Choose one skin condition graphic Shingles # 5  (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 the Comprehensive SOAP Template (see below template). 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  Learning Resources. #5 Shingles 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. 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, .

1. Choose one skin condition graphic Shingles # 5 (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 the
Comprehensive SOAP Template (see below template).
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 Learning Resources.
#5 Shingles
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)

2. 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

3. 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.
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:

4. Include cultural factors, economic factors, safety, and support
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:

5. 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.
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 people and things.
HEENT:
Neck:
Chest/Lungs: Always include this in your PE.

6. 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
supported 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. Support the treatment plan
with evidence and guidelines.
Health Promotion:
Include exercise, diet, and safety recommendations, as well as

7. any other health promotion strategies for the patient/family.
Support 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. Support 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?
3 References