NURS 6512 Week 4 Assignment – Step-by-Step Guide

The first step before starting to write the NURS 6512 Week 4 Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NURS 6512 Week 4 Assignment

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. 

Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NURS 6512 Week 4 Assignment

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NURS 6512 Week 4 Assignment

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NURS 6512 Week 4 Assignment

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NURS 6512 Week 4 Assignment

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NURS 6512 Week 4 Assignment

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded, in sentence sentence care. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

An Example NURS 6512 Week 4 Assignment Follows:

Week 4 Lab Assignment: Differential Diagnosis for Skin Conditions – Skin Comprehensive SOAP Note Template

Patient Initials: ____J.D.___        Age: _____45__            Gender: __Male_____

SUBJECTIVE DATA: 

Chief Complaint (CC): Figure 5 shows a cluster of red, inflamed blisters and sores on the patient’s upper back and shoulder.

History of Present Illness (HPI): A 45-year-old male African American man presents at the clinic with complaints of a blistering, painful rash on his upper back and shoulder. He reports that the rash first developed on the right side of his upper back, close to the base of his neck, five days ago. It began as a few red, itchy bumps that soon became fluid-filled blisters. Some blisters have ruptured or dried over the last 24 hours, forming crusts. The rash is tender and painful to touch and has an associated itch that becomes increasingly bothersome, especially at night and upon friction from clothing. He denies any recent fever, chills, fatigue, or malaise. He also denies any history of trauma or contact with known allergens. The rash is confined to the upper right shoulder and back and does not involve other body areas. He uses cool compresses to provide temporary relief from itching and pain. The rash is causing significant discomfort and impacting the patient’s sleep. He seems concerned about the rash’s appearance and the possibility of scarring.

Medications: Acetaminophen 500mg, 1-2 tablets every 4-6 hours as needed for pain. Diphenhydramine 25mg, one tablet at bedtime for itching.

Allergies: No known food or environmental allergies.

Penicillin allergy with mild rash reaction in childhood

Past Medical History (PMH): No history of diabetes, hypertension, asthma, or other chronic conditions.

Past Surgical History (PSH): Appendectomy at age 20 due to acute appendicitis

Sexual/Reproductive History: Heterosexual. Married for 20 years in a monogamous relationship. Negative history of sexually transmitted infections (STIs).

Personal/Social History: The patient is a 45-year-old married man with two children, aged 14 and 12. He is a construction foreman and finds relaxation in activities such as golfing and fishing during his leisure time. Although he gave up smoking five years ago, he does consume alcohol during social events.

Health Maintenance: Have you received any recent immunizations or health screenings appropriate for your age and risk factors?

He undergoes regular blood pressure and cholesterol checks

Has not participated in recent cancer screenings due to lack of perceived risk factors.

Immunization History: Up-to-date on other adult vaccines according to current guidelines. Tetanus booster received five years ago.

Significant Family History: Mother: History of Type 2 diabetes diagnosed at age 55, currently well-controlled with medication and lifestyle changes.

Father: Deceased at age 60 from complications of lung cancer.

Review of Systems: 

General: Denies fever, chills, changes in appetite, weight loss, or fatigue. He reports feeling well overall despite the discomfort from the rash and admits to having difficulties sleeping due to the itching and pain.

HEENT:

·       Head: No reports of recent headaches

·       Eyes: Denies any vision changes, eye pain, or discharge.

·       Ears, Nose, and throat: Denies ear/nose/throat issues.

Respiratory: Denies cough, shortness of breath, or chest pain.

Cardiovascular/Peripheral Vascular: Denies chest pain, palpitations, or leg swelling.

Gastrointestinal: Denies abdominal pain, nausea, or vomiting.

Genitourinary: Denies urinary frequency, urgency, or dysuria.

Musculoskeletal: No joint pain, stiffness, or weakness beyond the discomfort in the affected back and shoulder area.

