Case Study For Indented Streaks On The Abdomen Assignment

Case Study For Indented Streaks On The Abdomen Assignment

To Prepare
Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.
Consider the abnormal physical characteristics you observe in the graphic 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 Case Study For Indented Streaks On The Abdomen Assignment.

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Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.
The Lab Assignment
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. Formulate a differential diagnosis of three to 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 Case Study For Indented Streaks On The Abdomen Assignment.

The Lab Assignment: SOAP Note

Skin condition: Picture 2# Striae

Patient information

Patient initials:  R.K        Age: 28           Race: Hispanic       Gender: female

S.

CC:” Indented streaks on the abdomen.”

HPI: R.K, a 28-year-old Hispanic woman in her 30th week of pregnancy, presented to the clinic with the primary complaint of indented streaks on her abdomen that had grown in the previous two weeks. The patient denies any pain in the affected areas, but concedes that the area is itchy and the band is deepening. She observed small pink pimple-like lesions in her stretch marks, which had spread to her extremities. She reported having trouble sleeping due to itchiness and took diphenhydramine, an over-the-counter medication, with minimal success. The patient reports no headaches, vomiting, or diarrhea.

Medication: Vitafusion Prenatal Gummy and diphenhydramine 25mg QID for itchiness.

Allergies: no known drug and food allergies

PMH: No chronic illness reported.

Immunization: Up to date.  He last received his Covid-19 Janssen vaccine on 11/7/2021. Got her Tdap vaccine on 6/6/22.

Past surgical history: no history was reported.

Family history: Mother (57-year-old): hypertension. Father (64-y/0): Throat cancer. Maternal grandfather (deceased): Diabetes type 2

Social history: R.K, a 28-year-old patient, works as a part-time instructor at a nearby school. She is married to a wonderful man named John and has four children. The patient denies smoking but confesses to drinking alcohol on occasion. She mentioned going to gymnastics twice a week for exercise. She is financially secure, and her health is insured. The patient stated that he lives in a safe area. She stated that she was wearing a seat belt and that she was not using her phone while driving. She also stated that she ate a well-balanced diet high in fruits and vegetables. Case Study For Indented Streaks On The Abdomen Assignment

ROS

General: No fevers, chills, but significant weight gain reported.

HEENT: Denies pain, loss of vision, ringing in the ears, loss of hearing, and sinusitis.

Cardiovascular: Denies chest pain, irregular heartbeats, palpitation, and cardiac murmurs, or paroxysmal nocturnal dyspnea.

Respiratory: The patient denies chronic cough, SOB, and dyspnea on exertion.

GI: Denies vomiting, or experiencing diarrhea. The denies any change in bowel habits regurgitation or heartburn.

GU: The patient denies issue with urination, pain or burning. She denies cloudy or smoky urine. Denies nocturia and urine frequency.

Msk: No myalgias or arthralgias. Denied of history of trauma or orthopedic injuries.

Neurologic: Denies chronic headaches, seizures, and numbness in lower extremities.

Psychiatric: Denies depression or anxiety. Reported hypersomnia owing to itchiness in the afflicted region.

Endocrine: Denies heat or cold intolerances

Skin/lymph/heme: No rashes and bruits reported. She reported having multiple indented streaks on her abdomen and small pink pimple-like spots on the affected area.

O.

PE

VTS: BP 138/66 left arm, sitting using regular adult cuff. Wt.: 162 kg Ht.: 5’6 T.: 36.1 RR: 20 P: 78 Sp02: 98% Case Study For Indented Streaks On The Abdomen Assignment

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General: A&Ox3

HEENT; normocephalic, EOMI, PERLA

Cardiovascular: RRR, no murmur, SI and S2 are both normal, no carotid bruits. The extremities are warm and well vascularized.

Lungs: Clear to auscultation, no rales noted on percussion.

Skin: There are unilateral dark blood red, fluid-filled vesicles that are slightly warm to the touch on the upper chest and back noted.

Abdomen: Soft and distended on inspection. Bowel sounds are normoactive. Linear nigra and multiple indented streaks were remarkable. No masses or splenomegaly reported.

MSK: ROM intact. Normal gait and posture.

Neuro: Cranial nerve ii to xii intact. Deep tendon reflexes were normal.

Genital: External genitalia is normal in appearance without lesion. Cervix is non-tender. Uterus is anteflexed.

