Psoriasis

Posted: 02 Aug 2010 11:18 PM PDT

  Is a chronic, recurrent disease,

marked by epidermal proliferation.

 Its lesions, which appear as a

erythematous papules and plaques
covered with silver scales.

 This disorder commonly affects

young adults, it may strike at any age,
including during infancy.

 It is characterized by recurring
partial remissions and exacerbations.
Flare ups are commonly related to
specific systemic and environmental factors but may be unpredictable; they
can usually controlled by therapy.

Etiology
 The tendency to develop psoriasis is genetically determined. Researchers
have discovered a significantly higher than normal incidence of certain human
leukocyte antigens (HLA) in families with psoriasis, suggesting a possible
immune disorder. Onset of the disease is also influenced by environmental
factors.

 Trauma can trigger the isomorphic effect or Koebner’s phenomenon, in

which lesions develop at sites of injury. Infections, especially those resulting
from beta-hemolytic streptococci,may cause a flare up of guttate (drop shaped)
lesions. Other contributing factors include pregnancy, endocrine changes,
climate (cold weather tends to exacerbate psoriasis), and emotional stress.

 Generally, the skin cells takes 14 days to move from the basal layer to the
stratum corneum, where after 14 days of normal wear and tear, it’s sloughed
off. The life cycle of normal skin cell is 28 days, compared to only 4 days for a
psoriatic skin cell. This markedly shortened cycle doesn’t allow time for the cell
to mature. Consequently, the stratum corneum becomes thick and flaky,
producing the cardinal manifestations of psoriasis.

Signs and symptoms

 The most common complaint of the patient with psoriasis is itching and
occasional pain from dry, cracked, encrusted lesions.
 Plaques. Psoriatic lesions are erythematous and usually from well-defined
plaques, sometimes covering large areas of the body. Such lesions usually
appear on the scalp, knees, back, and buttocks. The plaques consist of
characteristic silver scales that either flake off easily or can thicken, covering
the lesion. Removal of psoriatic scales typically produces fine bleeding points
(Auspitz sign). Occasionally, small guttate lesion appear, either alone or with
plaques; these lesions are typically thin and erythematous, with few scales.

  Pustular Psoriasis. Rarely,
psoriasis becomes pustular, taking one
of two forms. In localized pustular
psoriasis, pustules appear on the palms
and soles and remain sterile until
opened. In generalized pustular (Von
Zumbusch) psoriasis, which commonly
occurs with fever, leukocytosis, and
malaise, groups of pastules coalesce to
form lakes of pus on red skin. These pustules also retain sterile until opened
and commonly involve the tongue and oral mucosa.

 Arthritic symptoms. Some patients develop arthritic symptoms, usually in

one or more joints of the fingers or toes, in the larger joints, or sometimes in
the sacroiliac joints, which may progress to spondylitis. Such patients may
complain of morning stiffness.

Diagnosis
 Diagnosis depends on patient history, appearance of the lesions and, if
needed, the results of skin biopsy. In severe cases, the serum uric acid level is
typically elevated due to accelerated nucleic acid degradation; however,
indications of gout are absent. HLA antigens may be present in early-onset
familial psoriasis.

Treatment
Appropriate treatment depends on the type of psoriasis, the extent of the disease
and the patient’s response to it, and the effect the disease has on the patient’s
lifestyle. No permanent cure exists, and all methods of treatment are palliative.
 UVB exposure. Methods to retard rapid cell production include exposure to
ultraviolet (UV) light (UVB or natural sunlight) to the point of minimal erythema.
Tar preparations of crude coal tar itself may be applied to affected areas about
15 minutes before exposure or may be left on overnight and wiped off the next
morning.
 A thin layer of petroleum jelly may be applied before UVB exposure ( the
most common treatment for generalized psoriasis).

Drug therapy
 Steroid creams and ointments are useful to control psoriasis. A potent
fluorinated steroid works well, except on the face and intertriginous areas.

 Low dose anti-histamines, oatmeal baths, emollients, and open wet

dressings may help relieve pruritus.

Nursing Interventions
1. Make sure that the patient understands his prescribed therapy; provide
written instructions to avoid confusions.

2. Teach the correct applications of prescribed ointment, creams, and lotions.

3. Warn the patient never to put an occlusive dressing over anthralin.

Suggest the use of mineral oil, then soap and water, to remove anthralin.

4. Caution the patient to avoid scrubbing his skin vigorously, to prevent

Koebner’s phenomenon.

5. Watch for adverse reactions, especially allergic reactions to anthralin.

6. Caution the patient receiving therapy to stay out of the sun on the day of
treatment, and to protect his eyes with sun glasses that screen UVA for 24
hours after treatment.

7. Because stressful situations tend to exacerbate psoriasis, help the patient

cope with the situation.

Chlamydial Infection
April 19, 2010 by Lhynnelli, RN · Leave a Comment  ·   Email This Post ·   Print This
Post
 Is a common sexual transmitted disease that occurs in women and men,
particularly in adolescents and young adults.
 Women are asymptomatic or present with cervicitis.
 Men are commonly asymptomatic but may present with urethritis.
 Untreated chlamydial infections can lead to epididymitis, salphingitis, pelvic
inflammatory disease and eventually sterility.
Mode of Transmission
1. The disease is transmitted through vaginal or rectal intercourse.
2. The disease is also transmitted through oral-genital contact with an infected
person.
3. Conjunctivitis, otitis media, and pneumonia may develop to children born to
mothers withchlamydial infection passed through birth canal.
Clinical Manifestations
1. May be asymptomatic or have vaginal discharge – may be clear mucoid to
creamy discharge.
2. May have dysuria and mild pelvic disorder.
3. Cervix may be covered by thick mucopurulent discharge and be tender,
erythematous, edematous, and friable.
Diagnostic Evaluation
1. DNA detection test on cervical smear or urine sample (by DNA amplification
method).
2. Chlamydia culture from cervical exudate.
3. Screening urinalysis in males for leukocytes; if positive result, confirmed by DNA
detection test.
4. ELISA
5. Direct fluorescent anti-body test.
6. The Centers for Disease Control and Prevention (CDC) recommends annual
screening for all sexually active adolescents women as well as young women, ages
20 to 24, and older women at high risk (multiple sex partners or new partner).
Complications
1. Pelvic Inflammatory Disease.
2. Ectopic pregnancy or infertility secondary to untreated or recurrent pelvic
inflammatory diseases.
3. Transmission to neonate born through infected birth canal.
Treatment
1. Doxycycline oral for several days.
2. Azithromycin in single dose.
Nursing Interventions
1. Advice abstinence from sexual intercourse until treatment has been completed.
No follow-up culture is necessary to ensure cure; however, re-screening is
 recommended 3 to 4 months after treatment to detect reinfection, particularly in
adolescents and young women.
2. Ensure that the partner is treated at the same time; recent partners should
receive treatment despite lack of symptoms and negative Chlamydia result.
3. Report case to local public health department (Chlamydia is a reportable
infectious disease).
4. Ensure that the patient begins treatment and will have access to prescription
follow up.
5. Explain mode of transmission, complications, and the risk for other STD’s.
6. Teach about all STD’s and their symptoms.
7. Explain the treatment regimen to patient and advise her of adverse effects.
8. Encourage abstinence, monogamy, or safer sex methods, such as female or
male condom.
9. Stress the importance of follow-up examination and testing to eradication of
infection. Recurrence rates are highest in young patients.