Neurological: Denies headaches, dizziness, weakness, numbness, or tingling sensations.

Psychiatric: Denies mood changes, anxiety, or depression.

Skin/hair/nails: Reports the presence of the rash in a cluster of red, inflamed blisters and sores on the upper right side of the back and the right shoulder. The rash covers a large area of the skin, from the base of the neck to the middle of the back and from the spine to the edge of the shoulder. It follows a stripe-like pattern.

OBJECTIVE DATA:

Physical Exam:
Vital signs: Temperature: 98.6°F, Pulse: 80 beats per minute, Blood pressure: 130/80 mmHg, Respiratory Rate: 16 breaths per minute
General: A well-nourished male of average build appears his age and is not in acute distress. However, due to the rash, he appears slightly uneasy but cooperative.
HEENT:

·   Head: Normocephalic and atraumatic.

·       Eyes: Pupils equal, round, and reactive to light. No conjunctival injection.

·       Ears: Bilaterally, canals are clear, and there is no discharge.

·       Nose: Nasal mucosa is pink, but there is no evidence of rhinorrhea or bleeding.

·       Throat: Oropharynx clear, moist, no erythema or exudates.

Neck: Supple, no jugular venous distention,  thyroid enlargement, or tenderness. Lymph nodes are not palpable.
Chest/Lungs:  Symmetrical chest expansion. Clear breath sounds bilaterally.
Heart/Peripheral Vascular: Regular rate and rhythm. No murmurs, rubs, or gallops. Radial and dorsalis pedis pulses are present and equal bilaterally.
Abdomen: Soft, non-tender, and not distended. No organomegaly or masses are palpable. Bowel sounds present.
Genital/Rectal: deferred
Musculoskeletal: Full range of motion in all extremities. No joint deformities or swelling.
Neurological: Alert and oriented to person, place, and time. Cranial nerves were intact—no motor or sensory deficits.
Skin: On the upper right side of the back and shoulder, extending from the base of the neck to the middle of the back and from the spine to the edge of the shoulder, there is a cluster of erythematous (red) tender fluid-filled blisters and pustules. Some vesicles have ruptured or dried, forming yellowish-brown crusts. The lesions are arranged in a stripe-like pattern following the dermatome distribution, consistent with T4 and T5 nerve distribution. The rash is unilateral and does not cross the midline to the left side of the back or chest. No other skin lesions are present in other areas of the body.

Diagnostic/Lab test and results: 

Culturing of Skin Swab: Used to detect potential bacterial or secondary infections.

Tzanck Test: Conducted to identify multinucleated giant cells, assisting in identifying viral conditions like herpes zoster (Yamamoto & Aoyama, 2021).

Complete Blood Count: Employed to evaluate indicators of infection, such as increased levels of white blood cells.

ASSESSMENT: 

Primary Diagnosis: Shingles (Herpes Zoster)

Herpes zoster, also known as shingles, occurs when the varicella-zoster virus becomes active again following a bout of chickenpox. It commonly manifests in adults and the elderly due to an impaired immune system. The virus replicates in nerve cells and causes inflammation and blistering on the skin, leading to pain from affected nerves (Nair & Patel, 2020). The rash’s location, appearance, history of pain, and distribution are all highly suggestive of shingles. The striped pattern, inflamed blisters, and unilateral presentation are classic features of this condition.

The rash adheres to the T4 and T5 dermatome pattern, a traditional manifestation of shingles along a specific nerve pathway. The combination of vesicles and pustules is a distinctive shingle feature, particularly during later stages.

Differential Diagnosis

Herpes Simplex Virus (HSV) Infection

Herpes simplex virus (HSV) infection can be recurrent and show up as a dermatomal distribution, similar to herpes zoster. The condition may be misdiagnosed if further laboratory testing is not performed (Janniger, 2021). While less likely due to the unilateral distribution and lack of involvement of the face or genitals, HSV-2 (genital herpes) can cause clustered blisters on the upper body in rare cases. However, the size and appearance of the blisters in the patient are more characteristic of shingles. Though less likely due to the unilateral distribution and location, HSV can also cause vesicular and pustular rashes. Viral cultures or PCR testing can help differentiate between HSV and shingles (Nikolic et al., 2019).

