION: Reflect on
your clinical experience and consider the following questions: What did you learn from this
experience? What would you do differently? Do you agree with your preceptor based on the
evidence? © 2019 Walden University Page 3 of 3 …