Module 3 Introduction
Dr. Tara Harris reviews the overall expectations for Module 3. Consider how you will manage your time as you review your media and Learning Resources for your Discussions, Case Study Lab Assignments, DCE Assignments, and your Midterm exam (12m).
Skin, Hair, and Nails – Week 4 (19m)
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 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.
Note: To access the online resources included with the text, you need to complete the FREE online registration that is located at https://evolve.elsevier.com/cs/product/9780323172660?role=student .
To Register to View the Content
- Go to https://evolve.elsevier.com/cs/product/9780323172660?role=student
- Enter the name of the textbook, Seidel’s Guide to Physical Examination (name of text without the edition number) in the Search textbox.
- Complete the registration process.
To View the Content for this Text
- Go to https://evolve.elsevier.com/
- Click on Student Site.
- Type in your username and password.
- Click on the Login button.
- Click on the plus sign icon for Resources on the left side of the screen.
- Click on the name of the textbook for this course.
- Expand the menu on the left to locate all the chapters.
- Navigate to the desired content (checklists, videos, animations, etc.).
Note: Clicking on the URLs in the APA citations for the Resources from the textbook will not link directly to the desired online content. Use the online menu to navigate to the desired content.
Suturing Tutorials
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 [Video file]. Retrieved from https://www.youtube.com/watch?v=c-LDmCVtL0o
Note: Approximate length of this media program is 5 minutes.
Mikheil. (2014, April 22). Basic suturing: Simple, interrupted, vertical mattress, horizontal mattress [Video file]. Retrieved from https://www.youtube.com/watch?v=MFP90aQvEVM
Note: Approximate length of this media program is 9 minutes.
Incision and Drainage of an Abscess (a common procedure in primary care)
New England Journal of Medicine (NEJM). (2013, September 30). NEJM abscess incision and drainage [Video file]. Retrieved from https://www.youtube.com/watch?v=MwgNdrA18fM&list=PL9UKTUFtRDcNq4–Vf2NYfUANEyObfeNm&index=8
Note: Approximate length of this media program is 10 minutes.
Dermablade Use for Shave Biopsies
Dermablade®. (2012, November 9). PersonnaBlades [Video file]. Retrieved from https://www.youtube.com/watch?v=D8u1Y18L9DQ
Note: Approximate length of this media program is 5 minutes.
Assignment 1: Lab Assignment: Differential Diagnosis 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 Lab Assignment, 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.
To Prepare
- 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.
By Day 7 of Week 4
Submit your Lab Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK4Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 4 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 4 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 4 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 4 Assignment 1 draft and review the originality report.
Week 4 Assignment Sample Paper
NURS 6512 Week 4 Assignment – Advanced Health Assessment and Diagnostic Reasoning
Advanced Health Assessment and Diagnostic Reasoning
Student’s Name:
Institutional Affiliation:
Patients Initials: Age: Gender: Male
Subjective DataChief Complaint: The patient no. 1 is a middle aged white male who complains of multiple red, oval-shaped bumps on the chest that bleeds when scratched or cut open. History of the illness: The patient presents with red moles that started developing since the early thirties and increases in size and number as the patient ages.
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Objective DataThe physical examination shows that the patient 1 presents with chest skin growths referred to as lesions, which vary in appearance, ranging from small red macules to a larger dome-topped polypoid papule. The color of the lesions ranges from bright red to dark red, depending on their stage of development and trauma applied on them.
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ASSESSMENTDifferential Diagnosis One of the differential diagnoses, in this case, is acute Urticarial. It refers to a vascular reaction of the skin. Clinical presentations include smooth, slightly elevated papules and plaques that are erythematous and that are often attended by severe pruritus. However, unlike in the current scenario, urticarial is self-limited and of short duration. The papules last between several hours to several days and resolve without scarring, and without any clinical intervention (Guastafierro et al. 2019). In cases of Chronic urticarial, there is the recurrence of the lesions and can last for as long as six weeks. Additionally, the lesions reaction is unsystematic in that they don’t attack any specific body part. They are equitably distributed to all body parts. Insect bite from blood feeders such as bed bugs is another differential diagnosis in this case. Once bitten by such insects, blood-filled lesions appear several hours in the bitten area after the bite. However, unlike in the current scenario, in blood feeder insect bites, the lesion is as large as 6 cm and worsen just after sleep episodes. They also mostly appear in the linear form, in exposed body parts such as legs, arms, and face and keep relocating due to new bites. Bacillary angiomatosis is another differential diagnosis in this scenario. It refers to the development of multiple red, purple, flesh-colored, or colorless Cutaneous lesions that vary in sizes, with the smallest being about 1mm. They are caused by immunodeficiency thus are commonest in immunocompromised persons such as HIV positive individuals. However, unlike in the current scenario, the Lesions mostly affect the oral mucosa, tongue, oropharynx, nose, penis, and anus. The lesions are also accompanied by other symptoms including Bone pain, Fever, chills, malaise, night sweats, anorexia, and weight loss. Melanoma is another differential diagnosis.it refers to a type of skin cancer. Clinical presentation entails skin changes, such as a skin sore that fails to heal and a firm red lump that bleeds when scratched and a flat, red spot that is rough, dry, or scaly (Swetter & Geller, 2018). It is caused by mutation of melanocytes, the pigment-producing cells, in to cancerous cells. The lesions mostly affect the chest and back. However, it is most common in women than in men.
