NURS 6512 WK 4 Assignment 1

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.NURS 6512 WK 4 Assignment 1

ORDER A PLAGIARISM -FREE PAPER NOW

Chief Complaint (CC): “I have an outbreak of scaly plaques and rashes on my face and the scalp”

History of Present Illness (HPI): FJ a 31-year-old woman presented with complaints about having an outbreak of rashes and scaly plaques.  Miss. FJ reported that she has had psoriasis for the last 3 years and she was taking oral and topical steroids. She however stated that there was no notable improvement after using the prescribed medications. The patient was referred to a dermatologist who prescribed topical ointments including Donovex ointment and synthetic Vitamin D3 derivative. However, the prescribed ointments did not improve the skin condition as she is still experiencing severe psoriasis flare-up.

Medications:

  • Oral and topical steroids
  • Synthetic Vitamin D3 derivative
  • Donovex ointment

Allergies:

  • Cats
  • Dust mites

Past Medical History (PMH):

  • Lesions and rashes flare-up on the skin
  • Asthma

 

Past Surgical History (PSH):

  • Nil

Sexual/Reproductive History:

  • Nil

Personal/Social History

  • Does not smoke
  • Does not take alcohol
  • A teacher by profession
  • Married with two sons

Immunization History:

  • Immunizations up to date

Family History:

  • Mother history of cancer and psoriasis
  • Father history of hypertension

Lifestyle:

Miss FJ stays with her husband and two sons.  She is a teacher by profession. The family is financially stable and they own a home in middle-class estate. The patient is very active physically and her diet mostly includes fruits and vegetables. The patient reports that she has been using various kinds of cream on her face to try to improve her skin. She uses make-up and foundation to hide the condition of her face.

REVIEW OF SYSTEMS:

General: Miss. FJ reported that she has been in good health, apart from the skin problem. No reported weight loss.

HEENT: Denies headache, normal scalp, no ear pain, no vision change. Denies tonsils, sore throat, or difficulties in swallowing.   

Neck: Denies any neck pain.NURS 6512 WK 4 Assignment 1

Breasts: Denies any masses or lump in the breast. Denies any breast pain or discharge from the nipple.

Respiratory: Denies any chest pain or breathing problems.

Cardiovascular: Denies any abnormal pulse rate or palpitations. Denies any history of hypertension or heart disease.

Gastrointestinal: Denies any abdominal pain; no constipation; no diarrhea; normal stool

GU: Normal urinary pattern. Denies any abnormal vaginal discharge. Last menstrual on 15/09/2020.

Musculoskeletal: Denies any joint or muscle pain; denies any fracture or backache or fracture.

Neurological: No reported dizziness. Denies any loss of balance, seizures, or loss of sensation.

Psychiatric: Denies any sleep disturbances; no history of mental illness; reports poor body-image and low self-esteem due to the skin problem as she thinks the skin problem has messed her beauty.

Endocrine: Denies any abnormal sweating or abnormal urination pattern.

ORDER A PLAGIARISM -FREE PAPER NOW

Skin: Reported plagues on the face and skin flare-up.

Allergic/Immunologic: Allergic to cates, mold counts, and dust mites

OBJECTIVE DATA

Physical Examination

Vital Signs: Temperature 36.5 c; BP 132/76; Pulse rate 80: Blood pressure; Respiratory rate 18

General: Oriented to time, place, and person. The patient is awake, alert, and cooperative. She has dressed appropriately for her age. The face has scattered erythematous plagues and rashes on the face and the scalp. The plagues have silvery scales.

HEENT: The scalp and the face and scalp have scattered erythematous plagues. Normal nasal mucosa; normal conjunctiva. Normal and clear oronasopharynx

Neck: Normal neck movement without any resistance. No lymphadenopathy on the lymph nodes. No bruits. Normal thyroid gladNURS 6512 WK 4 Assignment 1

Chest: Clear lungs; normal expansion of the lungs; normal air movement

Heart: Pulse rate 80; no murmurs in the heart; no palpitations; no gallops

Genital/Rectal: Normal stool; Normal vaginal and cervix; The rectal sphincter tone is normal

Musculoskeletal: Normal joint movement; normal range of motion in all joints

Neurological: No dizziness; no loss sensation; normal reflexes; She is alert and oriented to place, person, event, and time.

Skin: Erythematous plaques and rashes on the scalp and the face. Plagues have a silvery scale. Lesions have an irregular shape.

ASSESSMENT

Differential Diagnosis:

  1. Psoriasis
  2. Eczema
  3. Nummular dermatitis
  4. Seborrheic dermatitis
  5. Mycoses Fungoides (MF)

Diagnosis tests

  • Examination of lipid levels: According to the findings, the lipid levels were 15% of high-density lipoproteins.
  • The family has a history of psoriasis indicating that the patient has psoriasis. The plagues are well-defined with silver and erythematous appearance on the scalp and the face.
  • Skin biopsy: The lesions appeared tumor-like with abnormal morphology and thus a skin biopsy was conducted to test for Mycoses Fungoides (MF). MF was ruled out and the skin biopsy confirmed psoriasis diagnosis.NURS 6512 WK 4 Assignment 1

Diagnosis:

Psoriasis

References

Kelley N. (2015). Living with psoriasis: a patient case study. J Vis Commun Med, 38(3-4), 164-167.

Lakshi A & Robert H. (2018). Manifestations and Management of difficult-to-treat Psoriasis. Journal of the Dermatology Nurses’ Association, 10(4), 189-197.

Singh S, Young P & Armstrong AW (2017). An update on psoriasis and metabolic syndrome: A meta-analysis of observational studies. PLoS ONE, 12(7), e0181039.

Young M & Lakshi A. (2017). Psoriasis for the primary care practitioner. Journal of the American Association of Nurse Practitioners, 29(3), 157-178. NURS 6512 WK 4 Assignment 1