Nursing Care and Pathophysiology for Psoriasis

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Study Tools For Nursing Care and Pathophysiology for Psoriasis

Psoriasis (Picmonic)
Psoriasis (Image)
Psoriatic Plaque (Image)
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Outline

Overview

Pathophysiology: An autoimmune disorder where there is hyperproliferation of the epidermis and inflammation which leads to scaly patches of skin on skin. 

  1.  Psoriasis
    1. Autoimmune
    2. Scaly patches on skin

Nursing Points

General

  1. Common skin condition
    1. Body inflammatory response
      1. T cells attack healthy cells
      2. Overproduction of skin cells–>Buildup of cells on skin
      3. Cell death
  2. Immune response triggered by various factors
    1. Genetics
    2. Stress
    3. Smoking and alcohol
    4. Infections
    5. Obesity
    6. Cold, dry air
  3. May go into remission and come back
    1. Stress causes flare ups
  4. Types of Psoriasis
    1. Erythrodermic–>very red and rashlike
      1. Lesions nondefined
      2. Rare
      3. Temperature variations
      4. Dysregulation–> fluid and protein deficit
    2. Guttate–>pinkish/red spot
      1. Activated by upper respiratory infections
    3. Inverse–>Located in armpits, groin, skin folds
      1. Friction worsens
    4. Plaque (most common)–>Patches that are thick, red, with white scales
    5. Pustular–>Pus filled blisters and red skin
      1. Activated by chemicals, medications, infections

Assessment

  1. Presentation
    1. Assess skin on entire body
    2. Red patches with dry skin
    3. Cracked itchy skin
    4. Painful joints–>may result in psoriatic arthritis
  2. Considerations–>Secondary infections
    1. Fungal
    2. Bacterial/cellulitis

Therapeutic Management

  1. Moisturize skin
    1. Emollients
    2. Salicylic acid
    3. Corticosteroids
    4. Antifungal
  2. Medications for severe case–>suppress immune system
    1. Methotrexate
    2. Biologic therapy–>last option
  3. UV Phototherapy

Nursing Concepts

  1. Patient Education–>to avoid flare ups
    1. Avoid stressors
    2. Moisturize
  2. Tissue/Skin Integrity
    1. Skin has lesions from buildup of cells
  3. Immunity–>autoimmune disease
  4. Infection Control–>may be initiated by or lead to infection

Patient Education

  1. Manage stress
  2. Moisturize skin
  3. Quit smoking and drinking
  4. Get sun, avoid sunburn

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Transcript

Hey guys! Welcome to the lesson on psoriasis! By the end of this video, I want you to understand what psoriasis is and how it is treated.

 

Psoriasis is a common skin condition that typically shows as scaly patches on the skin. Psoriasis is actually an autoimmune disorder. Let’s explore what that means.

What happens is a stressor such as infection, smoking, alcohol, cold/dry air, obesity, or just stress in general occurs, and the body reacts inappropriately to that stress by going into an inflammatory response where the T cells begin attacking the healthy cells. This results in the overproduction of skin cells, which then build up on the skin. The layers of skin aren’t able to sufficiently be supplied with oxygen and nutrients that they need, so they die. This leaves those itchy, white, flaky patches on the skin. Now, psoriasis is a also genetic disorder that is more likely to happen in people with family members that have it.

Living with psoriasis can be stressful. If a patient can manage their stress and care for the skin lesions well, the psoriasis may go into remission. Unfortunately, it very easily flares back up with any of those stressors we talked about. Next, let’s talk about the different types of psoriasis that there are.

Plaque psoriasis is the most common type, and it’s probably what you think about when you hear the word psoriasis. These patients have thick patches of red skin with white scales on them.

Inverse psoriasis is located in the armpits, groin, and skin folds. This type of psoriasis worsens with friction, which is difficult to avoid in those areas of the body.

Guttate psoriasis looks more like pinkish/reddish spots. This type is usually comes about after an upper respiratory infection.

Pustular psoriasis shows as pus filled blisters with red skin. Chemicals, medication, and infections may bring about this type of psoriasis. For example, it’s been found that the chemicals in cigarettes can trigger pustular psoriasis in people.

Erythrodermic psoriasis is the most rare, and the most dangerous form of the disease. It appears as a very red rash that covers large areas of the body. The lesions aren’t defined like in the other types. You might actually see systemic effects in these patients. The patient may have variations in their temperatures, and may become deficit in fluid and protein because of the dysregulation of the skin. This type of psoriasis may occur after the sudden withdrawal of treatment.

