Choose one skin condition graphic identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment
Properly 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.
In 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.
- 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.
Expert Answer and Explanation
Comprehensive Soap Note
Subjective Data
Chief Complaint: “The patient in image 1 complains of red patches on his skin covered with thick and silvery scales.”
History of Present Illness:
Mr. C is a 65-years-old African American patient who came into the medical clinic complaining of skin condition. The patient notes that he started suffering from such skin disease 9 years ago. The condition has been coming and going for a while. However, three days ago, his skin started itching after sleeping on a grass flow.
His lower back and legs are the most affected area. He can measure the pain he feels on a scale of 7/10. He tried hydrocortisone drug medication, but the pain has persisted.
Medication:
Metformin, thiazide diuretics, and ACE inhibitors such as Zestril. The patient also took hydrocortisone drugs (OTC).
Allergies: Has no known allergies.
Past Medical History: The patient has well-controlled type 2 diabetes and HBP.
Past Surgical History: No major surgery.
OB/GYN History: N/A
Personal/Social History: Has smoked tobacco for the past 20 years.
Immunizations: AB does not remember when he was immunized last.
Family History: Father died from a car accident, and the mother died of depression through suicide.
Lifestyle: The patient is a retired school teacher and likes watching football in his free time. He also exercises three times a week.
Review of Systems
General: Reports no fever, vomiting, fatigue, and diarrhea.
HEENT: Healthy HEENT.
Respiratory: Reports a healthy respiratory tract.
CV: No, chest diseases.
GI: No GI conditions
GU: He is sexually active and has not a sexual disease.
MS: Reports stiff and swollen joints.
Integument/Heme/Lymph: Has sores in the skin.
Objective Data
Physical examination: The patient was observed and seen scratching his lower back. Also, observation revealed cracked skin in the lower back and legs with red patches. The joints seemed swollen.
Vitals: WH: 89 kg, He 167 cm, BP 148/98, HR 76, RR 20.
General: The patient’s lower back is cracked, itchy with red patches.
HEENT: Clear.
Neck: Clear.
Chest/Lungs: Clear.
Heart/Peripheral Vascular: High BP.
Abdomen: No rebound.
Musculoskeletal: Stiff and sore joints.
Skin: Sore, cracked, and itchy.
Assessment
Lab Tests: Biopsy can be done on the patient. Kim, Jerome, and Yeung (2017) note that biopsy can identify the disease, its causes, and its form.
Diagnostics: Diagnosis will start with a physical examination, and then the doctor will order a biopsy to confirm the results of the physical examination.
Differential Diagnosis
- Psoriasis (primary diagnosis)
- Eczema
- Acne
Reasons for Selecting Psoriasis as the Primary Diagnosis
Psoriasis is the primary diagnosis because of the following factors. First, the patient notes that he has been suffering from the disease for the past 9 years. Schadler, Ortel, and Mehlis (2019) note that Psoriasis has no cure and can affect the patient for a long time. Also, unlike the other three conditions, Psoriasis often makes the patent feel a lot of pain (Takeshita et al., 2017). Underlying chronic conditions, such as diabetes and HBP, can cause Psoriasis. The patient has these two conditions making Psoriasis the primary diagnosis. Lastly, Psoriasis is often caused by tobacco use (Kim et al., 2017). The patient has been using tobacco for the past 20 years.
Plan
Hydrocortisone has not worked, and thus Corticosteroids, together with vectical medications, can be prescribed to patients to help reduce the symptoms of the disease. To reduce inflammation, Protopic should be prescribed (Prinz & Dornmair, 2019).
References
Kim, W. B., Jerome, D., & Yeung, J. (2017). Diagnosis and management of psoriasis. Canadian Family Physician, 63(4), 278-285. https://www.cfp.ca/content/63/4/278.short
Prinz, J. C., & Dornmair, K. (2019). U.S. Patent Application No. 15/580,382. https://patents.google.com/patent/US20190225647A1/en
Schadler, E. D., Ortel, B., & Mehlis, S. L. (2019). Biologics for the primary care physician: review and treatment of psoriasis. Disease-a-Month, 65(3), 51-90. https://doi.org/10.1016/j.disamonth.2018.06.001
Takeshita, J., Grewal, S., Langan, S. M., Mehta, N. N., Ogdie, A., Van Voorhees, A. S., & Gelfand, J. M. (2017). Psoriasis and comorbid diseases: epidemiology. Journal of the American Academy of Dermatology, 76(3), 377-390. https://www.sciencedirect.com/science/article/pii/S0190962216306260
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