Week 4 Lab Assignment: Differential Diagnosis for Skin Conditions 1: 2: 3. 4. 5. �Note to Build: These images are still pending permissions so I don’t have credit lines yet or approval. Page 5 of 5 Feedback for draft Good topic. Here are suggestions for improving the paper for the final version. Out the outset you need to say why euthanasia is considered controversial. For each theory, you need first to briefly explain the theory and then apply it to the issue, with at least one separate paragraph per theory. For utilitarian, you need to consider both costs and benefits of euthanasia, and then determine what the balance is. On the Kantian side, you need to apply both version of the categorical imperative. Can allowing euthanasia be made a universal law? Does allowing euthanasia show respect for persons? You need to apply the virtue view by considering how specific virtues are relevant, such as mercy, justice, compassion, and practical wisdom. You need a paragraph comparing and contrasting the three views, and a closing in which you summarize what has come before. Euthanasia 2 Running Head: Euthanasia Euthanasia (Draft 1)Jason T. BonnetUpper Iowa University Euthanasia Looking at the international healthcare environment of today, practitioners face a multitude of ethical issues (Pesut et al. 2019). In context, it is their responsibility to develop a code of conduct and ethics of all participants in organizations and health institutions. There is a need to put this into action and ensure the healthcare environment has integrity in service provision (Pesut et al. 2019). In this paper, I will discuss Euthanasia as an ethical issue that is prominent at the business level and most in the health sector workplace. As we all know that medical centers aim at saving lives (Pesut et al. 2019). However, in some cases treatment or lack there of could aim to end someone’s life. In most cases, it is referred to as involuntary euthanasia. According to Storer, 2017, author of Euthanasia and the Law, Euthanasia "practice of ending a life to release one from suffering from disease or intolerable suffering." In my point of view, this an issue, and it should be surrounded by strict procedures and laws on how it is used (Storer, 2017). Theories surrounding these ethical issues in the healthcare outlook are Utilitarianism and Kantian Application ethical theories (Storer, 2017). The methods highlight how it is ethical for someone who is under treatment to terminate his or her life and get relieved from pain through voluntary euthanasia. Which is agreed upon by the patients family to seek physician-assited suicide. In this matter, death is inevitable, and their suffering is in vain (Pesut et al. 2019). From my point of view, the individuals involved will determine the suffering and pain of a patient (Storer, 2017). When a person is ready to die, the decision should be taken from the most significant number of members t ...

1. Week 4 Lab Assignment: Differential Diagnosis for Skin
Conditions
1:
2:
3.
4.
5.
�Note to Build: These images are still pending permissions so I
don’t have credit lines yet or approval.
Page 5 of 5
Feedback for draft
Good topic. Here are suggestions for improving the paper for
the final version.
Out the outset you need to say why euthanasia is considered
controversial.
For each theory, you need first to briefly explain the theory and
then apply it to the issue, with at least one separate paragraph
per theory.
For utilitarian, you need to consider both costs and benefits of
euthanasia, and then determine what the balance is.

2. On the Kantian side, you need to apply both version of the
categorical imperative. Can allowing euthanasia be made a
universal law? Does allowing euthanasia show respect for
persons?
You need to apply the virtue view by considering how specific
virtues are relevant, such as mercy, justice, compassion, and
practical wisdom.
You need a paragraph comparing and contrasting the three
views, and a closing in which you summarize what has come
before.
Euthanasia 2
Running Head: Euthanasia
Euthanasia (Draft 1)Jason T. BonnetUpper Iowa University
Euthanasia
Looking at the international healthcare environment of
today, practitioners face a multitude of ethical issues (Pesut et
al. 2019). In context, it is their responsibility to develop a code
of conduct and ethics of all participants in organizations and
health institutions. There is a need to put this into action and
ensure the healthcare environment has integrity in service
provision (Pesut et al. 2019).
In this paper, I will discuss Euthanasia as an ethical issue
that is prominent at the business level and most in the health
sector workplace. As we all know that medical centers aim at
saving lives (Pesut et al. 2019). However, in some cases

3. treatment or lack there of could aim to end someone’s life. In
most cases, it is referred to as involuntary euthanasia.
According to Storer, 2017, author of Euthanasia and the Law,
Euthanasia "practice of ending a life to release one from
suffering from disease or intolerable suffering." In my point of
view, this an issue, and it should be surrounded by strict
procedures and laws on how it is used (Storer, 2017).
Theories surrounding these ethical issues in the healthcare
outlook are Utilitarianism and Kantian Application ethical
theories (Storer, 2017). The methods highlight how it is ethical
for someone who is under treatment to terminate his or her life
and get relieved from pain through voluntary euthanasia. Which
is agreed upon by the patients family to seek physician-assited
suicide. In this matter, death is inevitable, and their suffering is
in vain (Pesut et al. 2019).
From my point of view, the individuals involved will
determine the suffering and pain of a patient (Storer, 2017).
When a person is ready to die, the decision should be taken
from the most significant number of members to break the tie.
According to the Kantian theory, I believe physician-assisted
suicide is the best way to end someone’s pain and suffering.
Therefore the legislature are creating a universal law for this
matter (Storer, 2017).References
Barbara MacKinnon and Andrew Fiala (2018). Ethics Theory
and Contemporary Issues Cengage Learning
Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M.,
Tishelman, C., ... & Janke, R. (2019). Nursing and euthanasia:
A narrative review of the nursing ethics literature. Nursing
ethics, 0969733019845127.
Storer, A. A. B. (2017). Euthanasia and the Law: The Rise of
Euthanasia and Relationship With Palliative Healthcare
(Doctoral dissertation).
Comprehensive SOAP Template

4. 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

5. 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: Includelast Tdp, Flu, pneumonia, etc.
Significant Family History: Include history of parents,
Grandparents, siblings, and children.
Lifestyle: 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.

6. 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, includewhat 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.
Heart/Peripheral Vascular: Always include the heart in your PE.
Abdomen:

7. 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.
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
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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

8. 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):

9. 1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
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. She 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 support system composed of family and friends.

10. 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 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.
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

11. 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.
Integument/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:
Vital signs: B/P 110/72, left arm, sitting, regular cuff; P 70 and

12. 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

13. Diagnoses/Client Problems:
1.) COPD
2.) HTN, controlled
3.) Tobacco abuse – 40 pack year 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
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© 2019 Walden University
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