Psychiatric: He is oriented to place and time, no abnormal affect noted. No visual or auditory hallucination.

Skin:  Appropriate color for ethnicity, pink nailbed with no cyanosis,

Assessment:

Lab test and result

CBC: results pending

CMP: result pending

Liver functional test

Diagnosis

Differential diagnosis

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

This is a medical condition characterized by an itchy rash on the stomach during late pregnancy. While the origin of PUPPP is unknown, it is assumed to emerge when the skin stretches. This condition usually appears during the third trimester of pregnancy. Furthermore, it often begins on the stomach and progresses to the other extremities (Kwan et al.,2021). The rash manifests as small, pink-pimple-like patches that mimic hives. Furthermore, PUPPP is generally itchy at night, creating difficulty sleeping.

 Stretch marks of pregnancy

This is a common pregnancy sickness that affects over 90% of pregnant women and is distinguished by itchiness in the affected areas (Ciechanowicz et al.,2018)Case Study For Indented Streaks On The Abdomen Assignment. Stretch marks on the breasts, thighs, hips, lower back, and buttocks are common during pregnancy. While they can appear anywhere on the body, they are most likely to originate in locations with a lot of fat.

Cholestasis

This is a common liver illness marked by extreme itching that started in the hands and feet and extended to the rest of the body. Cholestatic Itching frequently intensifies at night. The illness manifests itself during the third trimester, when pregnancy hormone levels are at their peak (Chaudhary et al.,2022). Other indications and symptoms of this illness include nausea, decreased appetite, and light-colored feces, which the client did not mention.

Primary diagnosis: Pruritic urticarial papules and plaques of pregnancy (PUPPP)

P.

 

References

Ciechanowicz, P., Sikora, M., Taradaj, K., Ruta, A., Rakowska, A., Kociszewska-Najman, B., … & Rudnicka, L. (2018). Skin changes during pregnancy. Is that an important issue for pregnant women?. Ginekologia polska, 89(8), 450-453. DOI 10.5603/GP.a2018.0077

Chaudhary, A. F., Goel, S., & Mehta, A. (2022). A cross-sectional study of cutaneous changes during pregnancy in a tertiary care hospital in Northern India. International Journal of Research, 8(3), 320. DOI: https://dx.doi.org/ 10.18203/issn.2455-4529.IntJResDermatol20221199

Kwan, P., Hay, K., & Rudra, T. (2021, May). Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)–Should obstetrician be concerned?. In AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY (Vol. 61, pp. 77-78). 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY. Case Study For Indented Streaks On The Abdomen Assignment

Week 4

Skin Comprehensive SOAP Note Template

 

Patient Initials: __JT_____             Age: ___32___                                 Gender: _F______

 

SUBJECTIVE DATA:

 Chief Complaint (CC): 2-STRIAE: PT REPORTS “I’VE NOTICED SOME DARK LINES ON MY STOMACH AND SIDES.”

 History of Present Illness (HPI): OBESITY AND UNCONTROLLED DIABETES.

 Medications:

1. TRAMADOL 50MG: 2 TABS TID (MORNING, NOON, AND NIGHT). LAST DOSE TAKEN THIS MORNING BEFORE COMING IN.
2. PRVENTIL (ALBUTEROL SULFATE) INHALER 90MCG: 2 PUFFS. NEEDS 2-3 TIMES/WEEK AND HAS BEEN NEEDING UP TO 3 PUFFS LATELY. LAST DATE TAKEN UNKNOWN.
3. ADVIL 200MG: 3 TABS TID OCCASIONALLY FOR CRAMPS. LAST TAKEN THREE WEEKS AGO.
4. DENIES VITAMINS OR SUPPLEMENT USE.

Allergies:

1. CATS: SNEEZING, ITCHY EYES, WHEEZING, ASTHMA EXACERBATION.
2. PENICILLIN: RASH AND HIVES

Past Medical History (PMH):

1. ASTHMA, WELL CONTROLLED: TRIGGERS ARE MOSTLY CATS. ALSO, DUST AND RUNNING UP STEPS. ASTHMA ATTACKS WITH FEELINGS OF CHEST AND THROAT TIGHTNESS, WHEEZING, AND FEELINGS OF “NOT ENOUGH AIR”. LAST ASTHMA ATTACK WAS IN HIGH SCHOOL.
2. DIABETES MELLITUS TYPE 2, POORLY CONTROLLED. DIAGNOSED AT AGE 24.
3. LAST HOSPITALIZED AT AGE 16 D/T ASTHMA ATTACK.

