NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS

Walden University NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS– Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS

Whether one passes or fails an academic assignment such as the Walden University NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS

The introduction for the Walden University NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS

After the introduction, move into the main part of the NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS

Patient Information: R.S, 50-year-old male  

Subjective 

CC: Nasal congestion as well as itching for the last 5 days 

HPI: R.S is a 50-year-old male that came to the unit with complaints of nasal congestion, rhinorrhea, sneezing, itchy nose, postnasal discharge, and itching ears and nose for the last 5 days. The patient reported using Mucinex medication to help ease breathing but it has been associated with minimal effectiveness. The patient denied any history of pain or headache.  

Medications: The patient currently uses Mucinex over-the-counter medication 1 tab orally on a daily basis. 

Allergies: The patient denied any history of drug or food allergy. The patient reported history of seasonal allergies.  

PMHx: The patient denied history of hospitalization, surgery, and blood transfusion. The immunization history of the client is up to date.  

Social Hx: The patient is married with two children. The patient stopped smoking in 2012. He drinks alcohol on occasional basis. His highest level of education is university. He has a degree in business administration and works at a local supermarket as a manager. He reported to engage in active physical activity. He reported that the symptoms of the disease had affected his sleeping patterns significantly.  

Family Hx: The parents of the patient are both alive. His father was diagnosed with diabetes in 2016 and has been on treatment. His mother was diagnosed with hypertension in 2020 and is on treatment. The patient is the second born in a family of three. His siblings are all alive and healthy.  

ROS 

General: The patient appeared well groomed for the occasion. He was oriented to time, place, and self. He denied fevers, fatigue, or chills. The patient reported being tired due to lack of enough sleep secondary to the symptoms of the health problem. 

HEENT: The patient denied headaches. The patient reported that his eyes are itchy and red. There were no changes in the vision. The tympanic membranes are intact, with absence of ear drainage of changes in hearing. The patient reported nasal congestion, itchy, with pale and boggy nasal mucosa. There was clear nasal drainage with slightly enlarged nasal turbinates. There was absence of tonsillitis. The throat was mildly erythematous.  

Neck: The trachea was midline without any deviation or lymphadenopathy. 

Skin: The patient denied skin rash, changes in skin color, and itching.  

Cardiovascular: The patient denied chest pain, palpitations, discomfort, or edema.  

Respiratory: The patient denied shortness of breath, cough or difficulty in breathing 

Musculoskeletal: The patient denied joint or muscle pain.  

Lymphatic: The client denied lymphadenopathy  

Allergies: The client denied any known food or drug allergy. He reported seasonal allergies.  

Objective 

HEENT: The patient reports that his eyes are itchy. The eyes appear red. The tympanic membranes are intact with the absence of any drainage. The nasals are congested, with boggy, pale mucosa and inflamed nasal turbinates. There is the evidence of drainage of thin, clear secretion. There is mild erythema on the throat with absence of tonsillitis and bleeding.  

Diagnostic Results 

The skin test revealed a positive reaction to pollen. The results showed that the patient has allergic rhinitis. Allergic rhinitis is a condition of the upper respiratory system that arises from an individual exposure to an allergen. Patients experience symptoms that include sneezing, rhinorrhea, itchy nose and eyes, nasal congestion, and sore throat among others. Diagnostic investigations are not recommended in allergic rhinitis since they do not have any cost benefits. Healthcare providers can utilize history taking and physical examination to diagnose patients with the condition. It is however important to perform tests such as skin tests to determine whether a patient has allergic rhinitis in people without history of allergic reactions.  

Differential Diagnosis 

Allergic Rhinitis: The first differential diagnosis for the patient is allergic rhinitis. As noted initially, allergic rhinitis is a respiratory condition that develops following an individual exposure to an allergen. The symptoms associated with allergic rhinitis include sneezing, nasal congestion, rhinorrhea, and itchy eyes. The symptoms developed due to IgE mediated reactions against the allergens (Okubo et al., 2020). Allergic rhinitis is the primary diagnosis for the patient due to the positive skin test. 