Most Likely Correct DiagnosisThe most likely accurate diagnosis in this scenario is Cherry Angioma. It refers to a skin tumor that results from the overgrowth of blood capillaries. It is most common in older adults after 30 years of age and affects 60% of adults. It is characterized by oval-shaped lesions whose color ranges from bright red, due to dilated capillaries to dark red, when pressure is applied, that bleed when scratched, increases in size and number as the own ages (Espinosa et al. 2018). The lesions are painless but uncomfortable if burst open. The angiomas affect mostly the chest, stomach, and back often appear in groups.
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Plan of CareSince the lesions are mostly painless therefore not a health concern, the method of care takes a cosmetic dimension. An excision process that entails shaving the lesion off the skin is recommended. An anesthetic is applied to minimize pain during the process. They can also be removed through electrodesiccation, which involves burning the skin growth with an electric needle to destroy the blood vessels. However, both processes leave scars. A biopsy on lesions is preferred in removing traumatized lesions where scarring is a concern |
References
Espinosa Lara, P., Medina-Puente, C., Riquelme Oliveira, A., & Jiménez-Reyes, J. (2018). Eruptive cherry angiomas developing in a patient treated with ramucirumab. Acta Oncologica, 57(5), 709-711.
Guastafierro, A., Verdura, V., Di Pace, B., Faenza, M., & Rubino, C. (2019). The Influence of Breast Cancer on the Distribution of Cherry Angiomas on the Anterior Thoracic Wall: A Case Series Study. Dermatology, 235(1), 65-70.
Swetter, S., & Geller, A. (2018). Melanoma: Clinical features and diagnosis. U: UpToDate.
Submit Your Assignment by Day 7 of Week 4
To participate in this Assignment:
Week 4 Assignment 1
Assignment 2: Digital Clinical Experience (DCE): Health History Assessment
In Week 3, you began your DCE: Health History Assessment. For this week, you will complete this Health History Assessment in your simulation tool, Shadow Health and finalize for submission.
To Prepare
- Review this week’s Learning Resources as well as the Taking a Health History media program in Week 3, and consider how you might incorporate these strategies. Download and review the Student Checklist: Health History Guide and the History Subjective Data Checklist, provided in this week’s Learning Resources, to guide you through the necessary components of the assessment.
- Review the DCE (Shadow Health) Documentation Template for Health History found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
- Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
- Review the Shadow Health Student Orientation media program and the Useful Tips and Tricks document provided in the week’s Learning Resources to guide you through Shadow Health.
- Review the Week 4 DCE Health History Assessment Rubric, provided in the Assignment submission area, for details on completing the Assignment.
Note: There are 2 parts to this assignment – the lab pass and the documentation. You must achieve a total score of 80% in order to pass this assignment. Carefully review the rubric and video presentation in order to fully understand the requirements of this assignment.
DCE Health History Assessment:
Complete the following in Shadow Health:
Orientation
- DCE Orientation (15 minutes)
- Conversation Concept Lab (50 minutes)
Health History
- Health History of Tina Jones (180 minutes)
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 4 Day 7 deadline.
Submission and Grading Information
By Day 7 of Week 4
- Complete your Health Assessment DCE assignments in Shadow Health via the Shadow Health link in Blackboard.
- Once you complete your assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding assignment in Blackboard for your faculty review.
- (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
- Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
- Download, sign, date, and submit your Student Acknowledgement Form found in the Learning Resources for this week.
- Note: You must pass this assignment with a minimum score of 80% in order to pass the class. Once submitted, there are not any opportunities to revise or repeat this assignment.
Grading Criteria
To access your rubric:
Week 4 Assignment 2 DCE Rubric
Submit Your Assignment by Day 7 of Week 4
To submit your Lab Pass:
Week 4 Lab Pass
To submit this required part of the Assignment:
Week 4 Documentation Notes for Assignment 2
To Submit your Student Acknowledgement Form:
Submit your Week 4 Assignment 2 DCE Student Acknowledgement Form
Assignment 3 (Optional) Practice Assessment: Skin, Hair, and Nails Examination
Advanced practice nurses are required to have the skills and knowledge necessary to perform many different physical assessments and health examinations. In this course, you will demonstrate your abilities in this area by conducting various optional examinations on a volunteer “patient.”
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice conducting an assessment of the skin, hair, and nails this week.
Note: This is an optional practice physical assessment.
To Prepare
- Arrange an appropriate time and setting with your volunteer “patient” to perform a skin, hair, and nails examination.
- Download and review the Skin, Hair, and Nails Student Checklist and Key Points, provided in this week’s Learning Resources, and review the Seidel’s Guide to Physical Examination online media.
Optional Lab Assignment
- Perform the skin, hair, and nails examination, covering all of the areas listed in the checklist.
What’s Coming Up in Week 5?
Next week, you examine how to properly assess the head, neck, eyes, ears, nose, and throat in order to form accurate diagnoses as you complete your Case Study Assignment of the Skin, Hair, Nails, and HEENT. You will once again complete a DCE related to a Focused Exam for cough. Make sure to plan ahead with your Please plan your time accordingly.
Week 5 Required Media
Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Case Study Assignment. There are several videos of various lengths. Please plan ahead to ensure you have time to view these videos and animations to complete your Assignment on time.
Next Week
To go to the next week:
Week 5
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