Past Surgical History (PSH):

VOICES NO PAST SURGICAL HISTORY

Sexual/Reproductive History:

1. JT HAS IRREGULAR MENSTRUAL PERIODS THAT ARE HEAVY AND PAINFUL. SHE STATES THEY LAST FOR 7 DAYS. VOICES FIRST TWO DAYS ARE VERY PAINFUL AND TAKES ADVIL 200MG 3 TABS TID TO RELIEVE PAIN DURING THIS TIME. VOICES SHE IS NOT CURRENTLY SEXUALLY ACTIVE. Case Study For Indented Streaks On The Abdomen Assignment

Personal/Social History:

1. SINGLE, NO CHILDREN
2. LIVES WITH MOTHER
3. BAPTIST, INVOLVED WITH FAMILY CHURCH.
4. DENIES TOBACCO USE.
5. LAST SMOKED MARIJUANA AT AGE 20 OR 21.

6. SOCIAL ALCOHOLIC BEVERAGES 1-2 TIMES/WEEK

Health Maintenance:

1. LAST BLOOD SUGAR CHECK UNKNOWN. STATES, “ABOUT A MONTH AGO.” CURRENT BLOOD SUGAR 238.
2. INSUFFICIENT BLOOD GLUCOSE MONITORING.
3. METFORMIN LAST TAKEN 3 YEARS AGO AFTER TAKING FOR A YEAR. DOSE UNKNOWN.
4. DIAGNOSED WITH DIABETES TYPE 2 3 YEARS AGO.
5. EATS 3 MEALS A DAY.
6. 15 LB WEIGHT INCREASE IN THE LAST MONTH

Immunization History:

Significant Family History:

1. FATHER: DIABETES TYPE 2 AND HTN. DIED IN CAR ACCIDENT LAST YEAR IN A CAR ACCIDENT.
2. MOTHER: HTN, HIGH CHOLESTEROL. MOTHER EXPERIENCE DEPRESSION AFTER SPOUSE DIED.
3. 1 SISTER WITH CONTROLLED ASTHMA
4. 1 BROTHER WITHOUT ANY HEALTH CONCERNS.
5. (P) GRANDMOTHER: HIGH CHOLEROL. TAKING BP MEDS FOR HTN.
6. (P) GRANDFATHER: TYPE 2 DIABETES, HTN. DIED OF COLON CANCER.
7. (M) GRANDMOTHER: DIED 5 YEARS AGO, POST CVA. HIGH CHOLESTEROL AND HTN.
8. (M) GRANDFATHER: HTN, MI. DIED IN CAR ACCIDENT WHEN PATIENT WAS A CHILD.
9. (P) UNCLE: ALCOHOLISM
10. FAMILY HISTORY OF OBESITY.

 Review of Systems:

General:

UNCONTROLLED DIABETES TYPE 2. INCREASED THIRST AND APPETITE.

HEENT:

BLURRY VISION AT TIMES. NO EAR PAIN OR HEARING DIFFICULTIES. NO SORE THROAT, NASAL ISSUES, CHANGES IN VOICE, OR DIFFICULTY SWALLOWING. NO LOSS OF TASTE AND SMELL. SHE VOICES NO USE OF GLASSES OR CONTACTS.

            Respiratory:

            Cardiovascular/Peripheral Vascular:

            Gastrointestinal:

            Genitourinary: FREQUENT URINATION. NO PAIN WHEN VOIDING.

            Musculoskeletal:

            Neurological:

            Psychiatric:

            Skin/hair/nails:

 OBJECTIVE DATA:

Physical Exam:

Vital signs: BMI-35, 155/82, 78, 18, 98% RA, 98.6-ORAL

General:

HEENT:

Neck:

Chest/Lungs:.

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Heart/Peripheral Vascular:

Abdomen: ROUNDED, DISTENDED WITH SYMMETRICAL DARK BROWN STRIAE NOTED.

Genital/Rectal:

Musculoskeletal:

Neurological:

 Skin: SYMMETRICAL, BROWN STRIAE COVERING MEDEIAL, LOWER, AND LATERAL ABDOMEN.

 Diagnostic results:

 ASSESSMENT:

 PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses Case Study For Indented Streaks On The Abdomen Assignment