• 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.

Comprehensive SOAP Template

Patient Initials: _______ Age: _______ Gender: _______

Note: The mnemonic below is included for your reference and should be removed before the submission of your final note.

O = onset of symptom (acute/gradual)

L= location

D= duration (recent/chronic)

C= character

A= associated symptoms/aggravating factors

R= relieving factors

T= treatments previously tried – response? Why discontinued?

S= severity

SUBJECTIVE DATA: Include what the patient tells you, but organize the information.

Chief Complaint (CC): In just a few words, explain why the patient came to the clinic.

History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (i.e. 34-year-old AA male). You must include the 7 attributes of each principal symptom:

1. Location

2. Quality

3. Quantity or severity

4. Timing, including onset, duration, and frequency

5. Setting in which it occurs

6. Factors that have aggravated or relieved the symptom

7. Associated manifestations

Medications: Include over the counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.

Allergies: Include specific reactions to medications, foods, insects, and environmental factors.

Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations, and risky sexual behaviors.

Past Surgical History (PSH): Include dates, indications, and types of operations.

Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, and sexual function.

Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.

Immunization History: Include last Tdp, Flu, pneumonia, etc.

Significant Family History: Include history of parents, Grandparents, siblings, and children.

Lifestyle: Include cultural factors, economic factors, safety, and support systems.

Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses). Remember that the information you include in this section is based on what the patient tells you. You do not need to do them all unless you are doing a total H&

Comprehensive SOAP Template

Patient Initials: __AM_ Age: _____38_ Gender: ___F_

SUBJECTIVE DATA:

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Chief Complaint (CC):

Patient present with multiple lesions on he left thigh that been present for several weeks, approximately 3 months.

History of Present Illness (HPI):

AM is a 38 years old Caucasian female presented to the clinic with multiple lesions on her left shoulder. Patient reported that lesion has been presents for about 2-3 months. Per patient, “I noticed like a nodule about 3 months ago now it’s about 4 nodules”. The lesion is palpable elevation which appears to be solid, firm and painless on examination. The nodules dimples in the middle when touched. Patient denies pains but says it could be painful when knocked. The nodules are about 5mm above the skin. Patient could not ascertain if nodules has increased in size. Pt is worried that it could be tumors or cancer. Pt has a family history of cancers or tumors.

Medications:

1. Nifedipine XL30mg by mouth daily for Hypertension

2. Lipitor 10 mg by mouth once daily at bedtime for high cholesterol

Allergies:

Medication allergies- Penicillin react with Hives

Denies food allergies or latex allergue

Past Medical History (PMH):

1. Primary Hypertension: diagnosed at age 28

2. Hyperlipidemia: diagnosed at age 30- control with medication, diet and exercise

Past Surgical History (PSH):

1. Cesarean sections- 2007 for her second pregnancy

2. Cholecystectomy – 2015

Sexual/Reproductive History:

Patient is sexually active. She is not currently any birth control, says husband uses condom. Patient has regular (28 days) menstrual cycle. She is married with 2 children.

Personal/Social History:

Patient denies alcohol and illicit drug use. Never a smoker. She is active around the house and tried to eat healthy. Patient is a case manager and lives in a rented apartment. Patient is married with 2 children (a boy 18 and a girl 13). She takes a brisk walk of about 30 minutes every day after work.

Immunization History:


8-2

Key Points

Copyright © 2015 by Mosby, an imprint of Elsevier Inc.

Copyright © 2015 by Mosby, an imprint of Elsevier Inc.

Ball: Seidel’s Guide to Physical Examination, 8th Edition



Chapter
08
:
Skin, Hair, and Nails



Key Points


This review discusses examination of the skin, hair, and nails.


Before the exam, gather the necessary equipment: a clear, flexible centimeter ruler; flashlight with transilluminator; handheld magnifying glass or dermatoscope; and Wood’s lamp.


To examine the skin, perform the following.


Use inspection and palpation to examine the skin. Make sure you have adequate lighting, preferably with daylight.

During inspection, expose the skin completely. As you finish inspecting each area, remember to redrape or cover the patient for warmth and modesty.

  • Inspect the skin in two ways.
  • First, perform a brief overall visual sweep of the entire skin surface. This helps identify the distribution and extent of any lesions, assess skin symmetry, detect differences among body areas, and compare sun-exposed areas with areas that were not exposed to the sun.
  • Second, observe the skin as each part of the body is examined.

  • When evaluating the skin and mucous membranes in each part of the body, note six characteristics.
  • The first characteristic is color, which can vary from dark brown to light tan with pink or yellow overtones.
  • The second characteristic is uniformity. The skin should be uniform in color overall with no localized areas of discoloration. However, the skin may have sun-darkened areas as well as darker skin around the knees and elbows.

    The third characteristic is thickness, which varies over the body. The thinnest skin is on the eyelids. The thickest is at areas of pressure or rubbing, such as the elbows, soles, and palms.

    The fourth characteristic is symmetry. Normally, the skin appears bilaterally symmetrical.

  • The fifth characteristic is hygiene, which may contribute to skin condition.
  • The final characteristic is the presence of any lesions, which are any pathologic skin change or occurrence.

  • During inspection, also palpate the skin to determine five characteristics.
  • First, palpate to detect moisture. Minimal perspiration or oiliness should be present. Even intertriginous areas should display little dampness.
  • Second, use the dorsal surface of your hands to assess temperature. The skin may feel cool to warm but should be bilaterally symmetrical.

    Third,

    Week 4 Lab Assignment:
    Differential Diagnosis for Skin Conditions

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    �Note to Build: These images are still pending permissions so I don’t have credit lines yet or approval.

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