Description
You should respond to at least two of your peers, by extending, refuting/correcting, or adding additional nuance to their posts. Please include references
CASE STUDY 1
K.B.’s Case Study
Common Triggers for Psoriasis
The most common triggers for psoriasis include bacterial infection, viral infection, dry air, dry skin, skin injuries, use of certain medicines, stress, too little or too much sunlight, and excessive alcohol consumption (Dlugasch & Story, 2021). These trigger a psoriasis exacerbation and make the condition more difficult to treat. There are different clinical types for this disease. The most common is the chronic plaque. This causes thick, red plaques covered by flaky scales. If they are lifted, it causes bleeding because of the abnormal blood vessels location (Dlugasch & Story, 2021). They are symmetrically distributed and well defined. The usual location being the scalp, elbows, knees, and gluteal cleft (Dlugasch & Story, 2021). Erythrodermic is another type, which could be acute or chronic. It is intense covering large areas from head to toe, painful and pruritic, and high risk for infections and fluid and electrolyte imbalances ((Dlugasch & Story, 2021). Guttate is another type which includes mall, pink-red papules and plaques which appear abruptly and acutely with no history of psoriasis (Dlugasch & Story, 2021). The location is usually in the trunk and proximal extremities and could progress to plaque psoriasis. Inverse psoriasis is erythema and irritation with no scaling in the armpits, groin, and skin folds ((Dlugasch & Story, 2021). Lastly, Pustular psoriasis are papules and plaques with pustules surrounded by erythema. This can be acute and severe forms can be associated with malaise and fever ((Dlugasch & Story, 2021). This type could cause sepsis and respiratory, renal, or hepatic complications.
Treatment
Treatments of psoriasis are only to improve symptoms significantly, but there is no cure. One treatment is topical, these basically decrease inflammation on the skin, decrease plaque buildup, reduce scaling, and reduce dryness (Dlugasch & Story, 2021). Phototherapy is another treatment, which also slows cell turnover, reducing scaling and decreases inflammation. Systemic therapy could be oral or injected and is only for severe or resistant cases (Dlugasch & Story, 2021). For K.B., since she usually uses topical corticoids, another method could be used. Since the area is generalized and all over her body, potentially using phototherapy could be beneficial. Another topical treatment such as retinoids or calcineurin inhibitors. IF these options become resistant, the patient could use systemic therapy for a brief period because of the serious side effects (Dlugasch & Story, 2021).
In addition to the methods mentioned above, stress management, avoiding triggers could be beneficial to avoid exacerbations. There are support groups and counseling available for those struggling to manage psoriasis.
Medication Review Importance
Medication review and reconciliation is vital for treating psoriasis. For one, if it is a medication being used for the psoriasis it is important to know that it is no longer working or has become resistant. Also, it is important to know if any medication could potentially be causing this exacerbation, especially since the patient has been fine for 18 months. Certain drugs have been linked to psoriasis, such as beta-blockers, lithium, and antimalarial drugs (Balak & Hajdarbegovic, 2017). Also, treatment withdrawals of cortical steroids or topical corticosteroids can cause a psoriasis flare (Balak & Hajdarbegovic, 2017).
Manifestations
Aside from the manifestations mentioned above with the skin, joint pain or aching are common. Commonly known as psoriatic arthritis. Nail changes such as thickening, yellow-brown spots, dents on the nail surface and separation in nail from the base are also symptoms (Dlugasch & Story, 2021). There is also an increased risk for cardiovascular disease, hypertension, inflammatory bowel disease, and other autoimmune disorders.
C.J.’s Case Study
Diagnosis for Patient
My diagnosis for C.J. is conjunctivitis. Conjunctivitis is an infection of the lining inside of the eyelids, sclera, and up to the cornea. It could be causes by viruses, bacteria, allergens, chemical irritants and trauma (Dlugasch & Story, 2021). Conjunctivitis produces edema, eye discharge, and eye redness. The patient had discharge, and now his eyes are red. Aside from this, conjunctivitis causes blurry vision but when the secretions are rinsed, vision should be normal (Dlugasch & Story, 2021). The patient stated that when he cleared his eyes of the discharge, his visual acuity was normal again. If vision was not normal after cleaning the eyes, the diagnosis would potentially change. In regard to the ear pain, if the conjunctivitis is viral, it could lead to otitis media (Dlugasch & Story, 2021).
Etiology
Conjunctivitis could either be viral, bacterial, gonococcal, allergic or trachoma. With viral, the discharge is watery and mucous like and scant. It also feels like there is sand in the eye and usually starts with one eye (Dlugasch & Story, 2021). It is also common to be accompanied by respiratory symptoms. The patient does not have any of those symptoms, his lngs and throat were normal. With bacterial, the discharge is yellow or green like the patient has said. It also can be accompanied by otitis media, which the patient does have ear pain and his tympanic membrane is opaque, bulging and red. Gonococcal conjunctivitis is sexually transmitted and can cause blindness, it usually starts from genitalia, to hands, to eyes (Dlugasch & Story, 2021). The conjunctiva looks like a bulging blister, so this is not it. Lastly trachoma conjunctivitis is the bacteria chlamydia trachomatis, which is normally is remote areas with lack of clean water and sanitation, which is not it either (Dlugasch & Story, 2021). I would say that the patient has bacterial conjunctivitis.
Therapeutic Approach
Most conjunctivitis will resolve without treatment. Symptomatic relief includes warm, most compresses and cool compresses for edema (Dlugasch & Story, 2021). Bacterial conjunctivitis is treated with antibiotics, either topical ointment or eyedrops Centers for Disease Control and Prevention, 2019).
