Psoriasis Overview and Treatment

Psoriasis

• Appearance: Characterized by silvery, erythematous, and scaly/thick plaques, commonly found on the scalp, elbows, knees, and lower back.

Psoriasis Treatment

• Topical: Corticosteroids, vitamin D analogs (calcipotriol), coal tar, salicylic acid.
• Phototherapy: UV light exposure under medical supervision.
• Systemic (moderate to severe): Oral medications (e.g., methotrexate, cyclosporine), biologics (e.g., adalimumab, etanercept, infliximab).
• Lifestyle: Stress management, moisturizers, avoid triggers (certain medications, stress, infections).

Concerns for Psoriasis Patients

• Physical: Pain from lesions, risk of secondary infections from cracked/open skin.
• Quality of life: Self-consciousness, social withdrawal, disrupted sleep or activities from itching/pain.
• Associated conditions: Psoriatic arthritis, increased risk of cardiovascular disease, obesity, diabetes, and depression.
• Psychological: Higher anxiety and depression rates due to visible/chronic condition.
• Medication: Potential side effects (immunosuppression, liver damage) from systemic therapies.

Pressure Injuries: Prevention and Treatment

• Positioning: Reposition patients every 1-2 hours to reduce pressure.
• Support: Use pressure-relieving surfaces (mattresses, cushions).
• Skin care: Keep skin clean, dry, and apply barrier creams.
• Nutrition: Adequate protein, vitamins (especially C), and hydration.
• Risk assessment: Use scales like the Braden Scale to identify high-risk patients.

Pressure Injury Treatment

• Staging: Determine injury stage (I-IV) to guide treatment.
• Stage I: Non-blanchable redness; use protective measures.
• Stage II: Partial-thickness loss; keep clean and moist with dressings.
• Stage III-IV: Full-thickness loss; may involve debridement, infection control, advanced wound care.
• Unstageable: Debride necrotic tissue to assess injury depth.
• Wound care: Cleaning, dressing (hydrocolloid, foam, alginate), and infection control (antibiotics if needed).
• Advanced therapies: Wound vac (negative pressure wound therapy), skin grafts for severe injuries.

Types of Exudate

• Serous: Clear/pale yellow, watery fluid; normal healing.
• Sanguineous: Red/bloody; active bleeding/vascular injury.
• Serosanguineous: Pink/pale red, watery; common in healing wounds.
• Purulent: Thick, yellow/green/brown; infection.
• Fibrinous: Sticky, yellow-white; chronic/severe inflammation.

Signs of Infection in Exudate

• Local: Redness, warmth, swelling, pain around wound, increased purulent drainage, foul odor, delayed healing, tissue necrosis.
• Systemic: Fever, chills, increased heart rate, elevated white blood cell count, elevated CRP/ESR.

Exudate Treatment

• Serous/serosanguineous: Continuation of regular wound care, protect area.
• Sanguineous: Assess for bleeding; apply pressure, use dressings to promote clotting.
• Purulent: Culture wound, start antibiotics, use antimicrobial dressings (silver, iodine).
• Excessive exudate: Manage moisture with absorbent dressings (alginate, foam).

Asthma Status Asthmaticus

• Severe asthma attack: Doesn't respond to standard treatments (inhaled bronchodilators, corticosteroids).
• Characteristics: Severe airway obstruction, inflammation, unrelenting bronchospasm, and potential respiratory failure needing immediate intervention.
• Life-threatening: Requires immediate medical attention.

Asthma Emergency Pathophysiology

• Bronchoconstriction: Smooth muscle tightening around airways.
• Inflammation: Airway wall swelling, narrowing airways.
• Mucus hypersecretion: Excess mucus further blocks already narrowed airways.

Asthma Emergency Clinical Manifestations

• Severe dyspnea (difficulty breathing).
• Wheezing (may be diminished in severe cases).
• Accessory muscle use and nasal flaring.
• Tachypnea (fast breathing) and tachycardia (fast heart rate).
• Cyanosis (blue lips/fingertips).
• Silent chest (often an ominous sign).
• Altered mental status.

Asthma Emergency Treatment

• Airway management: Ensure airway patency, intubation if respiratory failure occurs.
• Oxygen therapy: High-flow oxygen to maintain oxygen saturation above 92%.
• Bronchodilators: Nebulized short-acting beta-agonists (e.g., albuterol), often with ipratropium.
• Corticosteroids: IV methylprednisolone or oral prednisone to reduce inflammation.
• Magnesium sulfate: IV for severe cases to relax airway smooth muscles.
• Epinephrine: IM epinephrine in cases of anaphylaxis/severe bronchospasm.
• Pneumothorax treatment: Immediate needle decompression for tension pneumothorax, chest tube placement.
• Continuous monitoring: Watch oxygen saturation, ABGs, and vitals.

