Reflect on the provided patient information including history and physical exams. Think about a differential diagnosis
Discussion: Diagnosing Integumentary Disorders When entering examination rooms, advanced practice nurses often immediately begin assessing patients by looking for external abnormalities such as skin irritations or cloudy eyes. By making these simple observations, they can determine how to proceed with their patient evaluations. During the patient evaluation, advanced practice nurses will use initial observations to guide them in acquiring the necessary medical history, performing additional assessments, and ordering the appropriate diagnostics. The information obtained during this evaluation process will help in the development of a differential diagnosis. Once a diagnosis is made, the advanced practice nurse can consider potential treatment options and work with the patient to develop a plan of care. For this Discussion, consider the following three case studies of patients presenting with integumentary disorders. Case Study 1 A 46-year-old male presents to the office complaining of a pruritic skin rash that has been present for a few weeks. He initially noted the rash on his feet, but it then spread to between the fingers, his wrist, and waist. He notes that it does not seem to be on his face or trunk. He recently came home from a trip to Florida where he had stayed in multiple hotels. He takes occasional ibuprofen for knee pain, but denies taking other medications or having other health problems. He has no known drug allergies. The physical examination reveals a male with several tiny vesicles and scales in between the fingers, on the feet and ankles, around the patient’s wrist and around the belt line. Picture of a hand that is covered in a pruritic skin rash between the fingers, which covers the wrist. The rash does not uniformly cover the hand and is scaly in some areas. Case Study 2 K.B., a 52 year old Irish American patient who present today complaining of “a mole” on the skin that is changing colors. He said he has had this ‘mole’ for almost two years. K.B. is a construction worker currently residing in Hawaii. As a teen he worked outside and visited the tanning bed several times a month. He is a worried that this “mole” doesn’t look like the others on his body. On your examination, you note, the lesion as round, dark colored in appearance, and scaly. You also note the mole has an irregular border and about 0.2cm in size. Depicted on the skin are four moles. In the center is a large mole that is dark colored in appearance, with an uneven colored tone, appears scaly, and has an irregular border. The other three moles depicted appear normal in appearance. Case Study 3 J.V. 50 year old patient with history of eczema is here today complaining of lesions on the right side of her face and neck. She thinks it is a flare up of her eczema and is asking for a refill of her ointment, TAC 0.1%. She complains of some ‘itching’ and a bit of ‘tingling and pain’ to the lesions. She’s a pharmaceutical worker and thinks that the ‘pain’ maybe due to contaminate exposure. Denies any other associating symptoms. Below is a photo of the lesions. Patient presents with lesions on the right side of her face and neck. The lesions are red in appearance and vary in size. They appear scaly and do not uniformly cover the entire region of her face or neck. To prepare: Review Part 5 of the Buttaro et al. text and the case studies provided You will either select or be assigned one of the three case studies provided. Reflect on the provided patient information including history and physical exams. Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis. Reflect on potential treatment options based on your diagnosis.
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