Discussion 1 (Luna)
Sensory and Integumentary Function
Integumentary Function
Question I
Name the most common triggers for psoriasis and explain the different clinical types.
The etiology of psoriasis generates sporadic flares with various time gaps, however, some stressors, such as drunkenness, skin damage, and hormonal changes, can trigger the condition. The syndrome is triggered by excessive alcohol consumption since it creates a conducive atmosphere. Overconsumption of alcohol causes severe inflammation which encourages psoriasis given the condition’s chronic inflammatory properties (Kimmel & Lebwohl, 2018). Skin injuries work similarly. Due to the inflammatory reaction associated with open wounds, patients with latent psoriasis may experience a return if the skin sustains injuries such as cuts, sunburn, or abrasions. Hormonal changes can trigger psoriasis as well. Some hormones, such as the vascular endothelial growth factor, alter inflammatory changes by inhibiting or encouraging leucocyte action and psoriasis’ chronic inflammation hyperproliferation(Kimmel & Lebwohl, 2018). Other triggers include smoking and stress.
Clinical Types Psoriasis is present in multiple guises in different populations. Plaque psoriasis is the most prevalent and appears to be red inflamed skin with white scales around elbows, knees, and the scalp (Zhukova & Kasikhina, 2018). Inverse psoriasis presents similar skin patches but lacks white scales and can be triggered by friction, sweat, or fungi. Guttate psoriasis appears in children as pink spots on the trunk which disappear within weeks without medical therapies. Other psoriasis types include pustular, erythrodermic, and nail psoriasis.
Treatment Question II
There are several types of treatments for psoriasis, explain the different types and indicate which would be the most appropriate approach to treat this relapse episode for K.B. Also include non-pharmacological options and recommendations.
The goal of psoriasis treatment is to prevent cell reproduction in the afflicted areas. Pharmacological therapy is one type of intervention. Corticosteroids are frequently used as a last option due to their widespread effectiveness. This drug’s anti-inflammatory and immunosuppressive properties reduce cell division rates by affecting gene transcription in the cell nucleus (Albanesi, 2019). Vitamin D analogs provide relief in psoriasis as well. Calcipotriene and calcitriol achieve slow cell growth by binding nuclear receptors involved in inflammation and division(Albanesi, 2019). Some non-pharmacological therapies achieve a similar effect but efficiency decreases with severity. Light therapy, which involves controlled exposure to forms of light like sunlight and ultra-violet rays, can slow down cellular growth and inhibit psoriasis with a repeated application (Albanesi, 2019). Fish oil, aloe vera cream, and essential oils all have a similar effect.
Question III
Included in question 2
A pharmaceutical intervention involving corticosteroids is the most appropriate therapy for K.B.’s condition. This intervention’s efficiency in previous topical prescriptions implies a higher likelihood of better outcomes in subsequent use. Moreover, the patient is experiencing widespread outbreaks covering large regions. Corticosteroids’ availability in a variety of forms including sprays, shampoos, gels, lotions, and creams provide multiple application methods to choose from which allows convenience and treatment adjustment with preference. These options will encourage application despite the wide surface area (Albanesi, 2019).
Question IV
A medication review and reconciliation are always important for all patients, describe and specify why in this particular case is important to know what medications the patient is taking?
The diagnosis of psoriasis and the development of treatment programs for better patient outcomes are aided by knowledge of active prescriptions. Given the nature of certain medicines provoking psoriasis, medication evaluation and reconciliation is critical in K.B.’s case. Exposure to certain beta-blockers, lithium, chloroquine and terbinafine has a triggering an exacerbating effect on dormant and active psoriasis (Dogra & Kamat, 2019). Knowledge of active prescriptions for K.B. can identify such drugs and inform better medication recommendations. This step improves the patient’s outcome.
Question V
What other manifestations could present a patient with Psoriasis?
Patients with plaque psoriasis have a variety of symptoms. In addition to K.B.’s symptoms, the patient may have cracked skin and ridged nails. After a long period of rest, joints may become stiff and swollen, with numbness. K.B. may experience fever and malaise too. Broken skin in affected areas may ooze pus and produce a foul smell. The condition can develop into psoriatic arthritis if mismanaged (Dogra & Kamat, 2019).
