NURS6531_week_2_discussion_latest_2018_september.docx (112.09 KB)

NURS6531 week 2 discussion latest 2018 September Week 2 discussion

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.