Non-allergic rhinitis: Non-allergic rhinitis is the other possible condition affecting the client. Patients present with symptoms such as nasal congestion, rhinorrhea, sneezing, and itchy eyes among others. However, patients do not have history of allergic reactions to allergens (Zheng Ming et al., n.d.). This is the least diagnosis for the client in the case study because he has history of seasonal allergy.  

Sinusitis: sinusitis refers to a condition where the paranasal sinuses are inflamed. Sinusitis is attributed to causes such as fungal, viral or bacterial infections and allergic reactions. Patients with sinusitis experience symptoms such as nasal congestion, headache, rhinorrhea, fever, and facial pain (Little et al., 2018). Sinusitis is however, the least possible condition due to the absence of signs and symptoms associated with infections.  

Flu/Common cold: Common cold is the other potential diagnosis. Common cold is an acute viral infection affecting the upper respiratory system. It may involve sinuses, larynx or the pharynx. Patients experience symptoms such nasal drainage, malaise, fever, and headache among others. It is however the least likely due to the absence of signs and symptoms of infection (Sadeghirad et al., 2017).  

Sore throat: Sore throat is the other potential diagnosis for the patient. Patients experience pain in the pharynx on swallowing. Sore throat is largely attributed to viral infections. The patient however is least suffering from sore throat because of the absence of signs and symptoms of infection (Mahalingam et al., 2020).  

Also Read:

CASE STUDY ASSIGNMENT: ASSESSING THE HEAD, EYES, EARS, NOSE, AND THROAT

DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

LAB ASSIGNMENT: ASSESSING THE ABDOMEN

DIGITAL CLINICAL EXPERIENCE: ASSESSING THE HEART, LUNGS, AND PERIPHERAL VASCULAR SYSTEM

ASSESSING MUSCULOSKELETAL PAIN

CASE STUDY ASSIGNMENT: ASSESSING NEUROLOGICAL SYMPTOMS

DIGITAL CLINICAL EXPERIENCE: COMPREHENSIVE (HEAD-TO-TOE) PHYSICAL ASSESSMENT

LAB ASSIGNMENT: ASSESSING THE GENITALIA AND RECTUM

References 

Little, R. E., Long, C. M., Loehrl, T. A., & Poetker, D. M. (2018). Odontogenic sinusitis: A review of the current literature. Laryngoscope Investigative Otolaryngology, 3(2), 110–114. https://doi.org/10.1002/lio2.147 

Mahalingam, N. V., Abilasha, R., & Kavitha, S. (2020). Awareness of symptomatic differences COVID-19, sars, swine flu, common cold among dental students. International Journal of Research in Pharmaceutical Sciences, 11(Special Issue 1). https://doi.org/10.26452/ijrps.v11iSPL1.3431 

Okubo, K., Kurono, Y., Ichimura, K., Enomoto, T., Okamoto, Y., Kawauchi, H., Suzaki, H., Fujieda, S., Masuyama, K., & Allergology, T. J. S. of. (2020). Japanese guidelines for allergic rhinitis 2020. Allergology International, 69(3), 331–345. https://doi.org/10.1016/j.alit.2020.04.001 

Sadeghirad, B., Siemieniuk, R. A. C., Brignardello-Petersen, R., Papola, D., Lytvyn, L., Vandvik, P. O., Merglen, A., Guyatt, G. H., & Agoritsas, T. (2017). Corticosteroids for treatment of sore throat: Systematic review and meta-analysis of randomised trials. BMJ, 358, j3887. https://doi.org/10.1136/bmj.j3887 

Zheng Ming, Wang Xiangdong, Ge Siqi, Gu Ying, Ding Xiu, Zhang Yuhuan, Ye Jingying, & Zhang Luo. (n.d.). Allergic and Non-Allergic Rhinitis Are Common in Obstructive Sleep Apnea but Not Associated With Disease Severity. Journal of Clinical Sleep Medicine, 13(08), 959–966. https://doi.org/10.5664/jcsm.6694

Sample Answer 2 for NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS

SUBJECTIVE DATA:

Chief Complaint (CC): “I have some stretch marks and a line on my abdomen’

History of Present Illness (HPI): A.T. is a 28-year-old female client that came to the clinic with complaints of abnormal stretch marks and a line on her abdomen. The client is pregnant. The gestation of her pregnancy is 28 weeks. She has never started her antenatal clinic visits. The patient reports that the problem started four weeks ago and she was hopeful that it would diminish over time. She denied any associated symptoms such as pain or itchiness. However, she was worried that she may be having a skin condition that would require immediate intervention. She has not used any skin medications for the problem.

