Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine forthis Lab Assignment.
Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe thecharacteristics 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 LabAssignment.
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 theSullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not allcomprehensive SOAP data are included in every patient case
Skin Comprehensive SOAP Note Template
Patient Initials: __M.N_____ Age: ___26____ Gender: ____Female___
SUBJECTIVE DATA:
Chief Complaint (CC): stretch marks on the belly
History of Present Illness (HPI): 3 months ago
Medications: None
Allergies: None
Past Medical History (PMH): The patient has no history of major illnesses apart from a cold that she managed at home with home based remedies.
Past Surgical History (PSH): No previous surgeries
Sexual/Reproductive History: Six months pregnant.
Personal/Social History: The patient is a cashier in a retail store. She is married and this is her first pregnancy. She does not use alcohol or tobacco.
Health Maintenance: She has been engaging in low-intensity physical activity such as walking and dancing. She has been mainly consuming home-prepared meals with an emphasis on fresh fruits and vegetables and different types of healthy fluids.
Immunization History: The patient’s vaccination schedule is up to date. Her last jab was a tetanus jab that she had on August 14th, 2021.
Significant Family History: The patient’s parents are alive. Her grandparents died due to natural causes of death.
Review of Systems:
General: Weight gain, fatigue, nausea. No fever, chills, or weakness.
HEENT: Eyes: No visual loss, no blurred vision, no double vision or yellow sclerae. Ears, Nose, and throat. No hearing loss, no sneezing. Has nasal congestion. No sore throat or runny nose.
Respiratory: No shortness of breath, no cough, or sputum. The chest is clear and the patient has normal respiration depth and rhythm.
Cardiovascular/Peripheral Vascular: No chest pain, chest pressure or, chest discomfort. No palpations or, edema.
Gastrointestinal: Nausea and vomiting. No anorexia, no abdominal pain or blood.
Genitourinary: No burning on urination.
Musculoskeletal: No muscle pain, joint pain, back pain or, stiffness.
Neurological: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling of the extremities. Changes in bladder control.
Psychiatric: No history of depression or, anxiety
Skin/hair/nails: Skin around the belly has stretch marks. No rash, skin is warm to touch.
OBJECTIVE DATA:
Physical Exam:
Vital signs: Height 5’5, weight 148, BP 128/80, P 70
General: Weight gain, fatigue, no fever chills, or weakness
HEENT: Nasal congestion, no sneezing, no runny nose, no blurred vision, no double vision.
Neck:
Chest/Lungs: No shortness of breath, no cough or, sputum. The chest is clear and respiration rhythm is normal.
Heart/Peripheral Vascular: No chest pain or, chest pressure. Has no palpations or edema.
Abdomen: Tenderness around the belly button
Genital/Rectal: No masses, no tenderness
Musculoskeletal: No joint pain, no back pain or, muscle stiffness.
Neurological: No headache, dizziness, paralysis, numbness. Frequent bladder emptying
Skin: stretch marks around the belly
Diagnostic results:
Dermoscopy shows increased melanization (Oakley & Patel, 2021).
ASSESSMENT:
Based on the patient’s reproductive history, she is six pregnant with her first pregnancy which puts her at an increased risk of developing stretch marks. Nursing literature also indicates that striae are more common among women with darker skin tones as well young women compared to the older ones (Oakley & Patel, 2021). Greater prevalence is also linked to a bigger abdominal circumference and a significant weight gain which the patient exhibits.
Differential diagnosis
Striae gravidarum
Striae gravidum (SG) is the first primary diagnosis and the primary diagnosis based on the patient’s clinical manifestation and history of illness. SG is a common condition during pregnancy that causes disfiguring gestational changes affecting between 55 and 90 percent of women (Farahnik et al., 2016). The signs and the symptoms of the condition include atrophic linear scars. Striae gravidum causes itching, burning, and discomfort. It is most common in the late third trimester. The condition is caused by a combination of factors among them hormonal factors as well as an increase in the mechanical stress on the connective tissue. The pregnancy hormone milieu has been associated with influencing the connective tissue that is prone to the development of SG.
Linea Nigra
According to Florell et al. (2017), linea nigra is a longitudinal line that is located between the umbilical scar and the pubic symphysis. Sometimes it might extend up the xiphoid appendix. The line is caused by an increase in the levels of estrogen or progesterone during pregnancy. After giving birth and after the level of hormones return to normal, the linea nigra fades completely.
Linear focal elastosis
Linear focal elastosis is also known as elastotic striae. It is an abnormality of the elastic tissue characterized by symptomatic hypertrophic or atrophic, palpable yellowish or red indurated horizontal lines on the mid or lower back.
Striae from Topical Steroidal Abuse
Individuals with repeated use of topical steroids especially in areas where the skin touches skin can suffer from stretch marks. Stretch marks from topical use of steroids are usually permanent and irrevasible.The affected areas tend to become itchy.
Mid-Dermal Elastosis
Mid-dermal elastolysis refers to a rare hiatopathologic condition which is characterized by the wrinkling of the skin and mid-dermal loss of elastic fibers (Gambichler et al., 2020). The condition has been linked to inflammatory skin conditions like urticarial and granuloma annulare.
References
Farahnik, B., Park, K., Kroumpouzos, G., & Murase, J. (2016). Striae gravidarum: Risk factors, prevention, and management. International journal of women’s dermatology, 3(2), 77–85. https://doi.org/10.1016/j.ijwd.2016.11.001
Florell, A. J., Wada, D. A., & Hawkes, J. E. (2017). Linear focal elastosis associated with exercise. JAAD case reports, 3(1), 39–41. https://doi.org/10.1016/j.jdcr.2016.10.012
Gambichler, T., Mamali, K., & Scheel, C. (2020). A Brief Literature Update on Mid-dermal Elastolysis with an Emphasis on Pathogenetic and Therapeutic Aspects. The Journal of clinical and aesthetic dermatology, 13(9), E53–E58.
Oakley, A. M., & Patel, B. C. (2021). Stretch Marks. StatPearls [Internet].