When NURS 6512 reaches the body systems, the integumentary system usually goes first, and it is a sensible place to begin because everything is visible. This stage asks you to describe skin findings precisely enough that a reader who never saw the patient could build the same differential you built. Expect lesion morphology, distribution and configuration, the history that surrounds an eruption, and the diagnostic steps that confirm or exclude. Your classroom decides whether it arrives as a case discussion, a written note, or a pair of both.
As on every page in this set, the week number describes a stage rather than a published Walden schedule. Walden's syllabi are not public and its course guides sit behind a login. Match the method below to whatever your own rubric actually asks for, and let the rubric settle any disagreement. The code turns up both spaced and closed up, NURS 6512 and NURS6512, and this manual covers either.
How a skin case is scored
Rubrics in a dermatologic week reward description over naming. A note saying a rash is present on the arm has skipped the row. A note giving the primary lesion, its size, color, border, arrangement and distribution has answered it, and it does so before any diagnosis appears.
The second scoring pattern is traceability. Every differential you rank has to point back at a finding you described, and graders read in that direction rather than forwards. If the diagnosis at the top of your list depends on a feature you never wrote down, the row falls no matter how right you are.
Where this stage runs as a discussion, expect a source requirement inside the post itself. Walden asks for substantive participation spread across the week, so plan the initial post and the replies as separate sittings on separate days rather than one long evening.
The skin-case method, step by step
Six moves that make a skin case read as an examination rather than a guess.
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Take the history the skin actually needs
Onset, spread, itch or pain, prior episodes, occupational and outdoor exposure, new products, new medications, and everything already tried. Dermatologic cases are often solved in the history, and the exposure question is the one most frequently skipped.
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Describe the lesion before you name it
Primary morphology first: macule, papule, plaque, vesicle, pustule, nodule, wheal. Then size in millimeters, color, border, surface, and whether it blanches. Naming the condition first tempts you to describe what that condition ought to look like.
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Record distribution and configuration as evidence
Flexural, extensor, dermatomal, photodistributed, symmetric, linear, annular, grouped. Pattern narrows a differential faster than any single lesion does, and the rubric usually keeps a row waiting for it.
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Build the differential outward from morphology
Start with conditions that produce that primary lesion in that distribution, then use the history to rank them. Say what moved each one up or down, in a clause, sitting next to the diagnosis it explains.
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Justify every diagnostic step in one sentence
Potassium hydroxide preparation, Wood lamp, dermoscopy, bacterial culture, biopsy. Name what the test would confirm or exclude, because an order with no stated purpose is scored as a list.
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Read the note back as someone who cannot see the patient
Cover the diagnosis and read only your description. If it does not generate your own differential unaided, the description is doing less work than you think it is.
A structure that maps to the rubric rows
A shape that fits an episodic note or a focused skin case. The section sizes are planning guides from our desk, not Walden requirements.
| Section | What belongs in it | What the row rewards |
|---|---|---|
| Subjective | The complaint in the patient's words, the timeline of the eruption, symptoms, exposures, and what has been tried. | A history whose exposure and treatment questions have already narrowed the list before the exam starts. |
| Objective, general | Vital signs and anything systemic, including whether the patient looks well or unwell. | A recorded judgment about how sick the patient is, which sets the urgency of everything below it. |
| Objective, lesion description | Primary morphology, secondary change, size, color, border, surface and blanching. | Description precise enough that the lesion could be redrawn from the words alone. |
| Objective, distribution | Body regions involved, symmetry, configuration, and the areas deliberately checked and found clear. | Negative areas recorded, so the pattern is bounded instead of open ended. |
| Assessment | Three or more ranked differentials, each tied to findings named earlier in the note. | A ranking argued from the description above, with a reason each alternative sits lower. |
| Plan | Diagnostics, treatment, patient education, and follow-up with a return threshold. | Each element attached to the working diagnosis and to whatever would change it. |
Annotated sample excerpt
An original model paragraph from our team, written at the depth a description row expects. Learn the moves and apply them to your own patient.
The eruption consists of erythematous papules and small plaques, four to nine millimeters across, with poorly defined borders, fine overlying scale, and several excoriated at the surface.1 Lesions are distributed symmetrically across both antecubital fossae and the posterior knees, with the trunk, palms, soles and scalp inspected and clear.2 The involved skin is dry to the touch, and mild lichenification at the elbows suggests a process older than the four days the patient reports.3
- 1Morphology, size, border, surface and secondary change all appear before any diagnosis is suggested, which is the order the row is scored in.
- 2Distribution is given together with its negatives. The areas checked and found clear do as much diagnostic work as the areas involved.
- 3One finding is allowed to contradict the history out loud, and naming that tension is what separates a full-credit note from a merely competent one.
The free sample for your own case arrives written to your rubric, with the description carried to this depth and the differential ranked out of it.
The five mistakes that cost points on a skin case
- Naming the rash in the objective section. A diagnosis is an assessment. Putting it among the exam findings collapses two rows into one and forfeits the description points.
- No measurements anywhere in the note. Size in millimeters is the cheapest specificity available, and its absence is the most common note our QA pass leaves on skin cases.
- Distribution left out. Two conditions can share a morphology and differ only in where they sit, so a note without pattern cannot defend its own ranking.
- A biopsy ordered on reflex. Every diagnostic step needs a sentence about what it would settle, or the plan row reads as a menu of options.
- No return precautions. Skin conditions change across days, and a plan that never says what should bring the patient back leaves the follow-up row unanswered.
Pre-submission checklist
- Primary morphology is named before any diagnosis appears
- Every lesion carries a size in millimeters
- Distribution, configuration and the clear areas are all recorded
- Each differential points to a finding written earlier in the note
- Every diagnostic order says what it would confirm or exclude
- The plan closes with education and a return threshold
Have a skin case due?
Send the case and the rubric from your classroom. A premium original note comes back inside 24 to 48 hours with the description at rubric depth and the differential defended line by line.