Sensory Function
Question I
Based on the clinical manifestations presented in the case above, which would be your eyes diagnosis for C.J. Please name why you get to this diagnosis and document your rationale.
C.J.’s condition is consistent with bacterial conjunctivitis. After sleeping, the patient has a yellowish discharge that creates a crust. This symptom and the red eyes caused by increased capillary vasodilation and visibility resulting from increased blood density due to inflammatory responses in the eyes are consistent with conjunctivitis infection (Wirfs, 2020). Fast symptom progression within 24 hours and a throbbing ear suggest an advanced infection that spreads deeper into the sinus cavity causing redness and swelling inside the ear. The presence of a discharge eliminates several conditions, including viral conjunctivitis, foreign objects, and blocked tear ducts, whose presentations exclude discharge(Wirfs, 2020). Bacteria can cause pus discharge at the injection site, which contains damaged inflammatory compounds and dead bacteria. Pus discharge and bilateral conjunctival erythema indicate inflammatory activity which follows a bacterial infection. This combination of factors sums up a bacterial conjunctivitis diagnosis.
Question II
With no further information would you be able to name the probable etiology of the eye affection presented?
Viral, bacterial, allergic, gonococcal, trachoma. Why and why not. C.J.’s illness appears to be the result of a bacterial infection, according to the information available. The presence of a yellowish discharge eliminates viral etiology because viral infections cause little or no discharge (Marinos et al., 2019). Similarly, the presentations eliminate an allergic cause. Allergic reactions are temporary, often improving within hours and upon removal of the stimuli (Wirfs, 2020). These reactions also rely on the trigger to cause the infection. The lack of a possible trigger in the C.J.’s routine and sustained effects, which worsened within 24 hours, disqualified allergic cause. Several factors support a bacterial etiology including bilateral conjunctival erythema. Erythema indicates acute anterior inflammation which targets bacterial infections. Eye discharge supports a bacterial cause as well. This discharge results from the inflammatory activity and contain bacteria and tissue debris from this process. Redness and bulge in the tympanic membrane are an effect of the infection and the associated immune response processes.
Question III
Based on your answer to the previous question regarding the etiology of the eye affection, which would be the best therapeutic approach to C.J’s problem.
The best treatment plans take into account the nature and identification of the pathogenic bacteria, but for mild to moderate infections, some programs’ broad aim suffices. For eight days, C.J. may use topical antibiotics such as tobramycin, fluoroquinolone, and chloramphenicol four times every 24 hours. As an alternative, chloramphenicol and fusidic acid have similar results. The goal of this treatment is to get rid of the bacteria that is causing the problem. Some treatments fail to achieve this elimination, leading symptoms to worsen and the illness to spread. Every two days, patients should be examined to assess the efficacy of the treatment plan and to check for such progression. Besides that, the condition’s easy transmission necessitates isolation from work for four days to allow microbial clearance or recovery (Wirfs, 2020).
C.J. needs to implement additional steps for better outcomes, including hygienic strategies. Patients may need to clean their eyes several times a day to prevent the accumulation and formation of crust. Besides crust, pus may irritate the eyes and tear. Regular cleaning prevents such discomfort and associated complications. In addition, hygiene can help prevent contamination and the introduction of new bacteria types. Some bacteria, such as Chlamydia trachomatis, are contagious and are transmissible via contact. A patient’s contamination with such pathogens can lead to new infections which may fall without a treatment scope. The resulting sustained inflammatory state and symptom presentation will contribute to a poor outcome. Therefore, patient hygiene as part of treatment plans is crucial for microbial remission (Wirfs, 2020).
References
Albanesi, C. (2019). Immunology of Psoriasis. In Clinical Immunology. https://doi.org/10.1016/b978-0-7020-6896-6.00064-8
Dogra, S., & Kamat, D. (2019). Drug-induced psoriasis. Indian Journal of Rheumatology, 14(5). https://doi.org/10.4103/0973-3698.272159
Kimmel, G. W., & Lebwohl, M. (2018). Psoriasis: Overview and Diagnosis. https://doi.org/10.1007/978-3-319-90107-7_1
Marinos, E., Cabrera-Aguas, M., & Watson, S. L. (2019). Viral conjunctivitis: a retrospective study in an Australian hospital. Contact Lens and Anterior Eye, 42(6). https://doi.org/10.1016/j.clae.2019.07.001