Key Interventions for Asthma Emergencies

• Rapid escalation: Respiratory therapists, intensivists, critical care teams involved.
• Continuous patient reassessment: Evaluate response to treatment, prepare for intubation if needed.

Acid-Base Imbalances

• pH: 7.35-7.45
• PaCO₂: 35-45 mmHg
• HCO₃⁻: 22-26 mEq/L

Common Acid-Base Imbalances

• Respiratory Acidosis (e.g., asthma exacerbation, COPD): Low pH, high PaCO₂. Caused by hypoventilation or airway obstruction.
• Respiratory Alkalosis (e.g., hyperventilation, anxiety): High pH, low PaCO₂ .

Advanced Asthma Interventions

• Intubation: Prepare for mechanical ventilation if respiratory failure develops.
• ABG monitoring: Watch for rising PaCO₂ (hypercapnia) or falling pH (worsening acidosis).

Peritonitis Key Features

• Inflammation of the peritoneum. Caused by infection, perforation, or trauma.
• Symptoms: Severe abdominal pain, rigidity, rebound tenderness, fever, nausea/vomiting, tachycardia.

Treatment Plan: Peritonitis

• NPO, isotonic IV fluids, IV antibiotics, possible surgery (e.g., laparotomy).
• Monitor for sepsis signs.

Appendicitis Key Features

• Inflammation of the appendix. Often due to obstruction.
• Symptoms: Right lower quadrant pain (McBurney's point), rebound tenderness, nausea, fever, elevated WBC count.

Treatment Plan: Appendicitis

• Prepare for appendectomy.
• Pain management.
• IV fluids.
• Antibiotics.
• Post-op: Advance diet as tolerated, watch for infection signs.

Gastroenteritis Key Features

• Inflammation of the stomach and intestines. Can be caused by infection, toxins, or foodborne illness.
• Symptoms: Diarrhea, vomiting, abdominal cramps, dehydration.

Treatment Plan: Gastroenteritis

• Oral or IV rehydration, electrolyte replacement, antiemetics, and dietary adjustments (bland diet, avoid irritants).

Ulcerative Colitis Key Features

• Chronic inflammation of the colon with continuous lesions.
• Symptoms: Bloody diarrhea, urgency, abdominal pain, weight loss, fatigue.

Treatment Plan: Ulcerative Colitis

• Medications (aminosalicylates, corticosteroids, immunosuppressants).
• Monitor for complications (toxic megacolon, perforation).

Diverticulitis Key Features

• Inflammation/infection of diverticula.
• Symptoms: Left lower quadrant (LLQ) pain, fever, constipation, bloating, elevated WBCs.

Treatment Plan: Diverticulitis

• Bowel rest (NPO or clear liquids).
• Antibiotics.
• Pain control.
• Possible surgery for complications.

Nutritional Considerations for Irritable Bowel Syndrome

• Acute phase (itis): NPO or clear liquid diet for bowel rest.
• Maintenance: High-fiber diet (except during diverticulitis flare). Avoid trigger foods (dairy, caffeine, spicy foods). Adequate hydration.

Symptoms of Sepsis

• Fever or hypothermia.
• Tachycardia, tachypnea.
• Altered mental status.
• Hypotension (late sign).
• Elevated lactate levels, WBCs.
• Oliguria (decreased urine output).

Isotonic Fluids and Antibiotics

• Isotonic fluids: Restore intravascular volume (0.9% NaCl, lactated Ringer's).
• Antibiotics: Broad-spectrum initially (piperacillin-tazobactam) until cultures guide therapy.

Patient Education for ITTIS

• Complete antibiotic therapy.
• Recognize signs of infection/complications (fever, abdominal pain, diarrhea).
• Gradual reintroduction of diet.
• Stress management to avoid exacerbations.

Crohn's Disease Biggest Issues

• Chronic inflammation affecting any part of the GI tract.
• Challenges: Strictures, fistulas, abscesses, malnutrition (malabsorption).

Crohn's Exacerbation Signs/Symptoms

• Persistent diarrhea (may be bloody), abdominal cramping (often RLQ), fatigue, fever, weight loss, malnutrition, perianal abscesses/fistulas.

Dietary Recommendations: Crohn's Disease

• Low-residue diet during flares.
• High-calorie, high-protein diet for malnutrition.
• Avoid trigger foods (dairy, spicy foods, alcohol).

