psoriasis presentation

8/9/2019 Psoriasis Presentation

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Mohd Fauzi Hamdan

2009453476

Siti Rohaida bt Mohamed

2009248776

Erlisha Wendy Likimas2009614498

Nurul Syakila bt Naziron

2009607266

Nur Aida Jahari2008403214

NRS 427-FUNDAMENTAL

SURGICAL NURSING

GROUP 6

INFLAMMATORY SKINDISORDER

PSORIASIS


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INTRODUCTION


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Psoriasis is a medical condition that occurs when skin

cells grow too quickly

It is non-contagious common skin condition

Rapid skin cell reproduction resulting in red, drypatches of thickened skin


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Psoriasis is a medical condition that occurs when skin

cells grow too quickly

It is non-contagious common skin condition

Rapid skin cell reproduction resulting in red, dry

patches of thickened skin


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TYPES OF PSORIASIS&

CHARACTERISTIC


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There are five types of psoriasis:

Plaque

Guttate

Pustular

Inverse

Erythrodermic


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Plaque Psoriasis (psoriasis vulgaris)

Plaque psoriasis is most typically characterized by

circular-to-oval red plaques distributed over extensor

body surfaces and the scalp The plaques usually exhibit scaling as a result of

epidermal hyperproliferation and dermal inflammation


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Plaque Psoriasis (psoriasis vulgaris)

May also evolve into more severe disease, such as pustular

or erythrodermic psoriasis

Also called psoriasis vulgaris

Plaque psoriasis causes patches of thick, scaly skin that may

be white, silvery, or red


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Guttate Psoriasis

A variety of conditions can bring on an attack of guttate

psoriasis, including upper respiratory infections, streptococcal

throat infections (strep throat), tonsillitis, stress, injury to the

skin and the administration of certain drugs including

antimalarials and beta-blockers


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Pustural psoriasis

Primarily seen in adults, pustular psoriasis is characterized by

white or yellowish blisters of noninfectious pus (consisting of

white blood cells) surrounded by red skin

It begins with the reddening of the skin followed by formation

of pustules and scaling


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Pustural psoriasis

May be triggered by internal medications, irritating topical

agents, overexposure to UV light, pregnancy, systemic

steroids, infections, stress and sudden withdrawal of systemic

medications or potent topical steroids


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Inverse psoriasis

Inverse psoriasis is found in the armpits, groin, under

the breasts, and in other skin folds around the genitals

and the buttocks

This type of psoriasis appears as bright-red lesions

that are smooth and shiny


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Erythrodermic Psoriasis

Erythrodermic psoriasis causes protein and fluid loss that can lead to severe

illness. The condition may also bring on infection, pneumonia andcongestive heart failure

Known triggers of erythrodermic psoriasis include the abrupt withdrawal of

a systemic psoriasis treatment including cortisone; allergic reaction to a

drug resulting in the Koebner response severe sunburns; infection; and

medications such as lithium, anti-malarial drugs; and strong coal tar

products


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RISK FACTOR


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Triggers can include:

Genetic

strong genetic component to psoriasis

Emotional stress

Stress can cause psoriasis to flare for the first time or aggravate existing

psoriasis

Injury to the skin

some types of infection

upper respiratory infections, streptococcal throat infections (strep throat),

tonsillitis


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Reactions to certain drugs

Certain medications, like antimalarial drugs, lithium and certain beta-blockers, are also known to

cause psoriasis flares

Age

The first peak occurs in persons aged 16-22 years, and the second occurs in persons aged 57-60

years

Environmenet

cold, dry climates are at much greater risk of developing psoriasis

warm, humid weather helps to heal psoriasis symptoms.

Diet

Allergies


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PATHOPHYSIOLOGY


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Psoriasis is fundamentally an inflammatory skin condition with reactive abnormal

epidermal differentiation and hyperproliferation

Shorther skin cell cycle growth

Keratinocytes migrate to stratum corneum in 4-7 days (normal: 14 days)

condition called hyperkeratosis

Immature cells produce an abnormal keratin that form thick, flaky scale at skin

surface

Rapid cell metabolism stimulates increase vascularity that contribute to

erythema of lession


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The inflammatory mechanisms are immune based and most

likely initiated and maintained primarily by T cells in the

dermis and interleukin (IL)

