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Assignment: Skin Conditions

Assignment: Skin Conditions

Question Description

Differential Diagnosis for Skin Conditions

SUBJECTIVE DATA:

Chief Complaint (CC): “I have some stretch marks and a line on my abdomen’

History of Present Illness (HPI): A.T. is a 28-year-old female client that came to the clinic with complaints of abnormal stretch marks and a line on her abdomen. The client is pregnant. The gestation of her pregnancy is 28 weeks. She has never started her antenatal clinic visits. The patient reports that the problem started four weeks ago and she was hopeful that it would diminish over time. She denied any associated symptoms such as pain or itchiness. However, she was worried that she may be having a skin condition that would require immediate intervention. She has not used any skin medications for the problem.

Medications: The patient denied any current use of medications. She reported occasional use of Tylenol 1 gram for headaches.

Allergies: The patient reported allergic reaction to Penicillin and pollen. She denied food allergies.

Past Medical History (PMH): The patient reported a history of hospitalization when she was 18 years old because of pneumonia. She denied any history of chronic conditions such as diabetes and depression. She also denied any history of blood transfusion.

 

Past Surgical History (PSH): The patient denied any history of surgeries

 

Sexual/Reproductive History: The patient is sexually active. Her last menstrual period was 21/10/2022. She denied any history of sexually transmitted infections. She also denied any history of increased urgency, frequency, and dysuria. She does not have any history of pregnancy loss or use of contraceptives. She is heterosexual.

 

Personal/Social History: The patient is married. She is the first born in a family of three. Her parents are both alive. This is her first pregnancy. She works as an accountant in a local firm. She does not use alcohol or smokes. She engages in moderate physical activities twice weekly. She is a Christian. She considers her family her source of social support. She denies stress.

 

Health Maintenance: The patient engages in moderate exercises twice weekly. She does not take alcohol or smokes. She reports that she takes healthy diet. Her immunization record is up-to-date. She has not started her antenatal clinic despite her pregnancy being 28 weeks. She denies caffeine use. She has not undergone cervical cancer screening. She performs monthly self-breast examination. Her last dental and eye examinations were two years ago and were unremarkable.

 

Immunization History: Her immunization record is up-to-date.

 

Significant Family History: The client reports that her parents are both hypertensive. Her mother is diabetic. Her paternal grandmother and grandfather died of coronary artery disease. Her maternal grandmother died of cervical cancer. Her sister is obese. Her brother was recently diagnosed with substance use disorder.

 

General: The patient is well dressed for the occasion. She denied fatigue, fever, chills or night sweats. Reports weight gain of 10 pounds since she became pregnant.

 

HEENT: She denies changes in vision or hearing; she does wear glasses. She has no history of glaucoma, diplopia, floaters, excessive tearing or photophobia. She has had no recent ear infections, tinnitus, or discharge from the ears. She denied changes in sense of smell. She does not have a history of nasal polyps or recent sinus infection. She denied ulceration, lesions, gingivitis, gum bleeding, and has no dental appliances. She has had no difficulty chewing or swallowing.

 

Neck: She denies pain, injury, or history of disc disease or compression..

 

Breasts: She denies history of lesions, masses or rashes.

 

Respiratory: She denies cough, hemoptysis, difficulty breathing or chest pain. She a history of community acquired pneumonia when she was 18 years.

 

CV: She denies chest discomfort, palpitations, history of murmur. She has no history of arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication.

 

GI: She denies nausea or vomiting, abdominal pain. She also denies changes in bowel/bladder pattern.

 

GU: She denies change in her urinary pattern, dysuria, or incontinence. She is heterosexual. She denies history of STD’s or HPV. She is sexually active.

 

MS: She denies arthralgia/myalgia, arthritis, gout or limitation in her range of motion.

 

Psych: She denies history of anxiety or depression. She also denies sleep disturbance, delusions or mental health history.

 

Neuro: She denies syncope episodes or dizziness, paresthesia, change in memory or thinking patterns. She also denies twitches or abnormal movements, gait disturbance, falls or seizure history.

 

Integument/Heme/Lymph: She reports stretch marks and a line in the middle of her abdomen. She denies rashes, itching, or bruising.

 

Endocrine: She denies polyuria/polyphagia/polydipsia. She also denies fatigue, heat or cold intolerances, or shedding of hair

 

Allergic/Immunologic: She is allergic to Penicillin and pollen. She has no food allergies.

 

 

OBJECTIVE DATA

 

Physical Exam:

Vital signs: B/P 124/78, left arm, sitting, regular cuff; P 82 and regular; T 99.9 Orally; RR 20; non-labored; Wt: 168 lbs; Ht: 6’5

General: A&O x3, NAD

HEENT: PERRLA, EOMI, oronasopharynx is clear

Neck: Carotids no bruit, jugular venous distention or thyromegally

Chest/Lungs: Lungs clear of wheezing or rhonchi

Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial

ABD:  presence of bilateral strae gravidarum and central linea nigra. Normal bowel sounds with no organomegaly and suprapubic

Genital/Rectal: Non-contributory

Musculoskeletal: symmetric muscle development. Muscle strengths 5/5 all groups.

Neuro: Normal cranial nerve assessment with no gait imbalance or coordination problems. There is no loss of sensitivity to touch.

Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes

 

Diagnostic results: Obstetrics ultrasound performed one day ago: Intrauterine live pregnancy at 28/40 weeks in breech presentation. FHR-132 bpm, BPP 8/8, cervix closed

 

ASSESSMENT:

Differential Diagnosis

  • Linea nigra: Linea nigra is a hyperpigmentation characterized by a vertical line running down the middle of the abdomen. It is an indicator of pregnancy.
  • Strae gravidarum: Strae gravidarum refers to atropic linear scars that pregnant mothers develop. The form as stretch marks on the abdomen and diminish over time.
  • Post-inflammatory hyperpigmentation: Post-inflammatory hyperpigmentation is a disorder that develops after skin injury or inflammation. It is severe in dark-skinned individuals. It improves spontaneously but can also require treatment for immediate changes (Lawrence & Al Aboud, 2023). It is the least likely condition since the patient in the case study is pregnant.
  • Melanocytic naevi: Melanocytic nevi are benign hematomas or neoplasms that cause skin hyperpigmentation. It mainly affects the central nervous system and the skin. Melanocytic nevi are the least likely cause of the client’s problem since they do not occur in features such as midline vertical line that is seen in pregnancy (Yeh, 2023)

Primary diagnosis

  1. Normal pregnancy with features that include linea nigra and strae gravidarum: The client’s primary diagnosis is normal pregnancy with features that include linea nigra and strae gravidarum. Linea nigra is a normal occurrence in pregnant women. It refers to a form of hyperpigmentation that is witnessed in pregnancy. It is a dark vertical line running down the middle of the abdomen. It is an indicator of pregnancy. Linea nigra is associated with nipple, genital areas, and areola hyperpigmentation (Cappanera, 2022; Ferrando et al., 2019; Sharma et al., 2019). Strae gravidarum refers to atrophic linear scars that develop on the abdomen during pregnancy. They appear as stretch marks that may be of considerable concern to pregnant women (Dai et al., 2021). Strae gravidarum is non-pathological. The stretch marks fade over time and become hypopigmented (Karhade et al., 2021). The patient in the case study has these features, hence, a diagnosis of linea nigra and strae gravidarum. The patient is also pregnant, hence, the primary diagnosis with these conditions.

 

PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.

 

 

References

Cappanera, F. F., Gisella Sorrentino, Elena. (2022). Linea Nigra: Post/Human M/Others. In Engaging Donna Haraway. Routledge.

Dai, H., Liu, Y., Zhu, Y., Yu, Y., & Meng, L. (2021). Study on the methodology of striae gravidarum severity evaluation. BioMedical Engineering OnLine, 20(1), 109. https://doi.org/10.1186/s12938-021-00945-w

Ferrando, B. F., Sorrentino, G., & Cappanera, E. (2019). Linea Nigra: Post|Human M|Others. A/b: Auto/Biography Studies, 34(3), 501–505. https://doi.org/10.1080/08989575.2019.1664152

Karhade, K., Lawlor, M., Chubb, H., Johnson, T. R. B., Voorhees, J. J., & Wang, F. (2021). Negative perceptions and emotional impact of striae gravidarum among pregnant women. International Journal of Women’s Dermatology, 7(5, Part B), 685–691. https://doi.org/10.1016/j.ijwd.2021.10.015

Lawrence, E., & Al Aboud, K. M. (2023). Postinflammatory Hyperpigmentation. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK559150/

Sharma, A., Jharaik, H., Sharma, R., Chauhan, S., & Wadhwa, D. (2019). Clinical study of pregnancy associated cutaneous changes. International Journal of Clinical Obstetrics and Gynaecology, 3(4), 71–75. https://doi.org/10.33545/gynae.2019.v3.i4b.292

Yeh, I. (2023). Melanocytic naevi, melanocytomas and emerging concepts. Pathology, 55(2), 178–186. https://doi.org/10.1016/j.pathol.2022.12.341

Differential diagnosis is a process of elimination used to correctly identify the cause and type of a patient’s skin condition. A health professional can use this process to narrow down a set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms until one diagnosis is determined as the most likely cause.

In this Assignment, you will examine various visual representations of skin conditions, describe your observations, and use differential diagnosis techniques to determine the most likely condition.

To get ready:

Examine the Skin Conditions document in this week’s Learning Resources and choose one condition to focus on for this Assignment.
Consider the unusual physical characteristics you notice in the graphic you chose. What clinical terms would you use to describe the characteristics?
Investigate the various conditions that could be causing the skin abnormalities in the graphics you chose.
Consider which of the conditions is the most likely to be correct, and why.
Get the SOAP Template from this week’s Learning Resources.

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To finish:

Instead of the traditional narrative style, 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. For more information, see Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources. Keep in mind that not all comprehensive SOAP data is included in each patient case.
Explain the physical characteristics depicted in the graphic using clinical terminology. Create a differential diagnosis of three to five possible conditions for the skin graphic you selected. Determine which diagnosis is most likely correct and explain your reasoning using at least three different references from current evidence-based literature.

You should proofread your paper. However, do not rely solely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part, and your grade will suffer as a result. Papers with a high number of misspelled words and grammatical errors will be penalized. Before submitting your paper, go over it in silence and then aloud, and make any necessary changes. It is often beneficial to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point typeface (10 to 12 characters per inch). Smaller or compressed type, as well as papers with narrow margins or single spacing, are difficult to read. It is preferable to allow your essay to exceed the recommended number of pages rather than attempting to compress it into fewer pages.

Large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and other such attempts at “padding” to increase the length of a paper are also unacceptable, waste trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced, and have a one-inch margin on all four sides of each page. When submitting hard copies, use white paper and print with dark ink. It will be difficult to follow your argument if it is difficult to read your essay.

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