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.

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

·         Ethicon, Inc. (n.d.c). Wound closure manual. Retrieved fromhttp://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_m

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Metaphor in The Author to Her Book

The Author to Her Book by Anne Bradstreet is a perfect representation of the author’s feelings towards her book following its publication and criticism for being an unfinished piece. Bradstreet uses the controlling metaphor in the poem to illustrate an author’s dissatisfaction with her book. In essence, she uses the leading metaphor entailing Bradstreet and her book to the association of a caring mother and her kid so as to demonstrate the complicated attitude of the author, which changes in the entire process of the work. The controlling metaphor represents the poem’s part that expresses the faults characterizing her book, which shows the author’s conflicting tone. Thus, Bradstreet uses metaphor in the poem to clearly communicate her emotions towards the publication of her works.

While Bradstreet applies extended metaphor in the poem, The Author to Her Book to stress her displeasure with the works, she demonstrates an unwillingness to abandon her original piece. In the first line, Bradstreet offers the overall description regarding her view of her own creation. For instance, she says “ill-formed offspring” to illustrate that the book is her own making and that it is flawed (Bradstreet 1). Additionally, the author expresses her feeling of embarrassment concerning the publication of her private pieces without her approval. Bradstreet feels disappointed that the works were published before they were corrected and edited. From line six to nine, the author compares the humiliation from her unperfected work to the shame that a parent experiences because of their irritable child. Moreover, Bradstreet shows her intention to delete errors in line 10 through 14 of the poem. However, she notices that it is impossible to erase errors since the poem is already printed. Line 9 through 10 demonstrates that Bradstreet is not the finest mother (Shmoop 1). The author attempts to renounce the work since it is “irksome”, meaning that the book is irritating and frustrating.

In The Author to Her Book, Bradstreet demonstrates her shame, which is manifested throughout the poem. She struggles with the aspect of her piece’s publication before perfection. In her skillful usage of extended metaphor, the author piles a complex series of parallels entailing parent and author as well as book and child, which are both creator to creation associations. As a result, the reader is emotionally connected to the author’s condition (eNotes 1). Furthermore, Bradstreet equates herself to an imperfect parent or mother through metaphor. In line 17 through 18, Bradstreet contends, “In better dress to trim thee was my mind, / But nought save homespun cloth I’th’ house I find” (Bradstreet 1). Bradstreet maintains that despite her intentions to perfect the text, she could only manage to “dress it” using homely cloth. Metaphorically, the concept implies that Bradstreet uses what is at his disposal while she recognizes that the flaws in the texts were as result of homeliness as well as her individual brain shortfalls. Overall, it can be said that the “child”/texts are flawed because of the defective mind of the creator, who is Bradstreet in this case. Bradstreet instructs the “child” in the final lines. Generally, she maintains that the “child” only has a missing mother, which is the reason why she is unable to dress in a better cloth despite her desire.

Other metaphors exist within the extended metaphor. Bradstreet illustrates that she “washed” the book’s face to suggest that she attempted to enhance the content and appearance of the book. However, Bradstreet says “And rubbing off a spot still made a flaw” to mean that she committed other blunders in the process of correcting the errors in the book (Bradstreet 1). The metaphors to illustrate Bradstreet’s activities on the work are responsible for the personification of the book as a “child”. She also uses metaphor in the last line as sending the book out of the door implies that the book is released for publication. In conclusion, extended metaphor is used in The Author to Her Book to precisely demonstrate Bradstreet’s displeasure with her book, which is released while still imperfect.

Works Cited

Bradstreet, Anne. The Author to Her Book. 1978. Available at: https://www.poets.org/poetsorg/poem/author-her-book

eNotes. What literary devices are most important in Anne Bradstreet’s poem, “The Author to Her Book”? 2011. Available at: https://www.enotes.com/homework-help/what-literary-elements-would-anne-bradstreets-poem-268355

Shmoop. The Author to Her Book by Anne Bradstreet. 2019. Available at: https://www.shmoop.com/the-author-to-her-book/mother-children-imagery.html