Posted: August 1st, 2023

Nursing homework help>Response 2 Patho Luisa
Integumentary Function

Psoriasis Triggers and Types

Psoriasis is a common, chronic inflammatory condition that affects the life cycle of the skin

cells (Dlugasch, 2021). Some of the triggers to psoriasis are bacterial or viral infections, dry air

or dry skin, skin injuries such as cuts, burns, and insect bites, some medications such as

antimalaria agents, beta blockers, and lithium. Stress, exposure to sunlight or no sunlight at all,

and excessive alcohol (Dlugasch, 2021).

Plaque (chronic): is described as thick, red plaques covered by flaky, silver white scales

(most common). Lifting the scale causes bleeding. The bleeding occurs because of the abnormal

blood vessels proximity to the scales. Usual location is the scalp, extensor surface of elbow,

knees, and gluteal cleft (Dlugasch, 2021).

Erythrodermic (acute or chronic): extreme erythema and scaling that covers a large area

usually from head to toe. The lesions are usually pruritic and painful. There is high risk for

infections and fluid and electrolyte abnormalities due to the large skin area affected (Dlugasch,

2021).

Gluttate: small, pink-red papules and plaques that usually appear abruptly and acutely with

no necessary prior history of psoriasis. Guttate means drop-like and refers to the small size of the

lesion. Usual location is the trunk and proximal extremities. This type may remit, recur, or

progress to plaque psoriasis (Dlugasch, 2021).

Inverse: erythema and irritation usually with no scaling that occur in the intertriginous areas

such as armpits, groin, and skin folds; referred to as inverse as the location of the lesions are

opposite of the usual extensor surface areas that are affected (Dlugasch, 2021).

Pustular: papules or plaques with pustules surrounded by erythema. This type can be acute

in onset, and severe forms can be associated with infections signs such as malaise and fever.

Systemic complications can include sepsis and respiratory, renal, or hepatic abnormalities

(Dlugasch, 2021).

Psoriasis Treatments

Some of the treatments that can help Ms. K.B with her plaque type psoriasis are topical

treatments, phototherapy, and systemic medications (Dlugasch, 2021).

Topical treatments

Corticosteroids help slow cell turnover and decrease inflammation. Vitamin D analogues

slow down skin cell growth and immune modulations. Anthralin normalizes DNA activity in

skin cells, remove scales, and smooths the skin. Retinoids normalize DNA activity in skin cells

and possibly decrease inflammation. Calcineurin inhibitors disrupt the activation of T

lymphocytes. Salicylic acid promotes shedding of dead skin cells and reduces scaling. Coal tar

reduces scales, itching, and inflammation. Moisturizers reduce dryness, itching, and scaling.

Dandruff shampoo reduces cellular turnover (Dlugasch, 2021).

Phototherapy

Sunlight uv light natural/artificial active T lymphocytes in the skin to die, slowing cell

turnover, reducing scaling, and decreasing inflammation. Broadband ultraviolet B (UVB) slows

cellular growth. Narrowed UVB newer treatment and more effective, like broadband ultraviolet

B. Photochemotherapy, or psoralen plus ultraviolet A is a light sensitizing medication, psoralen

administration before exposure to UVA light to increase the response to the light. Excimer laser

is a controlled beam of UVB light of a specific wavelength that is directed to only the involved

skin (Dlugasch, 2021).

Systemic medications

Retinoids reduce production of skin cells. Methotrexate decreases skin cells and suppress

inflammation. Cyclosporine suppresses the immune system. Hydroxyurea suppresses the

immune system. Phosphodiesterase 4 inhibitor reduces cytokine. Immunomodulator drugs block

interactions between certain immune system cells, Janus kinase a inhibitors interrupt cellular

signaling (Dlugasch, 2021).

Nonpharmacological treatments that can help K.B are reducing stress, avoiding triggers, and

join support groups (Dlugasch, 2021).

Medication Reconciliation

In K.B case it is very important to know which medications she is taking because as we

discussed earlier some of the triggers to psoriasis can be related to medications such as

antimalaria agents, beta blockers, and lithium (Dlugasch, 2021).

Psoriasis Manifestations

Other manifestations relating to psoriasis are joint pain or aching. Nail changes such as

thickening, yellow-brown spots, dents on the nail surface and separation of the nail from the

base, nail changes can occur prior to skin manifestation (Dlugasch, 2021). Research studies show

that psoriasis has been shown to be associated with several comorbidities, such as psoriatic

arthritis, Crohn’s disease, psychological/psychiatric disorders, and ocular diseases. Several

ocular manifestations have been reported including uveitis, dry eye, retinal abnormalities,

blepharitis, conjunctivitis, keratitis, iridocyclitis, UV-induced cataracts, and birdshot

chorioretinitis (Ruggiero, 2021)

References

Dlugasch, L., & Story, L. (2021). Applied Pathophysiology for the Advance Practice Nurse. Jones &

Bartlett Learning.

Ruggiero, A., Fabbrocini, G., Cacciapuoti, S., Cinelli, E., Gallo, L., & Megna, M. (2021). Ocular

Manifestations in Psoriasis Screening (OcMaPS) Questionnaire: A Useful Tool to Reveal

Misdiagnosed Ocular Involvement in Psoriasis. Journal of clinical medicine, 10(5), 1031.

https://doi.org/10.3390/jcm10051031

Sensory Function

Diagnosis

Based on the clinical manifestations that C.J is presenting with we can conclude that he has

bacterial conjunctivitis with otitis media. Bacterial conjunctivitis is usually due to

Staphylococcus in adults. Usually shows up with symptoms such as the one C.J is experiencing

yellow-green exudate in one eye or both, and can be accompanied by otitis media (Dlugasch,

2021). Otitis media is an infection or inflammation of the middle ear. Physical manifestations are

inflammation as the tympanic membrane is red and bulging. Due to the middle ear effusion, the

tympanic membrane may be opaque and air-fluid levels may be visible behind the membrane

(Dlugasch, 2021).

Etiology

The probable etiology of the affected eye symptoms C.J is experiencing is due to the

bacterial conjunctivitis; this type of conjunctivitis is usually unilateral, and the manifestations are

yellow-green exudate in one eye or both, and can be accompanied by otitis media Dlugasch,

2021). Viral conjunctivitis normally produce watery or mucus like discharge that is scant and

stringy or rop-like. Allergic is due to allergens. Gonococcal is sexually transmitted form of

conjunctivitis that causes blindness. Trachoma conjunctivitis is also bacterial, but its has been the

leading cause of infectious blindness worldwide and is endemic in remote areas with lack of

resources such as clean water and sanitation (Dlugasch, 2021).

Therapeutic Approach

The best therapeutic approach to treat symptomatic relief is to include warm, moist

compress to soothe discomfort. Cool compress can improve edema if present. Artificial tears can

be used for relief. Bacterial conjunctivitis is treated with antibiotics (Dlugasch, 2021). Studies

agree that to treat some type of bacterial conjunctivitis includes the use of oral azithromycin or

oral doxycycline in adults, and erythromycin in neonate (Yeu, 2020)

Refences

Dlugasch, L., & Story, L. (2021). Applied Pathophysiology for the Advance Practice Nurse. Jones &

Bartlett Learning.

Yeu, E., & Hauswirth, S. (2020). A Review of the Differential Diagnosis of Acute Infectious

Conjunctivitis: Implications for Treatment and Management. Clinical Ophthalmology, 14, 805–

813. https://doi.org/10.2147/OPTH.S236571

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