Folliculitis

Folliculitis is histologically characterized by inflammatory cells in the hair follicle wall and Ostia, forming a pustule based on the follicle (Satter, 2021). The composition of inflammatory cells differs based on the cause of folliculitis and the timing of the biopsy specimen collection (Satter, 2021). The rash’s pattern on the upper back and shoulder area, characterized by pustules and crusting, suggests the likelihood of bacterial folliculitis. This condition may be influenced by the patient’s occupation and potential exposure to dirt or contaminants. Multiple hair follicles affected by deep folliculitis may exhibit a pustular appearance, resembling a component of the rash. Nevertheless, the absence of central hair shafts and the pattern of stripe-like distribution reduce the probability of folliculitis.

Contact Dermatitis

Contact dermatitis is a skin condition characterized by swelling and eczema. It occurs due to exposure to chemicals or metal ions that have toxic effects without causing a T-cell response, known as contact irritants, or due to small reactive chemicals altering proteins and provoking both innate and adaptive immune responses, known as contact allergens (Litchman et al., 2023). The patient’s occupation as a construction foreman increases the risk of developing contact dermatitis due to potential exposure to irritants or allergens in the work environment. The initial erythematous and pruritic papules and the possibility of exacerbation due to friction from garments are consistent with contact dermatitis. As stated by Litchman et al. (2023), contact dermatitis manifests as erythematous and pruritic skin, potentially progressing to the formation of blisters.

Allergic Reaction

An allergic reaction to a medication or contact allergen could produce a vesicular rash. However, the absence of recent medication changes or known exposures and the unilateral distribution make this less likely.

NURS 6512 Week 4 Assignment References

Janniger, C. K. (2021). Herpes zoster differential diagnoses. Emedicine.medscape.com. https://emedicine.medscape.com/article/1132465-differential#:~:text=Diagnostic%20Considerations

Litchman, G., Nair, P. A., Atwater, A. R., & Gossman, W. G. (2023, February 9). Contact dermatitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459230/

Nair, P. A., & Patel, B. C. (2020). Herpes zoster (shingles). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441824/

Nikolic, D., Kohn, D., Yen-Lieberman, B., & Procop, G. W. (2019). Detection of herpes simplex virus and varicella-zoster virus by traditional and multiplex molecular methods. American Journal of Clinical Pathology, 151(1), 122–126. https://doi.org/10.1093/ajcp/aqy111

Satter, E. K. (2021). Folliculitis: Background, pathophysiology, etiology. EMedicine. https://emedicine.medscape.com/article/1070456-overview

Yamamoto, T., & Aoyama, Y. (2021). Detection of multinucleated giant cells in differentiated keratinocytes with herpes simplex virus and varicella zoster virus infections by modified tzanck smear method. The Journal of Dermatology, 48(1), 21–27. https://doi.org/10.1111/1346-8138.15619

You have completed a soap note on skin conditions. You will now assess the head, eyes, ears and nose in week 5 assignment of NURS 6512. A case study will be provided, alongside a soap note template to complete. Be keen with your differential diagnosis and the diagnostic tools, if any.

Frequently Asked Questions (FAQs)

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Certainly, to see the structure and flow of a well-written essay, you might want to take a look at a student’s writing guide that provides insights and examples.

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Formatting guidelines typically involve using a legible font like Times New Roman or Arial, size 12, with double-spacing and one-inch margins on all sides. Check any specific requirements your instructor might have provided.

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For a personal essay, focus on a singular event or characteristic, ensuring your ideas are clear and you reflect on the significance of the subject matter. Use concise language and powerful imagery to maximize impact.

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