Whenever you have a new patient, you should assess their skin. Check all areas of the body, including the scalp. Remember, psoriasis usually shows as red patches with dry skin, or cracked itchy skin. The patient with psoriasis may complain of painful joints, and may be at risk for psoriatic arthritis. This is a disease that a rheumatologist would have to address with the patient as it is more complicated than just skin lesions.

 

Whenever you have a patient with psoriasis, it’s important to check out the skin lesions and make sure that they aren’t infected. The patient may be scratching at them, breaking them open and allowing bacteria in and possibly resulting in cellulitis. Fungal infections are more likely to occur in those patients that have inverse psoriasis in those moist areas of the body like the groin and skin folds.

Okay, so next let’s talk about treatment. Psoriasis results in dry, crusty skin, so it’s important to keep it moisturized to avoid cracking and help it heal. Emollients are great to keep the skin moist. Salicylic acid and corticosteroids  can help to heal the psoriasis patches by tackling the inflammation. Antifungals may be needed for the patient with inverse psoriasis that grows infected with yeast.

Sometimes skin topicals aren’t enough to keep the psoriasis under control. Severe cases might call for methotrexate or biologic therapy, which help by suppressing the immune system to slow the attacking of the T cells. Biologic therapy is typically the last option due to the expense and side effects of the medications.

Sometimes skin topicals aren’t enough to keep the psoriasis under control. Severe cases might call for methotrexate or biologic therapy, which help by suppressing the immune system to slow the attacking of the T cells. Biologic therapy is typically the last option due to the expense and side effects of the medications.

Alright, so with patients that are trying to manage their psoriasis, we need to remind them to try and manage the stress in their life, moisturize their skin regularly, quit smoking and drinking, and get sun while avoiding sunburns.

 

Our priority nursing concepts for the patient with psoriasis include immunity, tissue/skin integrity, and infection control.

 

Okay, now let’s review the key points. Psoriasis is an autoimmune response where the T cells attack the healthy cells and cause the skin cells to multiple too fast, resulting in cell buildup on the skin and cell death. The types of psoriasis include plaque, which is the most common, guttate, pustular, and erythrodermic, which is the most rare and dangerous form. Triggers for psoriasis flare ups include stress, smoking, alcohol, obesity, genetics, infections, and cold/dry air. People with psoriasis must keep their skin moisturized, and may use emollients, corticosteroids, salicylic acid, and antifungals to help heal the skin lesions. Those with psoriasis may use UV light therapy to help clear the lesions. Methotrexate and biologic therapy are the last resort and may be used to suppress the immune system to slow the attack of T cells on the healthy cells.

Thanks so much for listening! I hope you’ve gotten a good grasp on what psoriasis is and how to treat it. Now go out and be your best self today, and as always, happy nursing!