CASE STUDY 2
Integumentary Function
Name the most common triggers for Psoriasis and explain the different clinical types.
Triggers are activities or factors that increase a certain condition or elevate an individual’s symptoms of a given illness. In this case, there are various triggers that patients with Psoriasis encounter that elevate psoriasis-related symptoms. They include bug bites, skin injuries like cuts or scrapes, skin infections/ strep throat infections, weather (cold or dry seasons), exposure to second-hand smoking or direct smoking, and also taking some medication like antimalaria and high blood pressure medications like lithium and alcoholism (Raharja et al., 2021). Also, patients who rapidly withdraw from the oral corticosteroids can also trigger this condition. These triggers are known to flare up, thus leading to severe symptoms of Psoriasis. Identifying the patient triggers can help providers formulate the best plan for the patients by first addressing the triggers before initiating treatment (Raharja et al., 2021).
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 nonpharmacological options and recommendations.
This patient can be treated using various treatment options, including topical, phototherapy, or injection. For topical treatments, the patient can be given medication to apply on the mucous membrane or on the skin, which brings effect after entering the skin. This medication can help protect the patient’s skin from harm on the skin and will relieve the patient of the associated pain. Secondly, prescribing phototherapy is also recommended as it involves the utilization of specific light on patients and should not be sunlight; it exposes the skin to too much light, thus bringing about the desired outcomes. Thirdly, injections are also used but are less commonly recommended and only considered in cases where the patient has been irresponsive to other medications (Armstrong & Read, 2020).
The pharmacological treatments highly considered in treating patients with Psoriasis are corticosteroids. Also, patients are given Vitamin B analogs, which prevent skin cell growth. Also calcineurin inhibitors are also very effective and help by reducing the building up of the plague and inflammation. Coal tar is also recommended for reducing scaling, itching, and inflammation, which are common in Psoriasis. In this case, the best nonpharmacological treatment will be phototherapy (Armstrong & Read, 2020).
A medication review and reconciliation are always important in all patients; describing and specifying why, in this particular case, is important to know what medications the patient is taking.
There are cases of drug interactions that highly affect the effectiveness of administered medications. In that case, before administering any new medications, it is recommended that current medications be assessed to ensure that the patient remains safe while combining these medications. Also, some patients present with reoccurring illnesses, and thus, knowing the medications taken previously to treat similar symptoms can help modify the treatment plan to best address the reoccurrence issues (Beuscart et al., 2021). This implies that if a patient once suffered from Psoriasis and took an injection but did not get well or had severe side effects, another plan must be considered in this new plan. Also, as noted, some patients trigger Psoriasis after taking some medications like high blood pressure medication. This implies that if patients are assessed on the medications they have been taking, it can help identify some of the triggers of Psoriasis relating to the current medications and make necessary adjustments (Beuscart et al., 2021).
What other manifestations could present a patient with Psoriasis?
Other clinical conditions can present in patients with Psoriasis, including obesity, hypertension, diabetes, cardiovascular disease, dyslipidemia, metabolic syndromes, and psoriatic arthritis. Other clinical manifestations include patches of thick, red skin, thick, cracked skin, bleeding, and pitted thick nails. It is important for the provider to identify these presentations in a patient in order to diagnose Psoriasis. Also, a patient presenting with the above-mentioned conditions must be evaluated for Psoriasis as these conditions increase the likelihood of someone suffering from Psoriasis (Raharja et al., 2021).
Sensory Function
Based on the clinical manifestations presented in the case above, what would be your eye diagnosis for C.J.? Please name why you got to this diagnosis and document your rationale.
Based on the patient’s presentations and the clinical features identified, bacteria conjunctivitis is the best eye diagnosis that best fits this case. This eye infection affects the conjunctiva and spreads to the back side of the eyelid surface. Various signs and symptoms are associated with this condition, including yellowish discharge and bilateral conjunctival. In diagnosing this condition, providers are required to critically analyze the patient’s case to determine the cause so as to establish if the eye infection is caused by a virus, bacteria, or allergen (Pippin & Le, 2022). Assessing the patient’s history can help determine this and present symptoms and eye examinations. For patients presenting with bacteria conjunctivitis, the major signs include swelling and redness of the eye, followed by other symptoms that depend on the cause. The patient fits this diagnosis since the presentations include red eye, irritation, and discharge (Pippin & Le, 2022).
With no further information, can you name the probable etiology of the eye affection presented? Viral, bacterial, allergic, gonococcal, trachoma. Why and why not?
Eye infection presents different symptoms and signs depending on its etiology; therefore, it is possible to differentiate the eye etiologies based on the symptoms the patient is presenting. For instance, in this case, the patient is presenting with a yellowish discharge, which can also be described as pus discharge, which directly points to bacterial conductivities, implying bacteria infection. In other cases, patients presenting with viral eye infections will present with symptoms such as pinkish eye discharge (McCance & Huether, 2019).
Based on your answer to the previous question regarding the etiology of eye affection, which would be the best therapeutic approach to C. J.’s problem?
This patient can be advised to improve his hygiene since eye infection is likely to be obtained from touching contaminated places and touching the eye with a dirty hand. These bacteria might have spread from the hand to the eye. This hygiene routine can include regular hand washing and also should stay at home and not go to work for at least 1-3 days until the symptoms resolve. It is also important to recommend cool compresses as well as artificial tears, which can be done at least six times every day. Also, the patient can be prescribed antibiotics to help with the patient’s infection (McCance & Huether, 2019).
