NRS 420 Shadow Health Skin, Hair, and Nails
NRS 420 Shadow Health Skin, Hair, and Nails
In this GCU you will assess the skin, hair, and nails of Tina Jones, a Digital Standardized Patient. Interview and examine the patient, document your findings, and complete post-exam activities. Within the Shadow Health platform, complete Skin, Hair, and Nails. On average, this assignment should take 75 minutes to complete. Some students may need additional time.
You can attempt this GCU as many times as you would like. After completing Skin, Hair, and Nails, you will be awarded a Digital Clinical Experience (DCE) score. The DCE score will appear on your Lab Pass which you will submit to the classroom drop box. The DCE score will be used as your percentage grade for this assignment.
You are not required to submit this assignment to LopesWrite.
Skin Comprehensive SOAP Note Example Documentation
Patient Initials: __VC_____ Age: __55_____ Gender: __M_____
SUBJECTIVE DATA:
Chief Complaint (CC): Graphic 5: “I have had this rash that doesn’t seem to go away on my arm for the past 2 days”
History of Present Illness (HPI): VC is a 55-year-old African American male patient who presented to the outpatient clinic. He came with complaints of a unilateral rash localized to the right upper back side extending to the posterior aspect of the upper arm for five days. He reports that 2 days before the appearance of the rash, he experienced a burning sensation and pain on the same site. The vesicles were initially few and small in size but progressively increased in number. Some burst to release clear fluid while some coalesced to form bigger vesicles. The rash is severely painful and itchy.
The pain is continuous and radiates to the shoulder. It is exacerbated by contact and experiences minimal relief from over-the-counter painkillers. There is associated generalized body malaise, hotness of the body, and occasional headaches. There are no similar eruptions in any other parts of the body. There is no history of similar presentations in the past. He denies any use of any immunosuppressive drugs but admits to being seropositive for retroviral disease. There is no history of contact with irritant substances.
Medications:
1). Acyclovir 800 mg five times per day
2). Paracetamol 1 g three times a day
3). Dolutegravir/ Lamivudine/Tenofovir 50 mg/300 mg/300mg per day
4). Co-Trimoxazole 800 mg/160 mg per day
Allergies:
There is no known food or drug allergy reported by the client.
Past Medical History (PMH):
1). Pulmonary tuberculosis 12/10/2020
2). Cryptococcal meningitis 08/07/2021
3). HIV/AIDs
Past Surgical History (PSH):
1). Open reduction and internal rotation for a fractured left femur 16/02/2010
2). Appendectomy
3). Incision and drainage of an abscess.
Sexual/Reproductive History:
Bisexual.
Personal/Social History:
The client has been actively smoking cigarettes approximately one pack per day for the past two years.
He reports occasional alcohol consumption.
He denies abuse of any other recreational substance.
Immunization History:
Moderna COVID-19 vaccine; 1st dose on 22/01/2021 and second dose on 20/07/2021
Tdap 2020
Influenza vaccine 2017
Significant Family History:
The mother is hypertensive with congestive heart failure.
The father has diabetes and hyperlipidemia.
Review of Systems:
General: He reports generalized body weakness and fever. He denies any weight loss.
HEENT: There is no vision loss, no photophobia, no hearing loss, no dysphagia, no halitosis, and no nasal obstruction.
Respiratory: There is no reported shortness of breath, no cough, and no chest pain.
Cardiovascular/Peripheral Vascular: There are no palpitations, no paroxysmal nocturnal dyspnea and no chest pain.
Gastrointestinal: The client denies anorexia, vomiting, diarrhea, constipation, and abdominal pain.
Genitourinary: There is no dysuria, no hematuria, and no incontinence.
Neurological: There are occasional headaches but no convulsions, no dizziness, and no focal neurological deficits.
Psychiatric: The client denies any mental disorders.
Musculoskeletal: There is no arthritis, no muscle pain, and no joint stiffness.
OBJECTIVE DATA:
Physical Exam:
Vital signs: Blood Pressure 130/82, Pulse Rate 86, Respiratory Rate 17, Temperature 98.4, BMI 24.4
General: The patient is obviously in pain, is well groomed, is well nourished, and is well-hydrated.