Medications: The patient denied any current use of medications. She reported occasional use of Tylenol 1 gram for headaches.

Allergies: The patient reported allergic reaction to Penicillin and pollen. She denied food allergies.

Past Medical History (PMH): The patient reported a history of hospitalization when she was 18 years old because of pneumonia. She denied any history of chronic conditions such as diabetes and depression. She also denied any history of blood transfusion.

Past Surgical History (PSH): The patient denied any history of surgeries

Sexual/Reproductive History: The patient is sexually active. Her last menstrual period was 21/10/2022. She denied any history of sexually transmitted infections. She also denied any history of increased urgency, frequency, and dysuria. She does not have any history of pregnancy loss or use of contraceptives. She is heterosexual.

Personal/Social History: The patient is married. She is the first born in a family of three. Her parents are both alive. This is her first pregnancy. She works as an accountant in a local firm. She does not use alcohol or smokes. She engages in moderate physical activities twice weekly. She is a Christian. She considers her family her source of social support. She denies stress.

Health Maintenance: The patient engages in moderate exercises twice weekly. She does not take alcohol or smokes. She reports that she takes healthy diet. Her immunization record is up-to-date. She has not started her antenatal clinic despite her pregnancy being 28 weeks. She denies caffeine use. She has not undergone cervical cancer screening. She performs monthly self-breast examination. Her last dental and eye examinations were two years ago and were unremarkable.

Immunization History: Her immunization record is up-to-date.

Significant Family History: The client reports that her parents are both hypertensive. Her mother is diabetic. Her paternal grandmother and grandfather died of coronary artery disease. Her maternal grandmother died of cervical cancer. Her sister is obese. Her brother was recently diagnosed with substance use disorder.

General: The patient is well dressed for the occasion. She denied fatigue, fever, chills or night sweats. Reports weight gain of 10 pounds since she became pregnant.

HEENT: She denies changes in vision or hearing; she does wear glasses. She has no history of glaucoma, diplopia, floaters, excessive tearing or photophobia. She has had no recent ear infections, tinnitus, or discharge from the ears. She denied changes in sense of smell. She does not have a history of nasal polyps or recent sinus infection. She denied ulceration, lesions, gingivitis, gum bleeding, and has no dental appliances. She has had no difficulty chewing or swallowing.

Neck: She denies pain, injury, or history of disc disease or compression..

Breasts: She denies history of lesions, masses or rashes.

Respiratory: She denies cough, hemoptysis, difficulty breathing or chest pain. She a history of community acquired pneumonia when she was 18 years.

CV: She denies chest discomfort, palpitations, history of murmur. She has no history of arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication.

GI: She denies nausea or vomiting, abdominal pain. She also denies changes in bowel/bladder pattern.

GU: She denies change in her urinary pattern, dysuria, or incontinence. She is heterosexual. She denies history of STD’s or HPV. She is sexually active.

MS: She denies arthralgia/myalgia, arthritis, gout or limitation in her range of motion.

Psych: She denies history of anxiety or depression. She also denies sleep disturbance, delusions or mental health history.

Neuro: She denies syncope episodes or dizziness, paresthesia, change in memory or thinking patterns. She also denies twitches or abnormal movements, gait disturbance, falls or seizure history.

Integument/Heme/Lymph: She reports stretch marks and a line in the middle of her abdomen. She denies rashes, itching, or bruising.

