Pathophysiology of Disease Discussion Paper

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Pathophysiology of Disease Discussion Paper

Lab Assignment: Differential Diagnosis for Skin Conditions

Patient Initials: ___CL____               Age: ___433____                   Gender: ___M____

SUBJECTIVE DATA:

Chief Complaint (CC): The patient is a 33-year-old Caucasian male with symptoms that include fever, redness, swelling, discomfort, and warmth in the right lower limb around the shin area. This comes after unintentionally cutting himself a few days prior on a barn’s exposed nail. (The image chosen is number 4).  Pathophysiology of Disease Discussion Paper

History of Present Illness (HPI): The patient displayed the inflammation-related symptoms mentioned above. He disclaimed any prior instances of the same. Three days after sustaining the cut to his right lower limb, he claims to have been aware of the symptoms. The lesion feels warm to the touch and is painful in the typical way. He also laments having a temperature. Walking aggravates the discomfort, which is only momentarily relieved by painkillers and anti-inflammatory drugs like Tylenol. There is constant discomfort, warmth, and pain. He gives his symptoms an eight out of 10 for severity.

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Medications:

  1. Tylenol 1,000 mg prn. Bought over-the counter (OTC) for the pain.
  2. Zestoretic (lisinopril/ HCTZ) 10 mg/ 12.5 mg orally every day. This is a combination pill for the hypertension.

Allergies: He reports no known allergies to medications, food substances, or other known environmental irritants. Pathophysiology of Disease Discussion Paper

Past Medical History (PMH): He is a known hypertensive on lisinopril and hydrochlorothiazide (HCTZ) as Zestoretic.

Past Surgical History (PSH): He has no significant surgical history.

Sexual/Reproductive History: He describes himself as being heterosexual, is married, and has two children (a girl and a boy).

Personal/Social History: Patient CL is a truck driver who lives in a safe neighborhood on the outskirts of the metropolis with basic amenities such as water, a public transport network, good roads, and garbage collection services. He lives with his wife and two children and only on occasion leaves the house on the weekends to go out with friends. He is a social drinker and only drinks on these weekend outings but he denies smoking tobacco. He does not use his mobile phone while driving and always fastens his seatbelt when doing so. His hobbies include traveling, animal husbandry, and hiking.

Health Maintenance: Patient CL regularly goes for check-ups and follow-ups together with his family such as to the ophthalmologist, dentist, and otolaryngologist. Pathophysiology of Disease Discussion Paper

Immunization History: He had all of his shots as a child. He has received booster Tdap doses, as well as the flu and pneumonia vaccines, as an adult. After the pandemic started, he also received three doses of Covid-19, including a booster dosage.

Significant Family History: His father is obese and diabetic, while his mother is hypertensive. He has two siblings but none of them has any chronic illness.

Review of Systems (ROS):

General: Positive for fever but negative for malaise, chills, and weight loss.

HEENT: Negative for double vision, light sensitivity, otorrhea, tinnitus, runny nose, or sore throat.

Respiratory: Negative for difficulty in breathing, wheezing, or coughing.

Cardiovascular/Peripheral Vascular: Negative for chest pains, tightness, palpitations, or peripheral edema.

Gastrointestinal: Negative for diarrhea, vomiting, or nausea. Also denies changes in bowel movements.

Genitourinary: Negative for painful micturition, frequency of micturition, discharge, lesions, or oliguria.

Musculoskeletal: Negative for muscle pain, back pain, or joint pains.

Neurological: Negative for dizziness, syncope, or paraesthesia, paraplegia, paralysis, or loss of bowel and bladder control.

Psychiatric: Negative for anxiety or depression. Pathophysiology of Disease Discussion Paper

Skin/hair/nails: Positive for redness, swelling, warmth, and soreness of the skin on the lower right limb in the shin area but negative for rash or eczema (Ball et al., 2019).

OBJECTIVE DATA:

Physical Exam:

Vital signs: BP 135/90 regular cuff and sitting; P 81, regular; T 98.7° F; RR 17, non-labored; BMI 27.8 kg/m2 (overweight).

General: The patient is awake and well-oriented with regard to time, place, people, and events. He speaks in a goal-oriented manner that is coherent. He is appropriately dressed and groomed for the environment and time of day.

