Integumentary Function:
K.B. is a 40-year-old white female with a 5-year history of psoriasis. She has scheduled 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 psoriasis 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 confined to small regions on the elbows and lower legs.
Case Study Questions
- Name the most common triggers for psoriasis and explain the different clinical types.
- 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.
- Included in question 2
- A medication review and reconciliation are always important in all patient, describe and specify why in this particular case is important to know what medications the patient is taking?
- What others manifestation could present a patient with Psoriasis?
Sensory Function:
C.J. is a 27-year-old male who started to present crusty and yellowish discharged on his eyes 24 hours ago. At the beginning he thought that washing his eyes vigorously the discharge will go away but by 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 became red today, so he decided to consult to get evaluated. On his physical assessment you found a yellowish discharge and bilateral conjunctival erythema. His throat and lungs are normal, his left ear canal is within normal limits, but the tympanic membrane is opaque, bulging and red.
Case Study Questions
- Based on the clinical manifestations presented on the case above, which would be your eyes diagnosis for C.J. Please name why you get to this diagnosis and document your rational.
- 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.
- 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 problem.
Submission Instructions:
You Must complete both case studies when there are more than one.
- Your initial post should be at least 500 words, formattedusing the questions or a phrase that summarize the question as heading. This should be bold and centered and responses to each question under the heading. You must cite in current APA style with support from at least 4 academic sources within the last 5 years.
Integumentary Function:
Common Triggers and Clinical Types of Psoriasis: Psoriasis is a chronic inflammatory skin condition characterized by red, scaly plaques. The most common triggers for psoriasis include genetic predisposition, environmental factors such as stress, infection, injury to the skin, certain medications, and hormonal changes. There are several clinical types of psoriasis, including plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis. Plaque psoriasis, which is the most common type, presents as raised, red patches covered with a silvery-white buildup of dead skin cells.
Treatment Options for Psoriasis: Treatment for psoriasis aims to reduce inflammation, slow down skin cell turnover, and manage symptoms. The appropriate treatment approach for K.B.’s relapse episode depends on the severity and extent of her symptoms. Pharmacological options include topical treatments (such as corticosteroids, vitamin D analogs, and retinoids), phototherapy (exposure to ultraviolet light), oral medications (such as methotrexate, cyclosporine, and retinoids), and biologic agents (such as TNF-alpha inhibitors and IL-17 inhibitors). Given the generalized nature of K.B.’s outbreak, a combination therapy may be necessary, including topical corticosteroids for localized lesions and systemic medications for more widespread involvement.
Non-pharmacological options and recommendations for psoriasis management include lifestyle modifications to reduce triggers (such as stress reduction techniques, maintaining a healthy weight, and avoiding skin injuries), regular moisturizing to prevent dryness and itching, and phototherapy using natural sunlight when possible. Additionally, patient education on proper skincare, adherence to treatment regimens, and regular follow-up with healthcare providers are essential for long-term management of psoriasis.
Importance of Medication Review and Reconciliation: In K.B.’s case, medication review and reconciliation are crucial due to the potential interactions between her current medications and those used to treat psoriasis. Certain medications, such as systemic corticosteroids or immunosuppressants, may exacerbate her psoriasis or interfere with the efficacy of psoriasis treatments. Additionally, knowing her medication history allows healthcare providers to identify any potential triggers or underlying conditions that may contribute to her psoriasis flare-ups and tailor treatment accordingly.
Other Manifestations of Psoriasis: In addition to skin involvement, patients with psoriasis may experience various extracutaneous manifestations. These can include psoriatic arthritis, which affects the joints and causes pain, stiffness, and swelling; nail changes such as pitting, thickening, or separation from the nail bed; and ocular manifestations such as conjunctivitis, uveitis, or blepharitis. Furthermore, patients with psoriasis have an increased risk of developing comorbidities such as cardiovascular disease, metabolic syndrome, and psychological disorders like depression and anxiety. Therefore, comprehensive management of psoriasis should address both cutaneous and systemic manifestations to improve overall health outcomes.
Sensory Function:
Diagnosis and Rational for C.J.’s Eye Affection: Based on the clinical manifestations described, C.J. likely has acute bacterial conjunctivitis. The presence of yellowish discharge, bilateral conjunctival erythema, and red eyes are characteristic signs of bacterial conjunctivitis. The additional finding of a bulging, opaque, and red tympanic membrane suggests a possible concurrent otitis media, which can be associated with bacterial conjunctivitis, particularly in children. The throbbing pain in the left ear further supports the suspicion of otitis media.
Probable Etiology of Eye Affection: Without further information, it’s challenging to determine the exact etiology of C.J.’s eye affection. However, given the presence of purulent discharge and acute onset, bacterial conjunctivitis is the most likely diagnosis. Other potential etiologies such as viral conjunctivitis, allergic conjunctivitis, gonococcal conjunctivitis, or trachoma cannot be definitively ruled out without additional clinical and laboratory evaluation.
Therapeutic Approach for C.J.’s Problem: The best therapeutic approach for C.J.’s bacterial conjunctivitis would involve topical antibiotic treatment. Broad-spectrum antibiotics such as fluoroquinolones (e.g., moxifloxacin, ciprofloxacin) or polymyxin B/trimethoprim can effectively treat bacterial conjunctivitis. Topical antibiotics help to eradicate the bacterial infection and alleviate symptoms such as discharge and conjunctival erythema. Additionally, supportive measures such as warm compresses and artificial tears can provide symptomatic relief and promote ocular comfort. However, if C.J. also has otitis media, systemic antibiotics may be necessary to address the concurrent bacterial infection in the middle ear. Therefore, a comprehensive assessment and treatment plan considering both ocular and otic manifestations are essential for optimal patient management.