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Study Plan Lessons

05.01 Pancreatitis and Large Bowel Obstruction for CCRN Review
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
AIDS Case Study (45 min)
Airway Suctioning
Anemia for Progressive Care Certified Nurse (PCCN)
Anesthetic Agents
Anesthetic Agents
ARDS Case Study (60 min)
ARDS causes Nursing Mnemonic (GUT PASS)
Artificial Airways
Aspiration for Certified Emergency Nursing (CEN)
Assessment for Myasthenic Crisis Nursing Mnemonic (BRISH)
Asthma for Certified Emergency Nursing (CEN)
AVPU Mnemonic (The AVPU Scale)
Azithromycin (Zithromax) Nursing Considerations
Barbiturates
Brain Death v. Comatose
Brain Tumors
Bronchoscopy
Carbon Dioxide (Co2) Lab Values
Chest Tube Management
Chest Tube Management Case Study (60 min)
Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min)
Chronic Obstructive Pulmonary Disease (COPD) for Certified Emergency Nursing (CEN)
Cirrhosis Case Study (45 min)
Cold Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Complications of Immobility
Coronavirus (COVID-19) Nursing Care and General Information
Day in the Life of a Med-surg Nurse
Diabetes Insipidus Case Study (60 min)
Diabetes Mellitus Case Study (45 min)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Disseminated Intravascular Coagulation Case Study (60 min)
Dysrhythmias for Certified Emergency Nursing (CEN)
Enteral & Parenteral Nutrition (Diet, TPN)
Erythromycin (Erythrocin) Nursing Considerations
Fractures (Open, Closed, Fat Embolus) for Certified Emergency Nursing (CEN)
General Anesthesia
Head and Spinal Cord Trauma for Certified Emergency Nursing (CEN)
Heart Failure Case Study (45 min)
Heart Failure for Certified Emergency Nursing (CEN)
Hemorrhagic Fevers for Certified Emergency Nursing (CEN)
Histamine 1 Receptor Blockers
Hyperthyroidism Case Study (75 min)
Hypothermia (Thermoregulation)
Infectious Diseases: Influenza for Progressive Care Certified Nurse (PCCN)
Intraoperative (Intraop) Complications
Leukemia Case Study (60 min)
Levofloxacin (Levaquin) Nursing Considerations
Local Anesthesia
Lung Cancer
Malignant Hyperthermia
Melanoma
Meperidine (Demerol) Nursing Considerations
Metabolic Acidosis (interpretation and nursing diagnosis)
Miscellaneous Nerve Disorders
Moderate Sedation
Montelukast (Singulair) Nursing Considerations
Morphine (MS Contin) Nursing Considerations
Myocardial Infarction (MI) Case Study (45 min)
Nephrotic Syndrome Case Study (Peds) (45 min)
Neurological Disorders (Multiple Sclerosis, Myasthenia Gravis, Guillain-Barré Syndrome) for Certified Emergency Nursing (CEN)
Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Myasthenia Gravis
Nursing Care and Pathophysiology for Psoriasis
Nursing Care and Pathophysiology for Scleroderma
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for SIRS & MODS
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology of Pneumonia
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Activity Intolerance
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Anaphylaxis
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Aspiration
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Blunt Chest Trauma
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan (NCP) for Brain Tumors
Nursing Care Plan (NCP) for Bronchoscopy (Procedure)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Chronic Kidney Disease
Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD)
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Nursing Care Plan (NCP) for Emphysema
Nursing Care Plan (NCP) for Encephalopathy
Nursing Care Plan (NCP) for Endocarditis
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Guillain-Barre
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Nursing Care Plan (NCP) for Hyperthermia (Thermoregulation)
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Lung Cancer
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Nursing Care Plan (NCP) for Mumps
Nursing Care Plan (NCP) for Myasthenia Gravis (MG)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Nephrotic Syndrome
Nursing Care Plan (NCP) for Osteoporosis
Nursing Care Plan (NCP) for Pancreatitis
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Restrictive Lung Diseases
Nursing Care Plan (NCP) for Rubeola – Measles
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Nursing Care Plan (NCP) for Tuberculosis
Nursing Care Plan for Cirrhosis (Liver)
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Nursing Care Plan for Nasal Disorders
Nursing Care Plan for Pulmonary Edema
Nursing Care Plan for Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
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Nursing Case Study for Breast Cancer
Nursing Case Study for Cardiogenic Shock
Nursing Case Study for Hepatitis
Nursing Case Study for Pneumonia
Nursing Case Study for Type 1 Diabetes
Obstruction for Certified Emergency Nursing (CEN)
Obstructive Sleep Apnea for Progressive Care Certified Nurse (PCCN)
Ondansetron (Zofran) Nursing Considerations
Opioids
Pancreatitis For PCCN for Progressive Care Certified Nurse (PCCN)
Patient Positioning
Pentobarbital (Nembutal) Nursing Considerations
Peritonitis for Certified Emergency Nursing (CEN)
Pleural Space Complications (Pneumothorax, Hemothorax, Pleural Effusion, Empyema, Chylothorax) for Progressive Care Certified Nurse (PCCN)
Positioning (Pressure Injury Prevention and Tourniquet Safety) for Certified Perioperative Nurse (CNOR)
Post-Anesthesia Recovery
PPE Precautions (Personal Protective Equipment) for Certified Perioperative Nurse (CNOR)
Propofol (Diprivan) Nursing Considerations
Respiratory A&P Module Intro
Respiratory Alkalosis
Respiratory Course Introduction
Respiratory Depression (Medication-Induced, Decreased-LOC-Induced) for Progressive Care Certified Nurse (PCCN)
Respiratory Distress Syndrome for Certified Emergency Nursing (CEN)
Respiratory Failure (Acute, Chronic, Failure to Wean) for Progressive Care Certified Nurse (PCCN)
Respiratory Infections (Pneumonia) for Progressive Care Certified Nurse (PCCN)
Respiratory Infections Module Intro
Respiratory Procedures Module Intro
Respiratory Trauma for Certified Emergency Nursing (CEN)
Respiratory Trauma Module Intro
Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)
Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)
Spinal Cord Injury Case Study (60 min)
Stroke Assessment (CVA)
Surgical Wound Classification Documentation for Certified Perioperative Nurse (CNOR)
Systemic Lupus Erythematosus (SLE)
The Medical Team
Thoracentesis
Trach Suctioning
Tuberculosis for Certified Emergency Nursing (CEN)
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Ventilator Settings
Wound Dressing Maintenance for Certified Perioperative Nurse (CNOR)