Nurses/Doctors Please: SOAP Note for Skin Conditions

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 Discussion, 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.

Note: Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. 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.

To prepare:

·         Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion.

·         Consider the abnormal physical characteristics you observe in the graphics 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.

A description of the two graphics you selected (identify each graphic by number). Use clinical terminologies to explain the physical characteristics featured in each graphic. Formulate a differential diagnosis of three to five possible conditions for each. Determine which is most likely to be the correct diagnosis, and explain your reasoning.

REMINDERS:

Please follow the Note above. Do SOAP note format and check it out on the uploaded file the SOAP exemplar and template as your outline for your writings… No traditional essay on this assignment, again use SOAP note. Thank you.

Readings

·         Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

o    Chapter 8, “Skin, Hair, and Nails” (pp. 114-165)

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.

·         Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

o    Chapter 28, “Rashes and Skin Lesions” (pp. 325-343)

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: Download and use the Adult Examination Checklist and the Physical Exam Summary when you conduct your video assessment of the skin, hair, and nails.

·         Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for skin, hair, and nails. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. 

This Adult Examination Checklist: Guide for Skin, Hair, and Nails was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). Fromhttps://evolve.elsevier.com/

·         Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Skin, hair, and nails physical exam summary. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. 

This Skin, Hair, and Nails Physical Exam Summary was published as a companion to Seidel’s guide to physical examination(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). Fromhttps://evolve.elsevier.com/

·         Chadha, A. (2009). Assessing the skin. Practice Nurse, 38(7), 43–48.

Retrieved from the Walden Library databases.

In this article, the author explains how to take a relevant skin health history. In addition, the article defines common terms used to describe skin lesions and rashes.

·         Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part I. Differential diagnosis. American Family Physician, 81(6), 726–734. 

Retrieved from http://www.aafp.org/afp/2010/0315/p726.html

This article focuses on common, uncommon, and rare causes of generalized rashes. The article also specifies tests to diagnose generalized rashes.

·         Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part II. Diagnostic approach. American Family Physician, 81(6), 735–739. 

Retrieved from http://www.aafp.org/afp/2010/0315/p735.html

This article revolves around the diagnosis of generalized rashes. The authors describe clinical features that may help in distinguishing generalized rashes.

·         Everyday Health, Inc. (2013). Resources for dermatology and visual conditions. Retrieved from info/for_professionals 

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

·         Document: Skin Conditions (Word document) 

This document contains five images of different skin conditions. You will use this information in this week’s Discussion.

·         Document: Comprehensive SOAP Exemplar (Word document)

·         Document: Comprehensive SOAP Template (Word document)

Media

Online media for Seidel’s Guide to Physical Examination

In addition to this week’s media, it is highly recommended that you access and view the online resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 8 that relate to the assessment of the skin, hair, and nails.

The following suturing tutorials provide instruction on the basic interrupted suture, as well as the vertical and horizontal mattress suturing techniques:

·         Tulane Center for Advanced Medical Simulation & Team Training. (2010, July 8). Suturing technique.Retrieved from https://www.youtube.com/watch?v=c-LDmCVtL0o

·         Mikheil. (2014, April 22). Basic suturing: Simple, interrupted, vertical mattress, horizontal mattress. Retrieved from https://www.youtube.com/watch?v=MFP90aQvEVM

·         LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.

o    Chapter 6, “The Skin and Nails” 

In this chapter, the authors provide guidelines and procedures to aid in the diagnosis of skin and nail disorders. The chapter supplies descriptions and pictures of common skin and nail conditions.

·         Ethicon, Inc. (n.d.a). Absorbable synthetic suture material. Retrieved fromanuals/absorbable_suture_chart.pdf

·         Ethicon, Inc. (2006). Dermabond topical skin adhesive application technique. Retrieved fromanuals/db_application_poster.pdf

·         Ethicon, Inc. (2001). Ethicon needle sales types. Retrieved fromanuals/needle_template.pdf

·         Ethicon, Inc. (n.d.b). Ethicon sutures. Retrieved fromanuals/suture_chart_ethicon.pdf

·         Ethicon, Inc. (2002). How to care for your wound after it’s treated with Dermabond topical skin adhesive. Retrieved fromanuals/db_wound_care.pdf

·         Ethicon, Inc. (2005). Knot tying manual. Retrieved fromanuals/knot_tying_manual.pdf

·         Ethicon, Inc. (n.d.c). Wound closure manual. Retrieved from