Endocrine: She denies polyuria/polyphagia/polydipsia. She also denies fatigue, heat or cold intolerances, or shedding of hair

Allergic/Immunologic: She is allergic to Penicillin and pollen. She has no food allergies.

OBJECTIVE DATA

 Physical Exam:

Vital signs: B/P 124/78, left arm, sitting, regular cuff; P 82 and regular; T 99.9 Orally; RR 20; non-labored; Wt: 168 lbs; Ht: 6’5

General: A&O x3, NAD

HEENT: PERRLA, EOMI, oronasopharynx is clear

Neck: Carotids no bruit, jugular venous distention or thyromegally

Chest/Lungs: Lungs clear of wheezing or rhonchi

Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial

ABD:  presence of bilateral strae gravidarum and central linea nigra. Normal bowel sounds with no organomegaly and suprapubic

Genital/Rectal: Non-contributory

Musculoskeletal: symmetric muscle development. Muscle strengths 5/5 all groups.

Neuro: Normal cranial nerve assessment with no gait imbalance or coordination problems. There is no loss of sensitivity to touch.  

Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes

Diagnostic results: Obstetrics ultrasound performed one day ago: Intrauterine live pregnancy at 28/40 weeks in breech presentation. FHR-132 bpm, BPP 8/8, cervix closed

 ASSESSMENT:

Differential Diagnosis

• Linea nigra: Linea nigra is a hyperpigmentation characterized by a vertical line running down the middle of the abdomen. It is an indicator of pregnancy.
• Strae gravidarum: Strae gravidarum refers to atropic linear scars that pregnant mothers develop. The form as stretch marks on the abdomen and diminish over time.
• Post-inflammatory hyperpigmentation: Post-inflammatory hyperpigmentation is a disorder that develops after skin injury or inflammation. It is severe in dark-skinned individuals. It improves spontaneously but can also require treatment for immediate changes (Lawrence & Al Aboud, 2023). It is the least likely condition since the patient in the case study is pregnant.
• Melanocytic naevi: Melanocytic nevi are benign hematomas or neoplasms that cause skin hyperpigmentation. It mainly affects the central nervous system and the skin. Melanocytic nevi are the least likely cause of the client’s problem since they do not occur in features such as midline vertical line that is seen in pregnancy (Yeh, 2023)

Primary diagnosis

1. Normal pregnancy with features that include linea nigra and strae gravidarum: The client’s primary diagnosis is normal pregnancy with features that include linea nigra and strae gravidarum. Linea nigra is a normal occurrence in pregnant women. It refers to a form of hyperpigmentation that is witnessed in pregnancy. It is a dark vertical line running down the middle of the abdomen. It is an indicator of pregnancy. Linea nigra is associated with nipple, genital areas, and areola hyperpigmentation (Cappanera, 2022; Ferrando et al., 2019; Sharma et al., 2019). Strae gravidarum refers to atrophic linear scars that develop on the abdomen during pregnancy. They appear as stretch marks that may be of considerable concern to pregnant women (Dai et al., 2021). Strae gravidarum is non-pathological. The stretch marks fade over time and become hypopigmented (Karhade et al., 2021). The patient in the case study has these features, hence, a diagnosis of linea nigra and strae gravidarum. The patient is also pregnant, hence, the primary diagnosis with these conditions.

PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.

References

Cappanera, F. F., Gisella Sorrentino, Elena. (2022). Linea Nigra: Post/Human M/Others. In Engaging Donna Haraway. Routledge.

Dai, H., Liu, Y., Zhu, Y., Yu, Y., & Meng, L. (2021). Study on the methodology of striae gravidarum severity evaluation. BioMedical Engineering OnLine, 20(1), 109. https://doi.org/10.1186/s12938-021-00945-w

Ferrando, B. F., Sorrentino, G., & Cappanera, E. (2019). Linea Nigra: Post|Human M|Others. A/b: Auto/Biography Studies, 34(3), 501–505. https://doi.org/10.1080/08989575.2019.1664152