HEENT: Both pupils are equal, round, and reactive to light and accommodation (PERRLA). Extraocular muscles in both eyes are healthy (EOMI). The bilateral tympanic membranes exhibit good light reflex and the nasal turbinates are not inflamed. There is no erythema on the throat.

Neck: Absent jugular distension or cervical lymphadenopathy.

Chest/Lungs: Bilaterally both lung fields sound clear on auscultation with no crepitations, rales, rhonchi, or wheezing.

Heart/Peripheral Vascular: Heart sounds S1 and S2 audible with no murmur or bruit. Pathophysiology of Disease Discussion Paper

Skin: The whole of the right lower limb anteriorly and laterally is swollen, warm to the touch, red, and painful.

Diagnostic results:

  • C-reactive protein (CRP) is 8 mg/L. This is high and demonstrates that there is an inflammatory process going on.
  • His white cell count is 15,300 which is high and indicative of the presence of an infection. This is confirmed by the differential count showing the presence of leucocytosis.
  •  There are no tubercles or signs of lung consolidation on a standard antero-posterior (AP) chest X-ray (Hammer & McPhee, 2018). Pathophysiology of Disease Discussion Paper

ASSESSMENT:

From the above assessment of patient CL, a primary diagnosis and two differential diagnoses are made. These are discussed as follows:

  1. Cellulitis

The lower limbs are the most typical location for cellulitis, a serious illness brought on by a skin tear. The microbiota of the skin frequently contains the germs or bacteria that cause this ailment. In other words, they are the typical skin flora that surrounds a cut or skin breach (Hammer & McPhee, 2018). Any condition that weakens immunity or endangers the integrity of the skin predisposes a person to cellulitis. Among them are obesity, diabetes, and old age (Biglione et al., 2022). In these circumstances, staphylococci and streptococci are the most frequent causes of cellulitis. Methicillin-resistant Staphylococcus aureus (MRSA) poses major antibiotic treatment challenges, according to Rosenthal and Burchum (2018), as a leading cause of cellulitis.

  1. Thrombophlebitis

In thrombophlebitis, an inflammatory condition, one or more veins, usually in the legs, get blocked by a blood clot. A damaged vein may be deep within a muscle, resulting in deep vein thrombosis, or it may be close to the skin’s surface, resulting in superficial thrombophlebitis (Hammer & McPhee, 2018). Thrombophlebitis can be brought on by trauma (as in the case of patient CL), surgery, and prolonged immobilization, among other things. Pathophysiology of Disease Discussion Paper

  1. Contact Dermatitis 

This is a form of eczema or reaction that is brought on by an allergic response to a chemical. The affected area becomes inflamed, and it might be challenging to tell it apart from cellulitis (Hammer & McPhee, 2018). In this scenario, the existence of a positive history of unintentional trauma is the only factor that aids in the accurate diagnosis of cellulitis.

 

 

References

Ball, J., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2019). Seidel’s guide to physical examination: An interprofessional approach, 9th ed. Elsevier.

Biglione, B., Cucka, B., & Kroshinsky, D. (2022). Cellulitis and its mimickers: An approach to diagnosis and management. Current Dermatology Reports, 11(0), 138–145. https://doi.org/10.1007/s13671-022-00363-8

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.

Question:
• 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 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.
• Use clinical terminologies to explain the physical characteristics featured in the graphic. Pathophysiology of Disease Discussion Paper  Formulate a differential diagnosis of five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.
Formulate a different diagnosis of three to five possible considerations for the skin graphic. · Determine which is most likely to be the correct diagnosis, and explain your reasoning using at least three different references from current evidence-based literature. 50 to >44.0 pts
Excellent
The response clearly, thoroughly, and accurately formulates a different diagnosis of five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained clearly, accurately, and thoroughly using three or more different references from current evidence-based literature. Pathophysiology of Disease Discussion Paper

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5 to >4.0 pts
Excellent
Uses correct APA format with no errors.

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Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 to >4.0 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. Pathophysiology of Disease Discussion Paper

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

35 to >29.0 pts
Excellent
The response clearly, accurately, and thoroughly follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response clearly and thoroughly explains all physical characteristics featured in the graphic using accurate terminologies. Pathophysiology of Disease Discussion Paper