Differential Diagnosis for Skin Conditions

Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient鈥檚 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
路 Review the Skin Conditions document provided in this week鈥檚 Learning Resources, and select one condition to closely examine for this Lab Assignment.
路 Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
路 Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
路 Consider which of the conditions is most likely to be the correct diagnosis, and why.
路 Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
路 Review the Comprehensive SOAP Exemplar found in this week鈥檚 Learning Resources to guide you as you prepare your SOAP note.
路 Download the SOAP Template found in this week鈥檚 Learning Resources, and use this template to complete this Lab Assignment.
The Lab Assignment
路 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.
路 Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of聽three to five聽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鈥檚 Learning Resources.
RRUBRIC AND READINGS

Using the SOAP (Subjective, Objective, Assessment, and Plan) note format: 路聽 Create documentation, following SOAP format, of your assignment to choose one skin condition graphic (identify by number in your Chief Complaint). 路聽聽 Use clinical terminologies to explain the physical characteristics featured in the graphic. 30聽(30%)聽– 35聽(35%)
The response clearly, accurately, and thoroughly follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response clearly and thoroughly explains all physical characteristics featured in the graphic using accurate terminologies.
24聽(24%)聽– 29聽(29%)
The response accurately follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response explains most physical characteristics featured in the graphic using accurate terminologies.
18聽(18%)聽– 23聽(23%)
The response follows the SOAP format, with vagueness and some inaccuracy in documenting one skin condition graphic, and accurately identifies the graphic by number in the Chief Complaint. The response explains some physical characteristics featured in the graphic using mostly accurate terminologies.
0聽(0%)聽– 17聽(17%)
The response inaccurately follows the SOAP format or is missing documentation for one skin condition graphic and is missing or inaccurately identifies the graphic by number in the Chief Complaint. The response explains some or few physical characteristics featured in the graphic using terminologies with multiple inaccuracies.
路聽聽 Formulate a different diagnosis of three to five possible considerations for the skin graphic. 聽聽 路聽聽 Determine which is most likely to be the correct diagnosis, and explain your reasoning using at least three different references from current evidence-based literature. 45聽(45%)聽– 50聽(50%)
The response clearly, thoroughly, and accurately formulates a different diagnosis of five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained clearly, accurately, and thoroughly using three or more different references from current evidence-based literature.
39聽(39%)聽– 44聽(44%)
The response accurately formulates a different diagnosis of three to five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained accurately using at least three different references from current evidence-based literature.
33聽(33%)聽– 38聽(38%)
The response vaguely or with some inaccuracy formulates a different diagnosis of three possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained vaguely and with some inaccuracy using three different references from current evidence-based literature.
0聽(0%)聽– 32聽(32%)
The response formulates inaccurately, incompletely, or is missing a different diagnosis of possible considerations for the skin graphic, with two or fewer possible considerations provided. The response vaguely, inaccurately, or incompletely determines the most likely correct diagnosis with reasoning that is missing or explained using two or fewer different references from current evidence-based literature.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5聽(5%)聽– 5聽(5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4聽(4%)聽– 4聽(4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.
3聽(3%)聽– 3聽(3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%鈥79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.
0聽(0%)聽– 2聽(2%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5聽(5%)聽– 5聽(5%)
Uses correct grammar, spelling, and punctuation with no errors.
4聽(4%)聽– 4聽(4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3聽(3%)聽– 3聽(3%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
0聽(0%)聽– 2聽(2%)
Contains many (鈮 5) grammar, spelling, and punctuation errors that interfere with the reader鈥檚 understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing,聽margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5聽(5%)聽– 5聽(5%)
Uses correct APA format with no errors.
4聽(4%)聽– 4聽(4%)
Contains a few (1 or 2) APA f
   

READINGS
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019).聽Seidel’s guide to physical examination: An interprofessional approach聽(9th ed.). St. Louis, MO: Elsevier Mosby.

路 Chapter 9, 鈥淪kin, Hair, and Nails鈥 This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.
Colyar, M. R. (2015).聽Advanced practice nursing procedures.聽Philadelphia, PA: F. A. Davis.
Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright聽2015 by F. A. Davis Company. Reprinted by permission of聽F. A. Davis Company via the Copyright Clearance Center.

This section explains the procedural knowledge needed prior to performing various dermatological procedures.

Chapter 1, 鈥淧unch Biopsy鈥

Chapter 2, 鈥淪kin Biopsy鈥

Chapter 10, 鈥淣ail Removal鈥

Chapter 15, 鈥淪kin Lesion Removals: Keloids, Moles, Corns, Calluses鈥

Chapter 16, 鈥淪kin Tag (Acrochordon) Removal鈥

Chapter 22, 鈥淪uture Insertion鈥

Chapter 24, 鈥淪uture Removal鈥

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019).聽Advanced health assessment and clinical diagnosis in primary care聽(6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright聽2019 by Mosby. Reprinted by permission of聽Mosby via the Copyright Clearance Center.

Chapter 28, 鈥淩ashes and Skin Lesions鈥 This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.

Note:聽Download and use the Student Checklist and the Key Points when you conduct your assessment of the skin, hair, and nails in this Week鈥檚 Lab Assignment.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Student checklist. In聽Seidel’s guide to physical examination聽(9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright聽2019 by Elsevier Health Sciences. Reprinted by permission of聽Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Key points. In聽Seidel’s guide to physical examination: An interprofessional approach聽(9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright聽2019 by Elsevier Health Sciences. Reprinted by permission of聽Elsevier Health Sciences via the Copyright Clearance Center.

Sullivan, D. D. (2019).聽Guide to clinical documentation聽(3rd ed.). Philadelphia, PA: F. A. Davis.

路 Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1 and 3)

VisualDx. (n.d.). Clinical decision support. Retrieved June 11, 2019, from http://www.skinsight.com/info/for_professionals

This interactive website allows you to explore skin conditions according to age, gender, and area of the body.


Clothier, A. (2014). Assessing and managing skin tears in older people.聽Nurse Prescribing, 12(6), 278鈥282.

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