Medications and Education: Crohn's Disease

• Aminosalicylates: Reduce inflammation (e.g., mesalamine).
• Corticosteroids: Short-term use for flares (e.g., prednisone).
• Immunosuppressants: Maintain remission (e.g., azathioprine).
• Biologics: Target inflammatory pathways (e.g., infliximab, adalimumab).
• Antibiotics: Treat infections/abscesses (e.g., metronidazole).

Patient Education: Crohn's Disease

• Medication adherence.
• Recognize complications (fever, worsening abdominal pain).
• Importance of regular follow-ups and lab monitoring.
• Avoid NSAIDs (worsen inflammation).

Cirrhosis Exacerbation

• General: Jaundice, ascites, peripheral edema, caput medusae (dilated abdominal veins), muscle wasting.
• Symptoms: Fatigue/weakness, abdominal pain, confusion/lethargy (hepatic encephalopathy), bruising/bleeding tendencies.

Important Laboratory Values: Cirrhosis

• LFTs: Elevated AST/ALT, bilirubin, low albumin.
• Clotting: Prolonged PT/INR.
• Ammonia: Elevated ammonia (encephalopathy).
• Electrolytes: Low sodium, potassium imbalances.
• CBC: Anemia, thrombocytopenia, leukopenia.
• Creatinine/BUN: Monitor for hepatorenal syndrome.

Cirrhosis Management

• Ascites: Paracentesis, low-sodium diet, diuretics (spironolactone, furosemide).
• Hepatic encephalopathy: Lactulose to reduce ammonia, monitor mental status.
• Bleeding prevention: Avoid NSAIDs, monitor PT/INR, consider vitamin K.
• Nutrition: High-calorie, low-sodium, moderate-protein diet, vitamin supplementation (B vitamins, folic acid).
• Complications: Infection (spontaneous bacterial peritonitis), variceal bleeding (endoscopy as needed).

Cirrhosis Patient Teaching

• Avoid alcohol.
• Maintain low-sodium diet, monitor fluid intake.
• Recognize signs of encephalopathy/infection.
• Adhere to medications (including lactulose).
• Importance of follow-ups/routine labs.

Ammonia Management Medications

• Lactulose: Promotes ammonia excretion via stool. Side effects: diarrhea, bloating (adjust dosage).

Blood Pressure Management

• Beta-blockers (e.g., propranolol): Prevent variceal bleeding.
• Avoid ACE inhibitors/NSAIDs: May worsen renal function.

Preventing Hepatorenal Syndrome

• Maintain adequate fluid management for kidney perfusion.
• Avoid nephrotoxic medications.
• Treat infections promptly.
• Monitor for renal dysfunction closely.

Hepatitis Transmission and Types

• Hepatitis A: Fecal-oral, contaminated food/water. Prevention: Hand hygiene, vaccination, safe food preparation.
• Hepatitis B: Blood/body fluids (sexual contact, IV drug use). Prevention: Vaccination, safe sex, avoid sharing needles.
• Hepatitis C: Blood (IV drug use, transfusions before 1992). Prevention: No vaccine; avoid sharing needles, avoid sharing personal items.
• Hepatitis D: Blood/body fluids, co-occurs with Hepatitis B. Prevention: Hepatitis B vaccination (Hep D needs B to infect).
• Hepatitis E: Fecal-oral, contaminated water. Prevention: Hand hygiene, avoid contaminated water.

Hepatitis Patient Teaching

• Acute phase: Rest.
• Avoid alcohol/hepatotoxic medications.
• Emphasize vaccination for preventable types.
• Safe hygiene practices (handwashing, safe food preparation).

Acute Hepatitis Care

• Hepatitis A: Supportive care (hydration, rest, symptom management).
• Hepatitis B & C: Chronic: Antivirals (e.g., tenofovir, entecavir for Hep B; direct-acting antivirals for Hep C). Acute: Supportive care, monitor liver function.
• Hepatitis D: Treat as Hepatitis B with antivirals.
• Hepatitis E: Supportive care, avoid hepatotoxic substances.

Peptic Ulcer Disease (PUD)

• Ulcers in stomach, duodenum, or esophagus. Causes: H. pylori infection, chronic NSAID use, stress/alcohol.

PUD Treatment

• Lifestyle modification: Avoid alcohol, smoking, NSAIDs, manage stress, smaller, frequent meals.
• Medications: Proton pump inhibitors (PPIs), H2-receptor blockers, antacids, sucralfate.

