Lab Assignment: Differential Diagnosis for Skin Conditions
Lab Assignment: Differential Diagnosis for Skin Conditions
Subjective Data
Chief complaint: 4
History of Presenting Illness: JJ, 36 years old female, presented with complaints of left lower limb swelling and pain for the last two weeks. She reports that the swelling was of sudden onset and had been increasing in an ascending manner. She also reports that the pain is dull in nature, non-radiating, aggravated on limb movement and partially relieved by limb elevation and analgesics. She reports that it is associated with itching of the skin in the affected limb. Denies history of trauma, fall, or bite on the affected limb before the onset of symptoms Lab Assignment: Differential Diagnosis for Skin Conditions.
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Medications
OTC PO aceclopcm one tab 12 hourly.
Cetirizine 10mg 24 hourly nocte.
Allergies
No known food-drug allergy.
Past Medications History:
No history of chronic illnesses.
Past Surgical History:
Hemorrhoidectomy was done four years ago.
Sexual/Reproductive History:
The patient is sexually active with one partner.
No reports of past or current sexual assault.
Denies changes to libido.
Personal/Social History
She is married with three living children. She is employed full-time as an office manager in a pharmaceutical company. She is a social drinker and reports drinking 4-5 times a month with her friends. Denies cigarette smoking or illicit substance abuse.
Health Maintenance
She jogs 3-4 times per week every day. She wears her seatbelt when in the car. Her last physical was three months ago, and there was no abnormal detection.
Immunization
Up to date on all vaccinations. Recently received the morderna covid 19 vaccine three months ago.
Significant Family History:
She is the 3rd born in a family of 4. All siblings are alive and well.
Father is alive, 70 years old, and living with hypertension and diabetes.
Mother is alive, 65 years old and living with diabetes.
Maternal grandfather is deceased secondary to a stroke.
Maternal grandmother is alive, 90 years old, and living with dementia.
Paternal grandfather and grandmother are deceased secondary to a road traffic accident Lab Assignment: Differential Diagnosis for Skin Conditions.
Review of Systems
General: denies fever, chills, night sweats, weight loss, or weight gain.
HEENT: denies dizziness, headache, and trauma to the head. Eyes: denies blurry vision, double vision, or eye pain. Ears: denies ear pain discharge or tingling sensation. Nose and throat: denies nasal congestion, loss of smell, or recurrent nose bleeds. Denies ulcerations on the cheeks, tongue, or gums; denies difficulty in swallowing or opening or closing the jaw.
Respiratory: denies cough, difficulty in breathing, or chest pain.
Cardiovascular: denies orthopnea, palpitations or paroxysmal nocturnal dyspnea.
Gastrointestinal: denies abdominal pain, constipation, diarrhoea, nausea, or vomiting.
Genitourinary: denies dysuria, hematuria, and increased frequency.
Musculoskeletal: positive history of pain and swelling in the left lower limb.
Neurological: denies dizziness, loss of consciousness, or convulsions.
Psychiatric: denies self-harm or suicidal ideations.
Objective Data
Physical Exam
Vital signs: BP 120/78mm/hg, PR 68beats/min, RR 18 breaths/minute,spo2 of 98% room air, temperature 37.6degrees Celsius, RBS 5.2mmol/liter.
General:
HEENT: the skull is normocephalic; no scars or obvious swellings were observed. There is equal distribution of hair. No redness, swelling, or discharge of the eyes. Hearing is intact bilaterally, no pain on moving the pinna, and no discharge or swelling was noted on the inner and outer surfaces. The tympanic membrane is intact, grey, and shiny. There is no septum deviation; the mucous membrane is pink, moist, and intact. No sores or wounds on the tongue, gums, cheeks, or soft and hard palate.
Neck: no swelling or tracheal deviation. No neck stiffness was observed.
Chest/lungs: the chest is clear, and there is equal and bilateral air entry with no added sounds.
Heart: normoactive precordium, s1, and s2 heard with no added sounds.
Abdomen: abdomen is soft and moving with respiration. No organomegaly or tenderness was elicited. Bowel sounds are present Lab Assignment: Differential Diagnosis for Skin Conditions.
Genital/Rectal: patient declined.
Musculoskeletal: the skin is erythematous over the left lower limb, and there is obvious oedema of the left lower limb, which is pitting and tender. There is an increased temperature gradient as compared to the contralateral leg.
Neurological: alert, oriented in time, place, and person. All cranial nerves are intact bilaterally.
Diagnostic Results
- CBC: check for evidence of leukocytosis.
- ESR: assess for any evidence of inflammation.
- Blood culture: to identify an underlying causative organism.
- Doppler ultrasound: check the deep venous system for evidence of a thrombus.
Assessment
Cellulitis (L03.90): according to Brown & Hood (2021), it is a bacterial skin infection, mainly beta-hemolytic streptococcus, affecting the skin and subcutaneous tissue. It classically presents as a warm, erythematous, poorly demarcated area associated with tenderness on palpation and oedema. Risk factors include; surgical incisions, skin injuries, insect/animal bites, intravenous site punctures, and others (Sullivan & de Barra, 2018).
Deep vein thrombosis (I82.401): a blood clot that forms in the deep venous system of the leg but can also affect the cerebral mesenteric and veins of the arm. The causes are classified according to Virchow’s triad include; stasis of blood, hypercoagulability state, and endothelial damage (Schick & Pacifico, 2021). Patients typically present with; unilateral lower limb swelling, redness, and pain, especially in the calf muscles.
Contact dermatitis (L23.9): is an inflammatory skin disease mainly caused by metal ions or chemicals that provoke an immune response (Litchman et al., 2022). Symptoms often include; itching, burning, and pain in the affected region.
Diagnostic results:
ASSESSMENT:
PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.
Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions
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
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Assignment 2: Digital Clinical Experience (DCE): Health History Assessment
To Prepare
• Review this week’s Learning Resources as well as the Taking a Health History media program in Week 3, and consider how you might incorporate these strategies. Download and review the Student Checklist: Health History Guide and the History Subjective Data Checklist, provided in this week’s Learning Resources, to guide you through the necessary components of the assessment.
• Review the DCE (Shadow Health) Documentation Template for Health History found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
• Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
• Review the Shadow Health Student Orientation media program and the Useful Tips and Tricks document provided in the week’s Learning Resources to guide you through Shadow Health.
• Review the Week 4 DCE Health History Assessment Rubric, provided in the Assignment submission area, for details on completing the Assignment.
Note: There are 2 parts to this assignment – the lab pass and the documentation. You must achieve a total score of 80% in order to pass this assignment. Carefully review the rubric and video presentation in order to fully understand the requirements of this assignment.
DCE Health History Assessment:
Complete the following in Shadow Health:
Orientation
• DCE Orientation (15 minutes)
• Conversation Concept Lab (50 minutes, Required)
Health History
• Health History of Tina Jones (180 minutes)
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 4 Day 7 deadline.
Submission and Grading Information
References
Brown, B. D., & Hood, K. L. (2021, December 10). Cellulitis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549770/
Litchman, G., Nair, P. A., twater, A. R., & Bhutta, B. S. (2022, May 8). Contact Dermatitis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459230/
Schick, M. A., & Pacifico, L. (2021, August 11). Deep Venous Thrombosis Of The Lower Extremity. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470381/
Sullivan, T., & de Barra, E. (2018). Diagnosis and management of cellulitis. Clinical Medicine, 18(2), 160–163. https://doi.org/10.7861/clinmedicine.18-2-160 Lab Assignment: Differential Diagnosis for Skin Conditions