Diagnosing Integumentary Disorders

When entering examination rooms, advanced practice nurses often immediately begin assessing patients by looking for external abnormalities such as skin irritations or cloudy eyes.

By making these simple observations, they can determine how to proceed with their patient evaluations. During the patient evaluation, advanced practice nurses will use initial observations to guide them in acquiring the necessary medical history, performing additional assessments, and ordering the appropriate diagnostics.

The information obtained during this evaluation process will help in the development of a differential diagnosis. Once a diagnosis is made, the advanced practice nurse can consider potential treatment options and work with the patient to develop a plan of care.

For this Discussion, consider the following three case studies of patients presenting with integumentary disorders.

Case Study

A 46-year-old male presents to the office complaining of a pruritic skin rash that has been present for a few weeks. He initially noted the rash on his feet, but it then spread to between the fingers, his wrist, and waist. He notes that it does not seem to be on his face or trunk.

He recently came home from a trip to Florida where he had stayed in multiple hotels. He takes occasional ibuprofen for knee pain, but denies taking other medications or having other health problems.

He has no known drug allergies. The physical examination reveals a male with several tiny vesicles and scales in between the fingers, on the feet and ankles, around the patient’s wrist and around the belt line.

To prepare: • Review Part 5 of the Buttaro et al. text and the case studies provided • Reflect on the provided patient information including history and physical exams.

• Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis. • Reflect on potential treatment options based on your diagnosis.

ere are four general classes of lipid-lowering drugs: niacin, fibric-acid derivatives, bile-acid sequestrants, and HMG-CoA reductase inhibitors. Describe the pharmacodynamics, pharmacokinetics, and pharmacotherapeutics of each drug. When, specifically, do you use each drug? Include monitoring parameters and patient education.

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