Signals triggers an immune response, leading to T-cell

activation and the release of cytokines


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MEDICAL TREATMENT


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Psoriasis treatments fall into 3 categories:

1) Topical (applied to the skin) Mild to moderate psoriasis

2) Phototherapy (light, usually ultraviolet, applied to the skin)

Moderate to severe psoriasis

3) Systemic (taken orally or by injection or infusion)

Moderate, severe or disabling psoriasis


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TOPICAL AGENT


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Topical (skin applied) medications :

topical corticosteroids (such as hydrocortisone)

very useful and often the first-line treatment for limited or small

areas of psoriasis

vitamin D analogue creams (Dovonex)

may be used in combination with topical steroids for better results


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SYSTEMIC MEDICATION


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Oral medications include:

Acitretin

oral drug used for certain types of psoriasis.

it may be used in males and females who are not pregnant and not

planning to become pregnant for at least three years

major side effects include dryness of skin and eyes and temporarily

elevated levels of triglycerides and cholesterol (fatty substance) in the

blood


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Methotrexate

Drug used for rheumatoid arthritis and, in high doses, for

cancer treatment

Is usually given in small weekly doses (5 mg-15 mg)

Blood tests are required before and during therapy

The drug may cause liver damage in some patients


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3. drugs that decrease the number of activated T-cells-

Amevive (alefacept)

4. drugs that interfere with interleukin chemical

messengers of inflammation-Ustekinumab


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NURSING CARE


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Impaired Skin Integrity

Psoriatic skin lesion increase risk of infection, that delay

healing process

Certain treatment (UVA and UVB) may cause erythematic

or peeling of skin and altered skin integrity


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Nursing

diagnose

Goal/Desired

Outcomes

Nursing

Interventions

Rationale/

Explanation

Evaluation

Impaired skin

integrity related

to immunology

deficit

(psoriasis),

lesions andinflammatory

response

Client will get

smoother skin

with control of

lesions

1. Encourage client

to take bath if

client is

immobilize,

nurse can

perform bedbath do not

chemical agent

2. Use sterile

materials such as

sterile linen,

blanket, pillow

case and clothes

1. To promote

skin recovery

2. To reduce

risk for

infection andmaintain

hygiene

Goal met. Client

achieved

smoother skin and

control of lesions


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Nursing

diagnose

Goal/Desired

Outcomes

Nursing

Interventions

Rationale/

Explanation

Evaluation

Impaired skin

integrity related

to immunology

deficit

(psoriasis),

lesions andinflammatory

response

Client will get

smoother skin

with control of

lesions

3. Administer

daily soaks

and tepid,

wet

compresses

to theaffected

areas

3.To remove

scales.

Goal met. Client

achieved

smoother skin and

control of lesions


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Nursing

diagnose

Goal/Desired

Outcomes

Nursing

Interventions

Rationale/

Explanation

Evaluation

Impaired skin

integrity related

to immunology

deficit

(psoriasis),lesions and

inflammatory

response

Client will get

smoother skin

with control of

lesions

4.Encourage

client to

prevent the

skin from

drying out

5.Inform patient

that water

should notbe too hot

and skin

should be

dried by

patting with

a towel

4. To prevent

psoriasis

getting

worsen

5. To avoid from

burn of the

skin

Goal met. Client

achieved

smoother skin and

control of lesions


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Nursing

diagnose

Goal/Desired

Outcomes

Nursing

Interventions

Rationale/

Explanation

Evaluation

Disturbances

of body

image related

to skindisorder

Clients will

accept his body

image changing

1. Give moral

support related

to self-esteem

and how to

accept physical

appearance

2. Provide privacy

to client

3. Educate family

to give moralsupport to

client

4. Advice client to

wear long

sleeves.

1. To increase

Client self-

esteem

2. To avoid low

self-esteemof client

3. To increase

Client self-

esteem

4. To cover the

infected area

Goal met. Client

accepted his body

image changing


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Knowledge Deficit

Client knowledge related to preventive measures,

treatment and medication available is less related topsoriasis


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Nursing diagnose Goal/Desired

Outcomes

Nursing

Interventions

Rationale/

Explanation

Evaluation

Knowledge

deficit related to

complexity of

treatment.

Clients

knowledge and

understanding

about the

treatment will be

increased.

1. Assess clientsknowledge

level.

