NURS6512 Differential Diagnosis Skin Conditions

NURS6512 Differential Diagnosis Skin Conditions

NURS6512 Differential Diagnosis Skin Conditions

1 Differential Diagnosis – Skin Conditions

Name of University

2 NUR6512 – Advanced Health Assessment and Diagnostic Reasoning

3 September 27,

Patient Initials: JWW Age: 43 Gender: Male

Skin Condition Selected: Picture 2

SUBJECTIVE DATA:

Main Complaint: Red spots on the chest and abdominal area started to appear two weeks ago.

4 (HPI)History of Present Illness : 

John Wayne Weaver, a 43-year-old Caucasian presents today with approximately 30 red lesions that developed over the trunk area approximately two weeks ago. Patient denies any irritation, fever, or discomfort from the lesions. Upon onset patient states that he initially only saw approximately 5 of the red lesions but over the course of several days there was continual development to the number that appears now. There have been no significant changes in their appearance or quantity for the last two weeks. Patient states they do not affect his daily life, but he is concerned about what they are, and why they have not gone away despite his use of cortisone and Benadryl.

Medications:

Cortisone-Over the counter ointment topical.

Over the counter Benadryl topical spray Over the counter men’s multivitamin Lopressor 25mg BID Lovastatin 40mg QHS

Allergies:

Penicillin – Rash

Codeine – Rash / Hivelike

4 Past Medical History (PMH):

7 Chicken Pox – at the Age of  5

Measles – Age 7

High blood pressure-Diagnosed at the age of 35

Hyperlipidemia – Diagnosed at the age of 35

Atrial Fibrillation – Diagnosed at the age of 40

4 Periodic  Streptococcal Pharyngitis –Occurred at the age of 25

Past Surgical History (PSH):

Appendectomy – June 1991 (Age 15) Vasectomy – 2010 (Age 34) Herniorrhaphy – 2012 (Age 36)

4 Sexual/Reproductive History:

Patient denies any concerns related to sexual or reproductive processes. Patient is divorced has two children and underwent Vasectomy at the age of 34. Patient denies any history of STDs. Patient reports that he is heterosexual and has been in a monogamous relationship for the past five years. NURS6512 Differential Diagnosis Skin Conditions

4 Personal/Social History:

Patient denies using illicit drugs and

Patient drinks 1-2 beverages about 3-4 times per week. Patient goes to the gym two-three times per week and exercises in the form of cardio.  Patient states he is currently working on making changes in his diet to lead a healthier lifestyle. Patient had a history of smoking for ten years. He was smoking two packs a day. Patient admits stopping smoking 5 years ago. NURS6512 Differential Diagnosis Skin Conditions

Patient Immunization History:

Immunization history is up to date per record.

TD shot last received Jan 2019 Flu Immunization received Sept 2020

Patient agrees to receive Pneumococcal vaccination today.

Family Medical  History:

10 – maternal grandparent, mother, and brother dx in mid-late 30’s

High Blood Pressure-patients mother, maternal grandfather, maternal grandmother, brother.

Atrial Fibrillation – paternal grandfather, and father dx in 40’s

4 Diabetes Mellites – mother

Lung Cancer – paternal grandmother dx age 65

2 healthy sons

Lifestyle: Patient currently works as a construction foreman on upscale condo development. He was married for 18 years, divorced from wife, and has shared custody of his two sons. He does have a long-term girlfriend who he has been in a relationship with for the past five years. He lives in upper middle-class neighborhood and has just finished paying off his home. Big family and friends encouragement. Patient reports no financial issues and denies any stress above the normal level. Since being diagnosed with high blood pressure, elevated cholesterol, and A-fib patient has made some lifestyle changes related to smoking and is continuing to work on a healthier diet. NURS6512 Differential Diagnosis Skin Conditions

4 Review of Systems:

General:

Mr. Weaver is friendly, cooperative alert oriented, coherent male, good historian. Presented well groomed and maintaining a good hygiene. Not detected  with any acute abnormal conditions or  other distress.

HEENT: Negative for headaches, head trauma, visual changes, blurry vision.

Assessment did not show any ear infections, pain, discharge, tinnitus change in hearing pattern and any other abnormalities.

Negative for nasal drip, hay fever, or sinus related conditions. No sore throat, mouth sores, gingivitis, tooth pain, difficulty swallowing, gums soreness noted. NURS6512 Differential Diagnosis Skin Conditions

Streptococcus of the throat was positive three times in the past eight months.

Neck:  No lymphadenopathy, thyroid smooth on assessment, no redness, inflammatory signs, redness or other abnormalities found.

