Week 4 Assignment Sample Paper NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning   Advanced Health Assessment and Diagnostic Reasoning

Subjective Data

Chief Complaint:  The patient no. 1 is a middle aged white male who complains of multiple red, oval-shaped bumps on the chest that bleeds when scratched or cut open.

History of the illness: The patient presents with red moles that started developing since the early thirties and increases in size and number as the patient ages.

Objective Data

The physical examination shows that the patient 1 presents with chest skin growths referred to as lesions, which vary in appearance, ranging from small red macules to a larger dome-topped polypoid papule. The color of the lesions ranges from bright red to dark red, depending on their stage of development and trauma applied on them.

ASSESSMENT

Differential Diagnosis

One of the differential diagnoses, in this case, is acute Urticarial. It refers to a vascular reaction of the skin. Clinical presentations include smooth, slightly elevated papules and plaques that are erythematous and that are often attended by severe pruritus.  However, unlike in the current scenario, urticarial is self-limited and of short duration. The papules last between several hours to several days and resolve without scarring, and without any clinical intervention (Guastafierro et al. 2019). In cases of Chronic urticarial, there is the recurrence of the lesions and can last for as long as six weeks. Additionally, the lesions reaction is unsystematic in that they don’t attack any specific body part. They are equitably distributed to all body parts.

Insect bite from blood feeders such as bed bugs is another differential diagnosis in this case. Once bitten by such insects, blood-filled lesions appear several hours in the bitten area after the bite. However, unlike in the current scenario, in blood feeder insect bites, the lesion is as large as 6 cm and worsen just after sleep episodes. They also mostly appear in the linear form, in exposed body parts such as legs, arms, and face and keep relocating due to new bites.

Bacillary angiomatosis is another differential diagnosis in this scenario. It refers to the development of multiple red, purple, flesh-colored, or colorless Cutaneous lesions that vary in sizes, with the smallest being about 1mm. They are caused by immunodeficiency thus are commonest in immunocompromised persons such as HIV positive individuals. However, unlike in the current scenario, the Lesions mostly affect the oral mucosa, tongue, oropharynx, nose, penis, and anus. The lesions are also accompanied by other symptoms including Bone pain, Fever, chills, malaise, night sweats, anorexia, and weight loss.

Melanoma is another differential diagnosis.it refers to a type of skin cancer. Clinical presentation entails skin changes, such as a skin sore that fails to heal and a firm red lump that bleeds when scratched and a flat, red spot that is rough, dry, or scaly (Swetter & Geller, 2018). It is caused by mutation of melanocytes, the pigment-producing cells, in to cancerous cells. The lesions mostly affect the chest and back. However, it is most common in women than in men.

Most Likely Correct Diagnosis

The most likely accurate diagnosis in this scenario is Cherry Angioma. It refers to a skin tumor that results from the overgrowth of blood capillaries. It is most common in older adults after 30 years of age and affects 60% of adults. It is characterized by oval-shaped lesions whose color ranges from bright red, due to dilated capillaries to dark red, when pressure is applied,  that bleed when scratched, increases in size and number as the own ages (Espinosa et al. 2018). The lesions are painless but uncomfortable if burst open. The angiomas affec