H. pylori Treatment

• Triple therapy (14 days): PPI, amoxicillin, clarithromycin (or metronidazole).
• Quadruple therapy (14 days, for resistant cases): PPI, bismuth subsalicylate, tetracycline, metronidazole.

Hemorrhage Identification

• Hematemesis (vomiting blood, "coffee grounds").
• Melena (black, tarry stools).
• Fatigue, dizziness, pallor (anemia).
• Hypotension, tachycardia (shock).

Acute Hemorrhage Management

• Stabilize patient (IV fluids, blood transfusions).
• Monitor vitals/urine output.
• Endoscopic intervention (cauterization, injection therapy).
• Medications (IV PPIs).

PUD Patient Teaching

• Medication adherence.
• Avoid NSAIDs, alcohol, caffeine, smoking.
• Manage stress, balanced diet (avoid spicy/acidic).
• Recognize complications (bleeding, severe pain).

Irritable Bowel Syndrome (IBS)

• Functional disorder of the large intestine.
• Characterized by abdominal pain, bloating, and changes in bowel habits (diarrhea, constipation).
• Triggers: Stress, certain foods (e.g., dairy, gluten, caffeine, spicy foods).

IBS Dietary Modifications

• Low-FODMAP diet.
• High-fiber diet for constipation-predominant IBS.
• Avoid trigger foods.

IBS Medications

• Antispasmodics, laxatives (constipation), loperamide (diarrhea), antidepressants for pain/stress.
• Regular exercise, stress management techniques.

Cholecystitis

• Inflammation of the gallbladder, often from gallstones blocking the cystic duct.
• Symptoms: Right upper quadrant (RUQ) pain (often after fatty meals), nausea, vomiting, fever, jaundice (severe cases).

Acute Cholecystitis Management

• NPO.
• IV fluids, pain management, antibiotics.
• Prepare for surgery (cholecystectomy).
• Most common: Laparoscopic cholecystectomy.

Cholecystitis Diet

• Acute: NPO or clear liquids.
• Post-acute/post-surgery: Low-fat diet to avoid gallbladder stimulation.
• Gradual: Reintroduce normal diet, but limit fatty foods if needed.

Post-Cholecystectomy Discharge Teaching

• Monitor for infection (fever, incision redness).
• Avoid heavy lifting (4-6 weeks).
• Low-fat diet initially.
• Expect mild diarrhea (notify if severe).
• Pain management/incision care instructions.

Pancreas Functions

• Endocrine: Produces insulin, glucagon for blood sugar regulation.
• Exocrine: Secretes digestive enzymes (amylase, lipase, protease) for carbohydrate, fat, and protein breakdown.

Pancreatitis Clinical Symptoms

• Acute: Severe epigastric/upper abdominal pain (radiates to back), nausea, vomiting, fever, tachycardia, abdominal tenderness/distension.
• Potential jaundice (bile duct obstruction).
• Severe signs: Cullen's sign (bluish umbilicus), Grey Turner's sign (flank bruising).

Chronic Pancreatitis Symptoms

• Recurrent pain, malabsorption, steatorrhea (fatty stools), weight loss.
• Possible diabetes: Progressive loss of endocrine function.

Acute Pancreatitis Care Goals

• Pain management: IV opioids (e.g., morphine, hydromorphone). Positioning (sitting up/leaning).
• Fluids/Nutrition: Aggressive IV hydration (isotonic solutions), NPO initially (to rest pancreas), consider enteral feeding (nasojejunal tube) if prolonged fasting, low-fat, high-protein, high-carbohydrate diet when improving.
• Pulmonary care: Prevent atelectasis/pleural effusions, respiratory status monitoring, incentive spirometry.
• Blood glucose management: Monitor glucose frequently, administer insulin if hyperglycemia.

Pancreatitis Discharge Education

• Diet: Low-fat, nutrient-dense, small frequent meals, avoid alcohol entirely,
• Blood sugar management: Monitor blood glucose at home. Teach signs of hypo/hyperglycemia.
• Enzyme replacement: Use pancreatic enzyme supplements (e.g., pancrelipase). Swallow whole; do not crush/chew.
• Complications: Seek immediate care for severe pain, jaundice, fever, or infection signs.
• Follow-up: Routine follow-ups to monitor pancreatic function, glucose levels, nutritional status.

Kidney Disease Key Laboratory Value

• Decreased urine output (oliguria).

This quiz covers essential information about psoriasis, including its appearance, treatment options, and associated concerns. Dive into key aspects of managing this skin condition and understand its broader implications on health and quality of life.