Reply to discussion- Maria nur502
Maria,Gonzalez
NUR-502
8-3-20
K.B. is a 40 years old white female with 5 years old history of psoriasis. She has schedule an appointment with her dermatologist due to another relapse of psoriasis. This is her third flare-up since a definitive diagnosis was made. This outbreak of plaque is generalized and involves large regions on the arms, legs, elbows, knees, abdomen, scalp, and groin. K.B. was diagnosed with limited plaque-type psoriasis at age 35 and initially responded well to topical treatment with high-potency corticosteroids. She has been in remission for 18 months. Until now, lesions have been confirmed to small regions on the elbows and lower legs.
Psoriasis occurs in families, so the I a hereditary predilection. Several human leukocyte alleles are associated with the development of psoriasis. The mode of transmission is multifactorial. Environmental factors such us stress, cold. trauma, infections, obesity, excessive alcohol consumption and certain medications are known to trigger psoriasis
(Kim et al ., 2016). There are five clinical types.
Plaque (Chronic): Thick red plaques civered by flaky, silver-white scales ( the most common type.
Erythrodermic (acute or chronic): Intense erythema and scaling that covers a large area usually from head to toe.
Cuttate : Small , pink-red papules and plaques that usually appear abruptly and acutely with n necessary prior history of psoriasis; may occur post infection (e.g., streptococcal pharyngitis). Guttate means drop like and refers to the small size of the lesions (less than 1 cm). The unusual location of the lesions is the trunk and proximal extremity. Guttate psoriasis may remit, recur , or progress to plaque psoriasis.
Inverse: Erythema and irritation usually with no scaling that occur in the intertriginous areas such as armpits, groin, and skin folds; referred to as inverse as the location of the lesion s are opposite o he usual extensor surface areas that are affected.
Pustular: Papules or plaques with pustules surrounded by erythema. This type can be acute in onset, and severe forms can be associated with infectious signs such as malaise and fever.
Treatments
Plaque:
Vit D creams, such as calcipotriene (Dovonex) and (Rocaltrol) to reduce the rate that skin cell grow
Topical retinoids, to help reduce inflammation
Medications like (Tazorac , Avage)
Application of coal tar, either cream, oil or shampoo
Biologic, a category of anti-inflammatory drugs
In some cases, may need light therapy. This involves exposing the skin to both UVA and UVB rays. Sometimes treatments combine prescription oral medications, light therapies,
and prescription ointments to reduce inflammation.
Guttate psoriasis:
Steroid creams
Light therapy
Oral medications
Antibiotics
Flexural or inverse psoriasis:
Topical steroids cream
Light therapy
Oral medications
Biologics which are available via injection or intravenous infusion
Pustular psoriasis:
Many over the counter medications
Corticosteroid creams
Oral medications
Light therapy
Biologic may be recommended
Erythrodermic psoriasis:
May need hospital attention
At the hospital may receive a combination of therapies
Plaque psoriasis is the most common form of psoriasis ,An estimated of 80 to 90 percent of people with psoriasis have plaque psoriasis.(Koch et at., 2015)
Treatment for Mrs. K.B. is as follow:
Reduce stress
Vitamin D cream, such as calcipotriene ( Dovonex) and calcitrol (Rocaltrol) to reduce the rate that skill cell grow
Topical retinoids, to help reduce inflammation
Medication like tazarotene (Tazorac, Avage)
Application of coal tar, either by cream, oil, or shampoo
Biologic, a category of anti-inflammatory drugs
If Mrs. K.B. Corticosteroids is a powerful drug ease inflammation and can help a lot but should not use them over long period time. They can make skin thinner, could cause stomach ulcers, bone, thinning, and premature cataracts among other medical issues, and may stop working as well.
Other manifestations could be thickened , pitted or ridge nails, Swollen and stiff joints.
Conclusion, Psoriasis is a chronic skin disorder. It is considered an autoimmune disease. This means the immune system harm the body instead if protecting it. Around 7.4 million people in the United States have this condition (Joshi et al., 2016)
References
Joshi et al., 2016 A.A. Joshi, J.B. Lerman , T.M. Aberra, M. Afshar, H.L. Teague, J.A. Rodante,
et al. ClycA is a novel Biomarker of inflammation and subclinical cardiovascular disease in psoriasis [e-pub ahead of print] Circ Res (2016)
Kim et al., 2016a J. Kim, R. Bissonnette, J. Lee, J. Correa da Rosa, M. Suarez-Farinas, M.A.
Lowes, et al. The spectrum of mild to severe psoriasis is defined by common activation
Of I-17 pathway genes, but with key difference un immune regulatory genes. J Invest
Dermatol, 136)2016),pp. 2173-2182
Koch et al. (2015)., M. Koch, H Baurech, J.S . Ried, E. Rodriguez, S. Schlesinger, N> Volks,
Psoriasis and cardiometabolic traits: modest association but distinct genetic architect-
Tures. Retrieved from hpp://www.sciencedirect.com/science/article/pii/S00022202
X1632646x
Maria,Gonzalez
NUR-502
8-8-20
C. J. is a 27 year-old male who started to present crusty and yellowish discharge on his eyes 24 hours ago. At the beginning he though that washing his eyes vigorously the discharge will go away buy the contrary increased producing a blurry vision specially in the morning. Once he clears his eyes of the sticky discharge her visual acuity was normal again. Also, he has been feeling throbbing pain on his left ear. His eyes become red today, so he decided to consult to get evaluated. On his physical assessment you find a yellow discharge an bilateral conjunctival erythema. His throat and lungs are normal. His left ear
Canal is within normal limits, but the tympanic membrane is opaque, bulging.
Hyperacute bacterial conjunctivitis is a severe, slight-threatening ocular infection that warrants immediate ophthalmic work-up and management. The infection has an abrupt onset and is characterized by a copious yellow-green purulent discharge that reaccumulates after being wiped way(Morrow ,1998).
Bacterial conjunctivitis is cause by bacteria, often types of staphylococcus or streptococcus, is spread through poor hygiene or contact with other people or insects result in a thick , sticky discharge from the eye, and may- some cases -require antibiotic eye drops.
Etiology: Bacterial conjunctivitis is usually caused by staphylococcus aureus , streptococcus pneumonia, Haemophilus species, or less commonly, Chlamydia trochomatis. Neisseria gonorrhoeae causes gonococcasl conjunctivitis, which usually results form sexual contact with a person who has a genital infection(Mel vin, 2019).
Treatment: antibiotics (topical for all causes except gonococcal and chlamydia) If is the bacterial conjunctivitis is due to gonococcal and chlamydia specific antibiotics may the pat received doxicycline 100mg twice a day for ten days or azithromycin 1 g . Topical therapy with erythromycin also is recommended. Encourage patient to finish the regimen of antibiotics.
Bacterial conjunctivitis is very contagious, and standard infection control measures should follow . Use hand sanitizer or wash their hands properly (fully lather hands, scrubs hands for at least 20 seconds , rinse well, and turn off the water using a paper towel Conclusion, Conjunctivitis refer to any inflammatory condition of the membrane that lines the eyelids and covers the exposed surface of the sclera. It is the most common cause of red eye. The etiology can usually be determined by a careful history and an ocular examination, but culture is occasionally necessary to establish the diagnosis or to guide therapy.
References
Roat M. I. (2019) Overview of conjunctival and sclera disorders retrieved from
https//www.merckmanueal..com/home/eye-disorders/conjunctival-and-scleral-
dirorsers/ove
Morrow. G.L. Conjuntivitis (1998) Retrieved from
https://www.aafp.org/afp/1998/0215/p735.html
