Please see attachment for instructions.

For this Assignment, you will work with an adolescent patient that you examined during the last 3 weeks and complete a Focused Note Template in which you will gather patient information, relevant diagnostic and treatment 

information, and reflect on health promotion and disease prevention in light of patient factors, such as age, ethnic group, past medical history (PMH), socio-economic status, cultural background, etc. In this week’s Learning Resources, please refer to the Focused Note resources for guidance on writing Focused Notes.

Assignment

· Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent as well as possible reasons for these discrepancies.

· Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.

· Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority and include their ICD-10 code for the diagnosis. What was your primary diagnosis and why?

· Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.

· Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?

Case: teenager 16 y/o Hispanic girl looking for a dermatological referral to treat acne.

She does not follow any diet (using whole milk and white bread) she does not practice any sport. Denies family history of cardiovascular issues or MI before 65 y/o

Grades A/B in school. Struggling with acne.

Add the rest of the information according to this.

1-Management Plan 

Primary Diagnosis Acne vulgaris L70

Rationale: Acne is usually seen in teenagers or relatively young patients (our pt is 16 y/o); the distribution of the eruption follows a topic patron face, upper shoulder, and chest., including different stages like close or open comedones, pustules cyst, nodules or scars. The patient is motivated for her mother to come and get a dermatologist referral. 

Differential diagnoses: Fulminans acne, characterized by open comedones located in the same areas with an active infectious process. Rosacea is a common skin condition that causes blushing or flushing and visible blood vessels in the face. It may also produce small, pus-filled bumps. These signs and symptoms may flare up for weeks to months and then go away for a while.

References: 

Greywal T, Zaenglein AL, Baldwin HE, Bhatia N, Chernoff KA, Del Rosso JQ, Eichenfield LF, Levin MH, Leyden JJ, Thiboutot DM, Webster GF, Friedlander SF. (2017).Evidence-based recommendations for the management of acne fulminans and their variants. J Am Acad Dermatol. 2017;77:109–17.

Medications: Benzoyl -peroxide Start with 1 application per day, then gradually increase to 2 or 3 times per day if needed. Hypoallergenic soap on a daily basis.

Additional tests needed: N/R at this visit.

Referrals: N/R at this visit

Follow: Pt was oriented to make an app fallow in 6 weeks to evaluate the disease resolution and the treatment effectivity.

Social Determinants of Health: Pt is insured at this moment with availability to access the ordered medication.

Health Promotion: The patient and mother were educated on acne skin care. Wash the face no more than twice daily using a gentle non-soap facial skin cleanser (eg, Cetaphil, Oil of Olay bar or foaming face wash, or Dove bar) and warm (not hot) water. Do not pick or squeeze pimples because this may worsen acne and cause skin swelling and scarring. It can also cause lesions to become infected. The use of a moisturizer minimizes dryness and skin peeling. Some acne treatments increase the skin's sensitivity to sunlight (e.g., retinoids and doxycycline). To minimize skin damage from the sun, avoid excessive sun exposure and use a sunscreen with SPF 30 or higher, that is a broad spectrum 

The anterior is the extract of the plan of care; please, you need to add more information to the differential diagnosis that I already mentioned.

The document has to be written in APA format.

They ask for 5 (up to date last five years) references.