Breasts: Equal, no lymph noted. No discharge from nipples. Normocephalic bilaterally.

Respiratory: Unlabored breathing. Symmetrical and equal  with respirations. Breath sounds clear and equal bilaterally in all fields. No sinus pressure, sneezing, runny nose,  smell changing, cough noted. Last TB test on 2/19/18 – negative.

Cardiac: No chest pain, palpitations, gallop or other abnormal condition noted.

History of abnormal echocardiogram and present high blood pressure.

Peripheral vascular : no signs of  edema, thromboembolism, thrombophlebitis.

 

Gastrointestinal:

 

No change in bowel pattern such as constipation, diarrhea, nausea, vomiting heartburn noted. Abdomen soft, no mass present, all bowel sounds are present, easily audible. Liver, spleen, palpable, normal size, not enlarged. No jaundice noted. No history of liver or gallbladder abnormalities. NURS6512 Differential Diagnosis Skin Conditions

 

Skin: On thorax and the abdominal area moderate amount of bright red lesions present. Approximately 36. Patient denies acute discomfort like itching, irritable feeling on the skin and  urge to scratch.

Allergic/Immunologic: Patient is allergic to Penicillin, and Codeine. Not allergic to environmental and seasonal allergens.

 

OBJECTIVE DATA:

Physical Exam:0

Vital signs:

16 BP 138/72 (right arm, large cuff, sitting) | Pulse 78 | Temp 98F (37.6C) (Oral) | Resp 18 (non-labored) | Ht 6’3.75” (1.924 m) | Wt 196 lb (85kg) | BMI 24 kg/m2.

HEENT:

13 Head is  normocephalic, trauma free , bald,  light reflex present, oronasopharynx is clear.

Neck: 19 Supple, no palpable thyroid, midline trachea, no enlarged nodules, bruit, jugular vein distention, tmegally.

Chest/Lungs:

 

Lungs are clear. Chest symmetric. No rales or rhonchi, wheezing rales are noted on auscultations. Assessment by palpitations and percussions are performed, no abnormal signs found. NURS6512 Differential Diagnosis Skin Conditions

Heart/Peripheral Vascular: 5 Regular rate and rhythm, no hear murmur, rub, or gallop. Pulses +2 bilateral radials, and +2 bilateral pedals. Absence of peripheral edema.

Skin: Small, ruby red round papules (approx. 35) on trunk. 5 Turgor is good, no cyanosis or jaundice.

ASSESSMENT:

2 Lab Tests and Results:

5 CBC-RBC 4.7, PLT 200, HGB 13, HCT 44 Chemistry: Triglycerides 455, LDL 198, Total Cholesterol: 237 All other factors WNL

Primary Diagnosis: Cherry Angioma

Differential Diagnosis:

  • Drug eruption (2) Thrombocytopenic Purpura (3) Pityriasis Rosea

Cherry Angioma is confirmed by the patient assessment after evaluation of related symptoms. Patients Thrombocytopenic Purpura is presents as a lesions without  itching, acute irritation and painful sensations. This signs only located and limited to the torso area only. With no affect o the other areas of the body. NURS6512 Differential Diagnosis Skin Conditions

 

5 Diagnosis of Cherry Angioma in assessment of clinical presentation and history is best supported. Patient presents with non-painful, non-pruritic popular rash limited to the trunk of his body, with no additional symptoms or affects.

A drug eruption is possible when considering just the rash but the patient denies any use of new medications,, and the rash is no generalized, pink and morbilliform which would be the typical presentation related to drug eruption (Ball et al, 2015).

Pityriasis Rosea does meet some of the criteria based on assessment, but since the rash presented is not itchy, scaly, or presented in oval patches, as well as the patients denial of any recent illness it is not supported to be the primary diagnosis (Dains, Baumann, & Scheibel, 2016).

Thrombocytopenic Purpura is a contender for a primary diagnosis however since the patient labs results show normal platelet counts and all blood counts are WNL and there is no generalization of the rash this would be excluded as primary diagnosis (Ball et al, 2015)

NURS6512 Differential Diagnosis Skin Conditions References

Ball, J. W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2015). 20 Seidel’s guide to physical examination (8th Edition). St. Louis, MO: Elsevier Mosby.

Dains, J.E., Baumann, L.C., & Scheibel, P. (2016). 5 Advanced health assessment and clinical diagnosis in primary care (5th Edition). St. Louis, MO: Elsevier Mosby. NURS6512 Differential Diagnosis Skin Conditions