Karhade, K., Lawlor, M., Chubb, H., Johnson, T. R. B., Voorhees, J. J., & Wang, F. (2021). Negative perceptions and emotional impact of striae gravidarum among pregnant women. International Journal of Women’s Dermatology, 7(5, Part B), 685–691. https://doi.org/10.1016/j.ijwd.2021.10.015

Lawrence, E., & Al Aboud, K. M. (2023). Postinflammatory Hyperpigmentation. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK559150/

Sharma, A., Jharaik, H., Sharma, R., Chauhan, S., & Wadhwa, D. (2019). Clinical study of pregnancy associated cutaneous changes. International Journal of Clinical Obstetrics and Gynaecology, 3(4), 71–75. https://doi.org/10.33545/gynae.2019.v3.i4b.292

Yeh, I. (2023). Melanocytic naevi, melanocytomas and emerging concepts. Pathology, 55(2), 178–186. https://doi.org/10.1016/j.pathol.2022.12.341

Sample Answer 3 for NURS 6512 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS

SUBJECTIVE DATA:

Chief Complaint (CC): Graphic 5. Painful vesicles in the back and lower surface of the right arm for 5 days.

History of Present Illness (HPI): Calvin Harris is a 49-year-old Caucasian male who presents to the dermatology clinic complaining of multiple painful vesicles on his skin around his right side of the back, lower surface of the shoulder and upper right arm for 5 days that were preceded by a burning sensation. He describes the lesions as small fluid filled vesicles with an erythematous base, that first appeared as raised bumps. He reports that the eruptions began with a burning sensation and discomfort around the same area a few days prior to the appearance of the vesicles. He is HIV positive for 4 years and is on Tenofovir disoproxil fumarate 300 mg and Dolutegravir 50 mg, and Lamivudine 100 mg. He is also on cotrimoxazole 960 mg twice daily. The pain and the rash have affected his sleep and quality of life.

Medications:

1. Tenofovir disoproxil fumarate 300 mg once daily.
2. Dolutegravir 50 mg once daily
3. Lamivudine 100 mg once daily
4. Cotrimoxazole 960 mg twice daily.

Allergies:

Peanuts

Past Medical History (PMH):

1. HIV/AIDS
2. Tuberculosis- 2021
3. Pneumonia – 2020

Past Surgical History (PSH):

1. Appendicectomy- 2005
2. Adenotonsillectomy- 1980

Sexual/Reproductive History

Identifies as a heterosexual male

Personal/Social History:

He is a track driver.

Quit methamphetamine use 10 years ago.

No history of tobacco use.

Health Maintenance:

Colonoscopy- No polyps seen

Immunization History:

Tdap 10 years ago.

Covid19 Vaccination- 1^st dose 5/4/2021, 2^nd dose 6/5/2021, booster dose, 8/8/2023

Influenza vaccine-3/5/2018

Pneumococcal Conjugate Vaccine- 16/5/2022

Significant Family History:

Father died 4 years ago due to colorectal carcinoma.

Mother- diabetes mellitus diagnosed at age 68 years

One brother with schizophrenia diagnosed at age 49.

Review of Systems:

General: Mr. C.H is a middle-aged man, appears to be in a fair general condition, he is not in obvious pain or respiratory distress, is of good nutritional status.

HEENT: He denies headaches, blurring of vision, photophobia, double vision. He has no tinnitus, ear ache, or discharge. He has no nasal congestion, sore throat or difficulty swallowing.

            Respiratory: He denies cough, shortness of breath and wheezing.

Cardiovascular/Peripheral Vascular: He has no palpitations, no chest pain, no lower limb edema.

Gastrointestinal: He reports no constipation, no change of bowel habits, and no diarrhea.

Genitourinary: He denies, hesitancy, increased frequency, urethral discharge, dysuria and burning sensation on urination.

Musculoskeletal: He is negative for joint pains, muscle aches, stiffness of joints and reduced range of movements.

Neurological: Aside from the discomfort associated with the skin condition, Mr. C.H. does not report any neurological symptoms such as headache, dizziness, numbness, tingling, weakness, or changes in coordination.

Psychiatric: He denies any symptoms of depression, anxiety, mood changes, or sleep disturbances. He has no history of psychiatric disorders.

