Differential Diagnosis and Diagnostic Testing
The Patient’s Chief Complaint
The chief complaint or the presenting complaint is the reason for seeking healthcare, usually in the patient’s words (Hansoti et al., 2021). The chief complaint should include the onset of the problem, the characteristics, and the alleviating or aggravating factors at times; the chief complaint may be a combination of signs and symptoms (Hansoti et al., 2021). Based on the information provided in this case, Miss Washington’s chief complaint is that since she fell a week ago, she has developed a new leg ulcer, is gasping and coughing, and generally feels sick.
Physical Examination
Physical examination is the process where the healthcare provider checks on the patient’s body to determine if there is any physical problem. This process involves four main techniques used to do the examinations. The first technique is an inspection, where the health care provider assesses by looking at the body to detect changes in color, bruises, blisters, and open wounds. The second technique is palpation, which involves the use of fingers or hands to feel the body of the client. The third technique is auscultation, which involves using a stethoscope to listen to sounds. The fourth technique of physical exam is percussion, which involves tapping on specific areas to listen to the sound produced (Bernhardt & Cordum, 2023).
Based on the chief complaints of Miss Washington in the case scenario, a physical exam would focus on four main areas. Considering the symptoms, such as coughing and wheezing, a physical examination of the respiratory system would be of great importance. There should be an inspection of the chest movement, auscultation of the lung sounds, and a check for respiratory distress. Secondly, the wound should be inspected and classified according to the findings from the inspection. For instance, one should inspect for the depth to establish whether it is a superficial or deep tissue injury, inspect for exudate formation in the wound and its characteristics to establish any sign of inflammation, inspect for any necrotic tissue to establish the need for debridement, and note the smell the wound is producing to determine whether it is clean (Nagle et al., 2023). The patient does not state pain in the wound, and this justifies the need to conduct a neurological examination. It is possible to have sustained an injury that affected the nerve since the patient didn’t report pain from the ulcer. This might be a result of poor innervation to the site or even damage to the nerve. Lastly, it might be indicative of a cardiac problem when you have a patient, the age of Miss Washington, feeling generally sick, having wheezing in the chest as well as a wound in the extremity that occurs by itself. This might be suggestive of circulatory insufficiency and wheezing as a result of fluid accumulation in the lungs due to cardiopulmonary edema (Bernhardt & Cordum, 2023).
Diagnostic Tests
To come up with a comprehensive and evidence-based plan of care for Miss Washington, it is important to supplement the physical examination with diagnostic tests. Diagnostic tests are procedures that involve the collection of samples like blood, stool, and cultures, which are taken to the laboratory for investigation, and the results are compared to a standardized range given to act as a reference (Khan et al., 2020). These tests help establish the root cause of the problem and help the healthcare provider to establish appropriate and effective interventions—for example, the choice of drug class to prescribe, antibiotics or antifungals.
Based on the case scenario above, a blood sample would be collected and subjected to the first diagnostic test which is the complete blood count (CBC). This is aimed at checking on the number of cells, such as the granulocyte percentage, white blood cells (WBC), and the hemoglobin levels (HB) of the patient. WBC helps establish the presence or absence of infection. Also, HB would suggest whether anemia would be present due to the ulcer, which would result from ischemia or hypoxia to the extremities (Khan et al., 2020). To establish the cause of the respiratory symptoms, it is important to do a chest x-ray to visualize any the chest cavity and note any difference from the normal appearance. A culture would also be considered appropriate to be done in order to establish the main type of microorganisms responsible for the wound (Nagle et al., 2023).
Differential Diagnosis
Differential diagnosis is a list of conditions that share the same symptoms as presented by the patient (Klein, 2020). It is important to note that many diseases, such as respiratory conditions, may share the symptoms, but their management is different. This, therefore, necessitates the healthcare provider to come up with an actual diagnosis from the list of differential diagnoses to initiate proper management. In the scenario above, it is possible to have pneumonia as one of the differential diagnoses based on the coughing and wheezing reported by the patient. Secondly, the leg ulcer that the patient reports might lead to having a peripheral arterial disease as a differential diagnosis of ischemia. Thirdly, the leg ulcer, feeling unwell, coughing, and wheezing may indicate a general infection such as sepsis, adding it to the list of differential diagnoses. Lastly, deep venous thrombosis can also be added to the list of differential diagnoses because a clot in the vein might lead to an ulcer in the leg while also considering the respiratory symptoms reported by Miss Washington.
References
Bernhardt, D. T., & Cordum, A. (2023, January 1). Chapter 8 – Preparticipation physical examination (B. J. Krabak & A. Brooks, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/abs/pii/B9780323999922000256
Hansoti, B., Hahn, E., Rao, A., Harris, J., Jenson, A., Markadakis, N., Moonat, S., Osula, V., & Pousson, A. (2021). Calibrating a chief complaint list for low resource settings: a methodologic case study. International Journal of Emergency Medicine, 14(1). https://doi.org/10.1186/s12245-021-00347-8
Khan, F. A., Majidulla, A., Tavaziva, G., Nazish, A., Abidi, S. K., Benedetti, A., Menzies, D., Johnston, J. C., Khan, A. J., & Saeed, S. (2020). Chest x-ray analysis with deep learning-based software as a triage test for pulmonary tuberculosis: a prospective study of diagnostic accuracy for culture-confirmed disease. The Lancet Digital Health, 2(11), e573–e581. https://doi.org/10.1016/S2589-7500(20)30221-1
Klein, J. (2020, July 15). Differential diagnosis: Definition, examples, and more. Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/differential-diagnosis
Nagle, S. M., Waheed, A., & Wilbraham, S. C. (2023, June 26). Wound assessment. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482198/
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Question 
When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools to help in understanding a patient’s condition. In turn, beginning with a differential diagnosis supports the process of further applying information to narrow the possibilities of what the condition may be and working to arrive at the most accurate diagnosis for planning treatment.
Differential Diagnosis and Diagnostic Testing
For this Case Study Assignment, you will determine the physical exams and diagnostic tests that would be most appropriate for gaining information and a better understanding of your patient’s condition. Then, based on your analysis, you will formulate a differential diagnosis for the patient.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare:
By Day 1 of this week, your Instructor will assign a patient profile for this Assignment. Note: Please see the Course Announcements section of the classroom for your patient profile Assignment.
Review this week’s Learning Resources.
Review the details of the patient case study.
Consider what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition.
Reflect on how the results would be used to make a diagnosis.
Identify three to five (3–5) possible conditions that may be considered in a differential diagnosis for the patient.
Assignment: Diagnostic Reasoning
Include the following:
Identify the patient’s chief complaint.
Identify what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition. Be specific and explain your reasoning.
Explain how the results would be used to make a diagnosis.
Identify three to five (3–5) possible conditions that may be considered in a differential diagnosis for the patient. Explain your thinking.
BY DAY 7 OF WEEK 3