SOAP Note for 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 Discussion, 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.

Note: Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. 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.

To prepare:

·         Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion.

·         Consider the abnormal physical characteristics you observe in the graphics 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.

A description of the two graphics you selected (identify each graphic by number). Use clinical terminologies to explain the physical characteristics featured in each graphic. Formulate a differential diagnosis of three to five possible conditions for each. Determine which is most likely to be the correct diagnosis, and explain your reasoning.

REMINDERS:

 

Please follow the Note above. Do SOAP note format and check it out on the uploaded file the SOAP template as your outline for your writings… No traditional essay on this assignment, again use SOAP note. Thank you.

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Note: Because the information in this course is so vital, a large number of resources are provided in various formats to facilitate your competence in diagnosing a wide variety of health conditions. When multiple resources are available on the same topic, select those that best meet your personal learning needs to prepare you to accurately diagnose patient health problems.

 

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.

Readings

·         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.

o    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.

o    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). Fromhttps://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). Fromhttps://evolve.elsevier.com/

·         Chadha, A. (2009). Assessing the skin. Practice Nurse, 38(7), 43–48.

Retrieved from the Walden Library databases.

In this article, the author explains how to take a relevant skin health history. In addition, the article defines common terms used to describe skin lesions and rashes.

·         Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part I. Differential diagnosis. American Family Physician, 81(6), 726–734.

Retrieved from http://www.aafp.org/afp/2010/0315/p726.html

This article focuses on common, uncommon, and rare causes of generalized rashes. The article also specifies tests to diagnose generalized rashes.

·         Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part II. Diagnostic approach. American Family Physician, 81(6), 735–739.

Retrieved from http://www.aafp.org/afp/2010/0315/p735.html

This article revolves around the diagnosis of generalized rashes. The authors describe clinical features that may help in distinguishing generalized rashes.

·         Everyday Health, Inc. (2013). Resources for dermatology and visual conditions. Retrieved fromhttp://www.skinsight.com/ info/for_professionals 

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

·         Document: Skin Conditions (Word document)

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

·         Document: Comprehensive SOAP Exemplar (Word document)

·         Document: Comprehensive SOAP Template (Word document)

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

·         LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.

o    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 fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/absorbable_suture_chart.pdf

·         Ethicon, Inc. (2006). Dermabond topical skin adhesive application technique. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_application_poster.pdf

·         Ethicon, Inc. (2001). Ethicon needle sales types. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/needle_template.pdf

·         Ethicon, Inc. (n.d.b). Ethicon sutures. Retrieved fromhttp://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 fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_wound_care.pdf

·         Ethicon, Inc. (2005). Knot tying manual. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/knot_tying_manual.pdf

Introduction

Skin disorders are among the most frequent reasons for patient visits in primary care, and they often present a diagnostic challenge due to the broad range of possible causes and similar visual presentations. Properly identifying a skin condition requires more than simple observation—it involves a systematic process known as differential diagnosis, through which a clinician evaluates the patient’s symptoms, physical findings, and history to rule out less likely causes and determine the most probable diagnosis. Because many dermatologic disorders share overlapping features such as erythema, scaling, or vesiculation, the clinician’s ability to recognize subtle differences in morphology, distribution, and progression is essential to accurate assessment and management.

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This discussion focuses on the application of differential diagnosis in evaluating two selected skin condition graphics from the provided learning resources. By observing abnormal features—such as lesion color, shape, texture, and distribution—and describing them using clinical terminology, the analysis demonstrates how healthcare professionals systematically narrow down potential diagnoses. The approach is guided by evidence-based resources, including Seidel’s Guide to Physical Examination (2015) and Dains, Baumann, and Scheibel (2016), which emphasize structured observation, patient history, and diagnostic reasoning in dermatologic assessment.

The discussion will follow the SOAP note format (Subjective, Objective, Assessment, and Plan), allowing for an organized and clinically relevant presentation. Within this framework, each skin condition will be examined through a differential list of three to five possible diagnoses, supported by clinical reasoning that leads to the most likely condition. This method reinforces the critical thinking and diagnostic skills necessary in advanced nursing practice, ensuring that healthcare providers deliver accurate, patient-centered care.

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ASSESSMENT 1B – RESPONSE TO CASE STUDY (20%)

Due: Week 5

Word Count: 1,500 words (+/- 10%)

Task: For this assessment, you are required to demonstrate your understanding of key developmental theories and their application to real-life scenarios.