- facial

expression

- Complaint

2. Provide

physical

comfort and

quite

atmosphere to

client.

1. To plan thefurther

interventions

2. To make

client more

concentrate

on what is

being

discussed.

Goal met. Clients

knowledge level

increased.


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Outcomes

Nursing

Interventions

Rationale/

Explanation

Evaluation

Knowledge

deficit related to

complexity of

treatment.

Clients

knowledge and

understanding

about the

treatment will be

increased.

3. Educate clientand relative

continuously

about the burn

injury if they

do not really

understand.

4. Provide an

atmosphere of

respect,

openness,

trust, and

collaboration.

3. To improve

clientsknowledge

4. This is

especially

important

when

providing

education to

patients with

different

values and

beliefs about

health and

illness.

Goal met. Clients

knowledge level

increased.


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Outcomes

Nursing

Interventions

Rationale/

Explanation

Evaluation

Knowledge

deficit related to

complexity of

treatment.

Clients

knowledge and

understanding

about the

treatment will beincreased.

8. Introduce

client to the

other client with

the same

disease.

9. Reevaluate

clients level of

knowledge.

8. To share the

experience,

knowledge and

feeling.

9. To determine

the effectiveness

of nursing

intervention that

have been done

Goal met. Clients

knowledge level

increased.


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Risk for Infection

The psoriasis may cause lesions or decrease skin

turgor

So the open skin may expose to external environmentand high risk to get infection


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Outcomes

Nursing

Interventions

Rationale/

Explanation

Evaluation

Risk for infection

related to open

lesions

Client will not

expose to

infection

1. Asses the

appearance

of the lesionssuch as its

location,

frequency,

level of

itching and

manifestations

2. Teach client

how to

prevent

infection by

proper hand

washing andnot

scratching

the lesions

3. Keep the skin

lubricated

1. To plan

further

intervention

2. To prevent

the infection

from

spreading

3. to minimize

itching

Goal met. Client

not expose to

infection


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COMPLICATION


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Changes from mild psoriasis to severe psoriasis

Side effect of treatment or medication

Light therapy- Common side effects with PUVA and UVB include

burning, tanning of the skin, potential skin damage, increased brown

spots called lentigines, and possible increased risk of skin cancer,

including melanoma

Cyclosporine- Effects include kidney and blood-pressure problems

Acitretin- Elevated levels of triglycerides and cholesterol (fatty

substance) in the blood


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Thickened skin and bacterial skin infections caused by scratching in an

attempt to relieve severe itching

Fluid and electrolyte imbalance in the case of severe pustular psoriasis

Low self-esteem

Depression

Stress

Anxiety

Social isolation

psoriatic arthritis can cause erosion in joints


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Impaired Temperature Regulation.

Erythrodermic psoriasis (in which psoriasis covers the

entire skin) can cause abnormalities in the body's ability toregulate temperature.


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Zumbusch Psoriasis

A combination of erythrodermic and pustular psoriasis

causes a serious condition called Zumbusch psoriasis:

The condition can develop abruptly.

Symptoms may include fever, chills, weight loss, and

muscle weakness.

Patients may develop excessive fluid build-up, protein

loss, and electrolyte imbalances


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HEALTH TEACHING


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Self Care:

Use anti-bacterial cleaner

to inhibit microorganisms growth

Keep the skin moist and lubricated

to prevent skin dryness

Try to avoid scratching and picking skin and skin injuries (cuts or scrapes)

an injury to the skin can cause psoriasis patches to form anywhere on the

body, including the site of the injury. This includes injuries to your nails or

nearby skin while trimming your nails.


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Avoid infection such as strep throat

may cause psoriasis to appear suddenly (called guttate

psoriasis), especially in children.

Try to avoid medications such as beta-blockers and lithium

to avoid worsen psoriasis symptoms


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Lifesytle:

Try to avoid stress and anxiety.

stress can cause psoriasis to appear suddenly (flare) or can make

symptoms worse

Limit alcohol consume

which can help control psoriasis, especially for men.

Don't smoke smoking

make you more likely to get psoriasis and may make it more

severe.


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Environmental control

Try to avoid cold, dry climates

Try to avoid pollutant area

Try to avoid crowded area

Avoid exposure to contagious illness such as

influenza


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Thank Youfor

Your Attention&

Any Questions

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