HEENT: Head is normocephalic, the pupils are both equally reactive to light, the ear canals have minimal wax, and the throat is clear with no signs of inflammation.
Neck: There are no enlarged cervical lymph nodes, no jugular venous distension, and no vascular bruits.
Chest/Lungs: There are normal vesicular breath sounds on auscultation and no wheezes.
Heart/Peripheral Vascular: The precordium is normoactive, the first and second heart sounds were heard with no added sounds, and the rhythm is regular.
Abdomen: The abdomen is soft and non-tender, no masses or organomegaly were elicited on palpation.
Genital/Rectal: Digital Rectal examination was essentially normal with no blood on the examining finger.
Musculoskeletal: No joint stiffness, pain, or swelling, the range of motion is within normal ranges in all joints.
Neurological: There are no cranial nerve abnormalities elicited, the tone, bulk, power, and reflexes were normal in all limbs except the right upper limb which was slightly weak probably due to the pain in the affected area.
Skin: There is a rash unilaterally on the right upper side of the back extending to the right posterior upper arm with the dermatomal pattern. The rash is vesicular, with vesicles of variable sizes. Some of the vesicles have burst and are crusted. The vesicles contain clear fluid. The base of the rash is erythematous. No other rash or skin eruptions were noted in the other parts of the body.
Diagnostic results:
CBC – WBC 13,000
Blood cultures – no organism was isolated
Varicella Zoster specific IgM antibody- positive
ASSESSMENT:
Differential Diagnosis:
1). Herpes simplex: Herpes simplex is a possible differential diagnosis. This is because it presents with multiple clear fluid-filled vesicles commonly in the oro-labial or genital areas unlike shingles (James et al., 2020). The pain in herpes simplex is less severe than in shingles and dermatomal distribution is incomplete.
2). Contact dermatitis: Contact dermatitis which is an inflammatory skin condition can either be contact or irritant type (Li et al., 2021). Clinical features of contact dermatitis include itching, pain, erythema, and vesicular eruptions most of which were present in the patient. However, the presence of fever, headache, and malaise points more toward an infectious cause. The patient did not report any allergies or contact with irritant substances.
3). Impetigo: Impetigo is a bacterial skin infection that presents with multiple pustules that coalesce to form erythematous plaques with yellow crust (Primhak et al., 2022). Unlike shingles, the vesicles are pus-filled and they spread rapidly and are not localized to dermatomes.
Primary Diagnosis:
1). Shingles/ Herpes Zoster: This is the principal diagnosis in this patient based on the presentation and physical findings from the assessment. Shingles typically present with pre-eruptive pain or itchiness, a unilateral dermatomal clear fluid-filled vesicular rash with an erythematous base, fever, and malaise just like in this particular patient (Patil et al., 2022). Some of the likely predisposing factors present in this client include immune suppression from pre-existing HIV/AIDS and age greater than 50.
PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.
References
James, C., Harfouche, M., Welton, N., Turner, K., Abu-Raddad, L., Gottlieb, S., & Looker, K. (2020). Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Bulletin Of The World Health Organization, 98(5), 315-329. https://doi.org/10.2471/blt.19.237149
Li, Y., & Li, L. (2021). Contact Dermatitis: Classifications and Management. Clinical reviews in allergy & immunology, 61(3), 245–281. https://doi.org/10.1007/s12016-021-08875-0
Patil, A., Goldust, M., & Wollina, U. (2022). Herpes zoster: A Review of Clinical Manifestations and Management. Viruses, 14(2), 192. https://doi.org/10.3390/v14020192
Primhak, S., Gataua, A., Purvis, D., Thompson, J. M. D., Walker, C., Best, E., & Leversha, A. (2022). Treatment of Impetigo with Antiseptics-Replacing Antibiotics (TIARA) trial: a single blind randomized controlled trial in school health clinics within socioeconomically disadvantaged communities in New Zealand. Trials, 23(1), 108. https://doi.org/10.1186/s13063-022-06042-0