1. Read the case study (provided below).
2. Review Chapters 1 and 2 of the prescribed textbook: Sigelman, C. K., & Rider, E. A. (2017). Life-span human development.
3. Select TWO developmental theories from the following list and apply them to the case study:

o Erikson’s Psychosocial Theory

o Bronfenbrenner’s Ecological Systems Theory

o Bandura’s Social Learning Theory

Assessment Questions 1. Comparative Analysis (example, 750 words): Identify and describe aspects of Kalina and Yara’s upbringing and environments that were similar, as well as those that differed. Use the two selected theories to analyse and support your discussion. 2. Impact on Development (example, 750 words): Discuss how these factors may have influenced the developmental trajectories of Kalina and Yara, and how they contribute to their current divergent lifestyles. Academic Requirements • Support your arguments with references from at least five recent scholarly journal articles (published within the last 7–10 years), in addition to the prescribed textbook. • Use APA 7th edition for in-text citations and the reference list. • Ensure your response demonstrates critical analysis, application of theory, and integration of evidence-based literature.

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Assessment 1B – Case Study Kalina and Yara are 22-year-old identical twin sisters who were born and raised in Dubbo, a large regional town in New South Wales. Their early childhood was unsettled. Their mum, who was raising them on her own, struggled with alcohol misuse and couldn’t provide consistent care. When the twins were three years old, they were placed in foster care and grew up in separate homes. Kalina was placed with foster parents who had no other children. They gave her a lot of one-on-one attention and supported her schooling by enrolling her in a private school in Dubbo. Her foster family also encouraged her to take part in community sports and activities. As a young adult, Kalina has continued on this path. She is now studying a Master’s degree at a university in Sydney, is very committed to her studies, and has built a close circle of supportive friends. She is active in student clubs, fitness groups, and sporting teams. While generally calm and well-mannered, Kalina often demonstrates vocal outbursts, particularly when faced with defeat in sporting matches. Yara went to live with foster parents in Dubbo who often cared for several foster children at once. The home was busy and at times unpredictable, with children coming and going. She went to the local public school, where she struggled academically and often clashed with teachers. Yara currently has no job and spends most of her day sleeping and her nights socialising with a group of local young adults, often engaging in excessive alcohol consumption. When drinking, she frequently becomes irritable with her friends, displaying aggressive behaviour and intimidating them with threats of violence.

Introduction

Human development is a lifelong process influenced by a complex interplay of biological, psychological, and environmental factors. Understanding how these forces interact is critical to explaining the differences in individual outcomes, even among people with similar genetic makeups or early life experiences. The case study of Kalina and Yara, 22-year-old identical twin sisters raised in distinct foster environments, provides a valuable context for exploring how developmental theories explain variations in personality, behavior, and life trajectory. Despite sharing identical genetic material and early childhood adversity, the sisters’ current lifestyles diverge significantly—Kalina demonstrates academic motivation, emotional stability, and strong social ties, whereas Yara exhibits maladaptive behaviors, social instability, and poor self-regulation. These contrasts underscore the importance of examining the dynamic relationship between individual, environmental, and social influences throughout development.

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This essay aims to apply Erikson’s Psychosocial Theory and Bronfenbrenner’s Ecological Systems Theory to analyze the developmental paths of Kalina and Yara. Both frameworks offer complementary insights into how early life experiences and environmental contexts shape identity, coping mechanisms, and socio-emotional development. Erikson’s model emphasizes the progression through psychosocial stages, each involving a core conflict that contributes to personality formation and social competence. In contrast, Bronfenbrenner’s ecological perspective situates development within nested systems—ranging from immediate family and school settings to broader social and cultural structures—that interact over time to influence behavior and adjustment. Applying these theories to the case study enables a deeper understanding of how the twins’ differing environments and support systems affected their developmental outcomes.

The discussion will proceed in two main sections. The first section will provide a comparative analysis of the twins’ upbringing and environmental contexts using Erikson’s and Bronfenbrenner’s theoretical lenses. The second section will explore the impact of these differences on their developmental trajectories, examining how their early experiences contributed to their current psychosocial adjustment and lifestyle patterns. The analysis will integrate evidence-based literature from recent scholarly sources to support theoretical interpretation and demonstrate the relevance of developmental psychology in real-life contexts.

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NU 665 WEEK 3 ASSIGNMENT

Instructions

For this assignment, you will review the following case study and complete the Complicated Pregnancy Case Study Questions (Word).

Your answers should be thorough and match the complexity of the scenario. Provide resources to support your answers. You will need a minimum of two scholarly references to support your work, one of which should be from a nursing journal.