Skin/hair/nails:  Apart from the vesicles on the back and right arm, he has no discoloration of nails. He reports no easy falling off of the hair, no brittle hair.

 OBJECTIVE DATA:

            Physical Exam

Vital signs: BP-109/68 mm Hg left arm, sitting, Temp-98.4 axillary, RR- 15 b/min. Weight- 173 lbs. Height- 6’0. BMI- 23.5

General: Appears comfortable. Is oriented to time place and person, and is alert.

HEENT: Pupils bilaterally reactive to light, EOMI, nasopharynx is clear.

Neck: Has no distended neck veins, no scars, obvious masses.

Chest/Lungs: He has vesicular breath sounds, no wheezes, no crepitation, equal chest wall expansion.

Heart/Peripheral Vascular: Radial pulse bilaterally present, is of good volume, S1 and S2 heard, no murmurs, no thrills or heaves.

Abdomen: Abdomen is of normal fullness, moves with respiration, no organomegally, bowel sounds present, no ascites, no vascular bruits.

Genital/Rectal:

Musculoskeletal: No signs of joint swelling, erythema, there is muscle symmetry, no reduced range of movement.

Neurological: No focal neurological deficits. He reports hyperesthesia and significant pain along the affected dermatome.

Skin: He has multiple grouped vesicular lesions on the right side of the back, extending from the mid scapular region to the lower surface of the axilla and shoulder. The vesicles are approximately 0.5 to 1 cm in diameter in an erythematous background. The vesicles are filled with clear fluid. The skin is warm to touch at the affected side. No signs of flatulence.

Diagnostic results:

CBC- WBC- 16 000, Lymphocytes elevated.

Skin biopsy for histology- no parakeratosis, no dilated blood vessels, no perivascular infiltration of lymphocytes. Absence of suprapapillary thinning.

PCR for VZV DNA is positive.

KOH prep (for skin scrapping)- Negative.

ASSESSMENT:

Differential diagnoses

1. Herpes zoster
2. Herpes Simplex Virus Infection.
3. Plaque Psoriasis
4. Contact dermatitis
5. Dermatomycosis

Primary Diagnoses

Herpes Zoster (Shingles). The diagnosis of Shingles is strongly supported by the clinical presentation and characteristic features observed in the patient, plus the laboratory tests done (Patil et al., 2020 Herpes zoster is a viral infection caused by the reactivation of the varicella-zoster virus (VZV) within the dorsal root ganglia, often years after the initial chickenpox infection.  His immunity is immunocompromised with HIV which makes him susceptible to Herpes zoster infection (McKay et al., 2022). The patient first had a painful vesicular rash that follows a distinct dermatomal pattern, extending from his back to the lower surface of the axilla and shoulder. This dermatomal distribution is a hallmark of herpes zoster and corresponds to the affected sensory nerve pathway (Niederer et al., 2021). His description of burning sensations and discomfort preceding the eruption of vesicles is consistent with the prodromal phase frequently seen in herpes zoster, where patients experience neuralgic pain, itching, or tingling sensations (Rosamilia, 2020). The presence of vesicular lesions with clear fluid, some of which have ruptured and crusted, aligns with the characteristic appearance of herpes zoster blisters.

PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.

 References

McKay, S. L., Guo, A., Pergam, S. A., & Dooling, K. (2020). Herpes Zoster Risk in Immunocompromised Adults in the United States: A Systematic Review. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 71(7), e125–e134. https://doi.org/10.1093/cid/ciz1090

Niederer, R. L., Meyer, J. J., Liu, K., & Danesh-Meyer, H. V. (2021). Herpes zoster ophthalmicus clinical presentation and risk factors for loss of vision. American Journal of Ophthalmology, 226, 83-89. https://doi.org/10.1016/j.ajo.2021.02.002

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

Rosamilia, L. L. (2020). Herpes zoster presentation, management, and prevention: a modern case-based review. American Journal of Clinical Dermatology, 21(1), 97-107. https://doi.org/10.1007/s40257-019-00483-1