week 4 comprehensive soap
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. By Day 3 Post 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. Read a selection of your colleagues’ responses. By Day 6 Respond to at least two of your colleagues on two different days Make sure that you respond to colleagues who selected at least one graphic that is different from the ones you selected. For each, address all of the following: Critique your colleague’s clinical description of the physical characteristics of each. Suggest an additional possible condition for each graphic, and explain your reasoning. Provide an alternative correct diagnosis, and explain your reasoning. Validate an idea with your own experience and additional research. Comprehensive SOAP SLIDE 2: Patient Initials: __MP_____ Age: ___68____ Gender: _M SUBJECTIVE DATA: Chief Complaint (CC): Annual physical and multiple hard red bumps on my chest History of Present Illness (HPI): Mike Palmer is a 68-year-old Caucasian male who presents today for annual physical and want to address multiple hard red © 2014 Laureate Education, Inc. Page 1 of 10 bumps on his chest appearing. He reports there is a gradual onset of at least 4 new areas on his chest then last year. He is concerned he may have tumors because he did a google search and reported it said he had tumors on his chest. He denies any itching, pain, exudate, bleeding, color changes or climate variations. He reported they are located on his abdomen and chest. He denies any fever, new medications and no exposure to contact irritants. No increase in stress or lifestyle changes. No personal or family history of skin cancer. Medications: 1. Metoprolol 50mg BID Allergies: NKDA Past Medical History (PMH): 1. Hypertension: diagnosed at age 54 – well controlled Past Surgical History (PSH): 1. Repair of a torn rotator cuff, left shoulder (Dr. Bakker, Grand Haven, MI), age 40 Sexual/Reproductive History: Heterosexual, not sexually active Personal/Social History: Never smoked, denied ETOH or illicit drug use. Immunization History: His immunizations are up to date. He received the influenza vaccine last November 2016 and the Pneumococcal vaccine at the same time from Walgreens Pharmacy Significant Family History: Both parents deceased from car accident, no siblings. He has one daughter in her 30s, healthy, living in nearby neighborhood. Social History: He is a retired engineer, has been widowed x 7 years, and lives in his own home. He is not sexually active. He has one daughter and three grandchildren, all live close to him. He is very active and walks 2 miles daily. He attends Catholic mass daily then goes to breakfast at the same diner every morning with a group on 7 friends at the local diner. Review of Systems: General: Mr. Palmer is a well-developed, well-nourished Caucasian male who is alert and cooperative. Good hygiene. He is a good historian and answers questions appropriately.
Información del documento
- Subido en
- 11 de junio de 2022
- Número de páginas
- 10
- Escrito en
- 2017/2018
- Tipo
- Examen
- Contiene
- Preguntas y respuestas