Please refer to the Grading Rubric for details on how this activity will be graded.

Introduction

This paper presents a focused analysis of a Complicated Pregnancy Case Study, applying advanced clinical reasoning to evaluate maternal and fetal risks, interpret diagnostic data, and develop an evidence-based management plan. Complicated pregnancies demand careful synthesis of obstetric, medical, and psychosocial information; timely decision-making can materially affect perinatal outcomes. Using the Complicated Pregnancy Case Study Questions as a guiding framework, this assignment will systematically address pertinent history, physical findings, laboratory and imaging results, differential diagnoses, and appropriate interventions that align with current standards of care.

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The analysis emphasizes a holistic approach that integrates physiologic considerations (e.g., hypertensive disorders, gestational diabetes, infection), obstetric risk factors (e.g., fetal growth restriction, preterm labor), and psychosocial contributors (e.g., access to care, social support, mental health). Each clinical recommendation will be supported by scholarly evidence, including at least two peer-reviewed references—one from a nursing journal—to ensure that nursing-sensitive considerations and interprofessional collaboration are highlighted. Special attention will be given to patient safety, ethical and legal implications of care decisions in pregnancy, and the importance of clear communication with the patient and family.

Outcomes of the case analysis will include prioritized differential diagnoses, monitoring parameters, immediate and longer-term management strategies, and referrals or consultations necessary for comprehensive care. The goal is to demonstrate competency in synthesizing complex clinical data into a coherent, patient-centered plan that optimizes maternal and neonatal health while respecting patient values and informed consent. This paper will thereby illustrate how evidence-based practice and interprofessional teamwork guide high-quality management of complicated pregnancies.

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NU 665B WEEK 5 DISCUSSION

Complete this assignment according to the Week 5 Pair Presentation assignment instructions.

Please refer to the Grading Rubric for details on how this activity will be graded. Please remember that you and your partner must each submit the assignment, even if it is the same file so that you both receive feedback and credit.

You may view each other’s submission and comment if you would like. Reply posts are optional for this assignment and students will only be graded on the Pair Presentation that they submit.

Primary Care of the Psychiatric Mental Health Client II

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Week 5 Presentation Instructions

You and your partner will create a 15–30-slide PowerPoint presentation with voice over on one of the following topics:

ADHD

Social communication disorder

Oppositional defiant disorder

Gender dysphoria

Depression

Obsessive compulsive disorder

Social anxiety disorder

Reactive attachment Disorder

Autism spectrum disorder

Self-injurious behavior

Traumatic loss / grief

Bipolar disorder

Generalized anxiety disorder

Separation anxiety disorder

Movement disorder

Eating/feeding disorder

Completing this presentation will prepare you to:

Remember the diagnostic criteria of your chosen topic.

Create an evidence-based treatment plan for a patient with the chosen condition, including pharmacologic and non-pharmacologic treatment

options.

Summarize factors that may lead to positive and negative outcomes for patients served and how the role of the PMHNP can improve outcomes.

Create your PowerPoint presentation with the objective of teaching your peers about your chosen topic. For tips on effective preparation of PowerPoint

presentations, see standards of professional development for Microsoft PowerPoint presentations.

The assignment must include the following:

1. Three learning objectives for the activity
2. DSM-5 criteria
3. Screening tools with validity and reliability
4. Pharmacologic and non-pharmacologic treatment options
5. Differences in symptoms and treatments across the lifespan, if applicable
6. Ethical and legal considerations
7. Potential barriers to treatment related to cultural and/or socioeconomic factors and how these impact outcomes of populations served
8. An analysis of how the PMHNP role can serve to improve outcomes for individuals with your chosen diagnosis.

Introduction

Psychiatric disorders in children, adolescents, and adults present complex challenges that require evidence-based and individualized approaches to diagnosis and treatment. This presentation aims to provide a comprehensive overview of a selected psychiatric condition by integrating current research, diagnostic standards, and treatment strategies. The goal is to enhance understanding of the disorder’s presentation across the lifespan, explore appropriate management options, and highlight the critical role of the Psychiatric-Mental Health Nurse Practitioner (PMHNP) in improving patient outcomes.

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The selected topic will be examined through a clinical and theoretical lens, beginning with a review of the DSM-5 diagnostic criteria to establish a foundation for accurate identification and assessment. Validated screening tools will be discussed, emphasizing their reliability and clinical utility. The presentation will also outline pharmacologic and non-pharmacologic interventions, supported by the latest evidence-based guidelines. Additionally, it will explore ethical and legal considerations, along with cultural and socioeconomic factors that may influence diagnosis, treatment adherence, and overall outcomes.

