This week, you will explore how to assess the skin, hair, and nails, as well as how to evaluate abnormal skin findings.

Learning Objectives

Students will:

• Apply assessment skills to diagnose skin conditions
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the skin, hair, and nails
• Apply assessment skills to collect patient health histories

Required Readings – Assignment 1: Differential Diagnosis for Skin Conditions

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

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.

• 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.

• 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). From https://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). From https://evolve.elsevier.com/

Everyday Health, Inc. (2013). Resources for dermatology and visual conditions.

Retrieved from http://www.skinsight.com/info/for_professionals

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

Clothier, A. (2014). Assessing and managing skin tears in older people. Nurse Prescribing, 12(6), 278–282. Retrieved from http://www.nurseprescribing.com/

Retrieved from the Walden Library Databases.

Watkins, J. (2013a). Skin rashes, part 1: Skin structure and taking a dermatological history. Practice Nursing, 24(1), 30–33. doi:10.12968/pnur.2013.24.1.30

Retrieved from the Walden Library Databases.

Watkins, J. (2013b). Skin rashes, part 2: Distribution and different types of rashes. Practice Nursing, 24(3), 124–127. Retrieved from http://www.practicenursing.com/

Retrieved from the Walden Library Databases.

Watkins, J. (2013c). Skin rashes, part 3: localized rashes. Practice Nursing, 24(5), 235–241. doi:10.12968/pnur.2013.24.5.235

Retrieved from the Walden Library Databases.

Document: Skin Conditions (Word document)

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

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.

Required 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

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

• 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 from https://web.archive.org/web/20170215015223/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/absorbable_suture_chart.pdf

Ethicon, Inc. (2006). Dermabond topical skin adhesive application technique. Retrieved from https://web.archive.org/web/20150921174121/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_application_poster.pdf

Ethicon, Inc. (2001). Ethicon needle sales types. Retrieved from https://web.archive.org/web/20150921171922/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/needle_template.pdf

Ethicon, Inc. (n.d.b). Ethicon sutures. Retrieved from https://web.archive.org/web/20150921202525/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/suture_chart_ethicon.pdf

Ethicon, Inc. (2002). How to care for your wound after it’s treated with Dermabond topical skin adhesive. Retrieved from https://web.archive.org/web/20150926002534/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_wound_care.pdf

Ethicon, Inc. (2005). Knot tying manual. Retrieved from https://web.archive.org/web/20160915214422/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/knot_tying_manual.pdf

Ethicon, Inc. (n.d.c). Wound closure manual. Retrieved from https://web.archive.org/web/20170829043048/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/eth

Assignment 1: 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 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 for Assignment 1: Differential Diagnosis for Skin Conditions:

• Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this 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.
• Download the SOAP Template found in this week’s Learning Resources.

To complete:

• 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 3 different references from current evidence based literature.

Assignment 2: Health History Assessment Video

IMPORTANT INSTRUCTIONS: Adjust your camera to show a full view of both you and your patient volunteer, show your government issued photo ID/passport for verification of who you are, scan the room that you are using for verification that notes are not being used or posted, then begin the video. You may NOT take notes during the examination. You must show an interview with a patient who presents with a specific complaint/problem. The video must show you interviewing a patient and the patient must answer the questions. Omitting these instructions or obtaining a score of less than 69.5% will result in a failure of the video assignment and the course.

By Day 7

Submit your video using the Kaltura Mashup tool accessible through the Assignment submission link provided. Assignment 1: Differential Diagnosis for Skin Conditions

ADDITIONAL INFORMATION;

Differential Diagnosis for Skin Conditions

Introduction

Skin conditions are very common in humans. The skin is the largest organ of the body and plays a major role in protecting us from infection, disease and injury.

Ulcers

Ulcers are sores that form on the skin. Ulcers can be caused by a variety of things, including infections, injuries or diseases.

They typically appear red or purple in color and usually have a distinct edge. They may also throb when touched or move around when you press on them with your finger (known as “rolling”).

They’re shallow lesions that bleed easily but don’t generally cause pain unless they break open and release bacteria into your bloodstream.

Burns

Burns are a type of trauma to the body. They can be caused by many things, including the sun, fire and electricity. The most common type of burn is thermal (heat or flame) injury that occurs when skin comes into contact with an intense source of heat such as fire or candles.

Burns are classified based on severity and thickness: first degree burns are superficial (only touchable), second degree burns go all the way through your skin but do not reach any deeper tissues; third degree burns involve full thickness tissue loss with blisters and scabs forming on your skin.

Skin Cancer

Skin cancer is the most common form of cancer in the United States, with about five million new cases being diagnosed each year. Skin cancers are caused by exposure to ultraviolet (UV) radiation from the sun or tanning beds. They can be treated with surgery and/or radiation therapy but may not go away completely even after treatment has ended.

Skin cancers are divided into two groups: basal cell carcinoma and squamous cell carcinoma. Basal cell carcinomas begin on hair-follicle roots and then spread to other parts of your body through an extensive network of blood vessels that supply nutrients for cells throughout your body.* Squamous cell carcinomas start on existing skin cells below where hairs grow out from; they don’t spread beyond this initial site.*

Basal Cell Carcinoma

Basal cell carcinoma is one type of non-melanoma skin cancer.* It’s also known as BCC or Bowen’s Disease because it was first described by Scottish dermatologist John Thomas Bowen* in 1815 while he was studying burns caused by solar radiation during a trip abroad.* Patients usually present themselves complaining only mildly at first but then develop changes over time such as itching or crusting on top layer – which may be mistaken for psoriasis until later stages when sores appear like those seen with eczema

Boils

Boils are skin infections that cause painful red bumps on the skin. They’re caused by a type of bacteria called staphylococcus aureus, which can also be found in your nose and mouth.

Boils can be treated with antibiotics or prescription creams such as hydrocortisone cream or benoxinate lotion (which help reduce swelling). If you have more than one boil at once, it’s important to see your doctor for treatment so they can determine which is causing the infection and how much damage has been done to your body.

Scars

Scar tissue is formed when the body attempts to heal a wound. Scar tissue is composed of dense collagen and does not have the same elasticity as normal skin, so it can’t stretch like healthy tissue. It also has less vascularity than normal skin, which means that there isn’t much blood flow through it (blood vessels are necessary for oxygen supply). Because scar tissue doesn’t have this blood supply, it can become infected more easily than healthy skin does and because scar tissues aren’t as sensitive to pain perception, they may feel superficial wounds even if they’re deep.

If you suspect that your scarring isn’t from an accident or surgical procedure but rather something else entirely (like too much sun exposure), talk to your doctor about what might be causing it!

Differential Diagnosis for Skin Conditions

Differential diagnosis is the process of determining which of the above conditions are best to treat. When a patient presents with symptoms that could be caused by one or more of these conditions, it is important to rule them out first before moving on to symptoms related only to another condition.

The differential diagnosis for skin disorders includes:

– Allergic reactions – Autoimmune disorders – Bacterial infections (cellulitis, impetigo) – Candidiasis (yeast infection) – Cellulitis (bacterial infection of the skin and underlying tissue)

Conclusion

It’s important to remember that all skin conditions are not cancer. There are many possible causes of skin lesions and other lesions on the body, including some of the more common ones we discussed above. If you have any concerns about your patient’s skin condition, please consult a dermatologist.