Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions
Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP
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.
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.
By Day 7 of Week 4
Submit your Lab Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
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- Click the Week 4 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
ANSWER
Comprehensive Soap Note
Subjective Data
Chief Complaint:
The patient complains of burning and sore skin and stiff joints
History of Present Illness:
Patient AB is a 54 years old American man of Mexican origin. The patient came to the hospital complaining of stiff joints that she has experienced for the last three weeks. Also, the patient mentions that she has rushes on her skill which are burning at a high rate. She says that she cannot sleep due to the sore skin that is burning. He is trying to apply diphenhydramine but did not see any changes. She scales the pain she feels like 8/10.
Medication: Over the counter hydrocortisone drug, over the counter hydroxyzine, and diphenhydramine. The patient also took the antimalarial drug.
Allergies: AB is allergic to sulfa and penicillin drugs.
Past Medical History: The patient had urinal tract disease at the age of 27 and also contracted the pelvic inflammatory disease.
Past Surgical History: AB has no history of surgical treatment.
OB/GYN History: N/A
Personal/Social History: He is not alcoholic and does not abuse drugs.
Immunizations: AB does not remember when he was immunized last.
Family History: His father and mother both died of diabetes. He has two brothers who both have hypertension. He is married with no children.
Lifestyle: He is a practicing lawyer living in a city with moderate crime rates. He is a university graduate owing a house and is financially stable. The patient has an insurance cover and a personal doctor who check him often.
Review of Systems
General: The patient reports that his skill is swollen and burning. He also feels stiffness in joints. He feels pain since the illness started.
HEENT: All organs in the head area are healthy.
Breasts: He has healthy breasts. He has never reported any case of breast infection or injury.
Respiratory: Has no respiratory problem.
CV: No, chest discomfort.
GI: No GI infections or conditions
GU: He is sexually active and has not a sexual disease.
MS: He feels stiffness in joints.
Integument/Heme/Lymph: He has rashes and sores in the skin.
Endocrine: No hormone medications.
Allergic/Immunologic: He is allergic to sulfa and penicillin drugs
Psychiatric: He is stressed due to the condition. However, the patient has never reported any mental health. Also, he has not had any suicidal thoughts.
Objective Data
Physical examination: The patient’s weight is 87 kg and height is 168 cm. His BP is 116/67. Heart rate is 72 beats per minute. His respiration rate is 18. The skin in his left arm has sores and has red patches. His head, nose, eyes, ears, and teeth are healthy and free from any infection. The patient cannot stand for long due to stiff joints.
General: The patient complaints of pain due to sores in his skin. He also mentions that he feels as if his skin is burning. The patient is in a sad mood because of the pain. However, he is dressed smart and washed his mouth before coming to the hospital. However, his temper is so high in that he reacts to people harshly. Also, he cannot concentrate because he continually scrubs his skin.
HEENT: Clear.
Neck: Clear.
Chest/Lungs: Clear.
Heart/Peripheral Vascular: High BP.
Abdomen: Benign and no rebound.
Genital/Rectal: No adnexal masses and cervical motion tenderness.
Musculoskeletal: AB cannot stand for long.
Neurological: Has no neurological problem.
Skin: The skin sore and dry.
Assessment
Lab Tests: Biopsy.
Diagnostics: physical examination and biopsy.
Differential Diagnosis
Differential diagnosis was made to find out three possible conditions ailing the patient. Below is a differential diagnosis for graphic 5 in week four lab assignment document.
Psoriasis
Psoriasis is the first diagnosis and the most possible disease ailing the patient. According to Takeshita et al. (2017), psoriasis is a skin disease that accelerates the growth of cells in the skin area. In other words, the infection causes that cells in the skin to develop rapidly, and as a result form red patches and scales that can be painful and itchy. The patient is likely to have psoriasis due to the nature of the disease in the image. The disease has sores and makes the patient feel a lot of pain.
Eczema
Eczema is the second possible diagnosis for the disease. The condition symptoms include scaly patches, bumpy rashes, and bubble rashes that can cause permanent itching (van Zuuren et al., 2017). Some of these symptoms can be seen in the image, and thus makes the disease the possible cause of pain.
Acne
Acne is a skin disease that occurs when oil has been overproduced in the skin leading to the development of bacteria and causes pimples (Chien, 2018). The disease also causes itching and dry skin. Ridd et al. (2018) argue that acne affects arms, shoulders, neck, and chest mostly compared to other parts of the body.
Reasons for Selecting Psoriasis as the Probable Diagnosis
The disease is the most probable condition because unlike the rest conditions it can be caused by taking antimalarial drugs (Takeshita et al., 2017). Also, unlike other conditions, patients with Psoriasis often feel severe burning.
References
Chien, A. (2018). Retinoids in acne management: review of current understanding, future considerations, and focus on topical treatments. Journal of drugs in dermatology: JDD, 17(12), s51-55. https://europepmc.org/article/med/30586483
Ridd, M. J., Gaunt, D. M., Guy, R. H., Redmond, N. M., Garfield, K., Hollinghurst, S., … & Metcalfe, C. (2018). Comparison of eczema severity measures. British Journal of Dermatology, 179(2), e99-e99. https://doi.org/10.1111/bjd.16953
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
van Zuuren, E. J., Fedorowicz, Z., Christensen, R., Lavrijsen, A. P., & Arents, B. W. (2017). Emollients and moisturisers for eczema. Cochrane Database of Systematic Reviews, (2). https://doi.org/10.1002/14651858.CD012119.pub2
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