By addressing variations in symptom expression and treatment response across developmental stages, this presentation underscores the importance of lifespan-informed care. Furthermore, it examines potential barriers to effective management and provides strategies to mitigate them through patient education, collaboration, and culturally competent practice. Ultimately, this presentation seeks to strengthen clinical competence and reinforce the PMHNP’s pivotal role in promoting recovery, resilience, and quality of life among individuals with psychiatric disorders.

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NU 665 WEEK 7 DISCUSSION POST 1: EVALUATING A TREATMENT PLAN FOR A PATIENT WITH POST-TRAUMATIC STRESS DISORDER (PTSD)

Value: 100 points

Due: Create your initial post by Day 3 and reply to at least two of your peers by Day 7.

Grading Category: Discussions

Note: In this type of discussion, you will not see the responses of your classmates until after you have posted your own response to the following prompt.

This is an exercise intended to help you identify the benefits and shortcomings of generative artificial intelligence (GAI) use in healthcare and education settings.

The following prompt was entered into ChatGPT™: “Create a PMHNP treatment plan for a 49-year-old female Latinx patient with a diagnosis of PTSD and alcohol use disorder”.

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Initial Post

Critique the Treatment Plan for PTSD developed by ChatGPT™ by creating a video up to five minutes long answering any two of the following prompts.

• Please provide a brief rationale for each test in the diagnostic tools section. Are they appropriate?
• Establishing treatment goals: Are the short-term and long-term goals appropriate?
  • Brief reflection: do you set clear treatment goals in clinical?
• Please describe the treatment plan you would choose for this patient.
  • Pharmacologic option for PTSD
  • Pharmacologic option for alcohol use disorder
  • Type of therapy and why
• Please briefly describe the strengths and shortcomings of
  • The non-pharmacologic treatment options for this patient
  • The patient education section
  • The follow up plan
  • Addressing of the patient’s cultural needs

You will need to cite at least two research-based resources for this discussion.

To create your video, follow the instructions for Zoom Tutorial and create an unlisted YouTube video. The following tools can be used to create your video: Zoom or your personal preference.

You will need to submit the YouTube video URL for this discussion. The best way to do this is to copy and paste the hyperlink URL for the YouTube video into a Word document. Your faculty will access your video via the link. Do not upload a video file (mp4).

Replies

Reply to at least two of your peers. In each of your reply posts, write a maximum of two paragraphs (with two to three sentences each). Describe what you would do differently than your peer. Also explain something new you learned from your peer’s post. These paragraphs should synthesize one to two pieces of research.

Please make certain that your initial and reply posts are in APA format. Please refer to the Grading Rubric for details on how this activity will be graded.

The described expectations meet the passing level of 80%. You are directed to review the Discussion Grading Rubric for criteria which exceed expectations.

Introduction

For this discussion, you will review and critique a ChatGPT-generated treatment plan developed for a 49-year-old Latinx female diagnosed with Post-Traumatic Stress Disorder (PTSD) and Alcohol Use Disorder (AUD). The purpose of this exercise is to critically evaluate the strengths and limitations of Generative Artificial Intelligence (GAI) in formulating psychiatric treatment plans, particularly in the context of cultural sensitivity, diagnostic accuracy, and clinical applicability. As artificial intelligence tools become increasingly integrated into healthcare and education, it is essential for psychiatric-mental health nurse practitioners (PMHNPs) to understand both their potential and their shortcomings in clinical decision-making.

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PTSD and AUD often coexist, creating complex challenges for treatment planning, adherence, and recovery. This case invites reflection on how GAI models conceptualize trauma-informed care, pharmacologic management, and evidence-based psychotherapy. It also encourages a closer look at whether AI-generated plans appropriately address cultural identity, language considerations, and the patient’s lived experiences, all of which are vital components of holistic and ethical mental health care.

In this discussion, I will focus on two key areas: (1) evaluating the appropriateness and rationale of the diagnostic tools used in the AI-generated treatment plan, and (2) examining the strengths and weaknesses of the non-pharmacologic and patient education components. The goal is to determine how well ChatGPT aligns with current clinical practice guidelines and to identify areas where human clinical judgment, empathy, and cultural competence remain irreplaceable.

By analyzing this AI-generated treatment plan through a professional nursing lens, this discussion aims to highlight how PMHNPs can responsibly integrate GAI tools into practice—leveraging their efficiency while maintaining critical thinking, cultural sensitivity, and evidence-based care.

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