Psoriasis Overview and Treatment Options
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Questions and Answers

What is the appearance of psoriasis?

Silvery, erythema, scaly/thick

What are some topical therapies used to treat psoriasis?

  • Corticosteroids (correct)
  • Vitamin D analogs (correct)
  • Coal tar (correct)
  • Salicylic acid (correct)
  • All of the above (correct)

Which of the following are concerns for a client with psoriasis?

  • Pain and discomfort from lesions (correct)
  • Risk of secondary infections (correct)
  • Quality of life issues (correct)
  • Associated conditions like psoriatic arthritis (correct)
  • Psychological impact due to the visible nature (correct)
  • All of the above (correct)

What are some preventative measures to take to reduce the risk of pressure injuries?

<p>Frequent repositioning (A), Support surfaces like specialized mattresses (B), Skin care routine (C), Nutritional support (D), Risk assessment tools (E), All of the above (F)</p> Signup and view all the answers

How do you treat a stage II pressure injury?

<p>Keep the area clean and moist with dressings (D)</p> Signup and view all the answers

What type of exudate is thick, yellow, green, or brown and indicates infection?

<p>Purulent (A)</p> Signup and view all the answers

Increased purulent drainage and a foul odor are local signs of infection in wound exudate.

<p>True (A)</p> Signup and view all the answers

What type of exudate would you expect in a wound that is actively bleeding?

<p>Sanguineous (C)</p> Signup and view all the answers

What is the definition of status asthmaticus?

<p>A severe asthma attack that does not respond to standard treatments like inhaled bronchodilators and corticosteroids.</p> Signup and view all the answers

A tension pneumothorax is a less severe form of pneumothorax.

<p>False (B)</p> Signup and view all the answers

Which of the following is NOT a pathophysiological mechanism involved in asthma exacerbations?

<p>Pulmonary embolism (B)</p> Signup and view all the answers

What are some clinical manifestations of a severe asthma attack?

<p>Tachypnea (D), Cyanosis (E), Altered mental status (F), All of the above (G), Severe dyspnea (A), Wheezing (B), Use of accessory muscles (C)</p> Signup and view all the answers

Which of the following medications is NOT used in the emergency treatment of asthma?

<p>Digoxin (E)</p> Signup and view all the answers

A silent chest is a good sign indicating adequate airflow in a severe asthma attack.

<p>False (B)</p> Signup and view all the answers

What is the usual range for PaCO₂ in a healthy individual?

<p>35-45 mmHg (A)</p> Signup and view all the answers

What is the most likely cause of respiratory acidosis?

<p>Hypoventilation (A)</p> Signup and view all the answers

What type of acid-base imbalance is most likely to occur in a patient experiencing hyperventilation?

<p>Respiratory alkalosis (C)</p> Signup and view all the answers

Intubation is an option for managing severe asthma exacerbations if respiratory failure develops.

<p>True (A)</p> Signup and view all the answers

Which of the following is a sign of worsening acidosis in a patient with severe asthma?

<p>Decreasing blood pH (A), Increasing PaCO₂ (B)</p> Signup and view all the answers

Which of the following is NOT a symptom of peritonitis?

<p>Headache (E)</p> Signup and view all the answers

Which type of medications are typically used for pain control during an acute pancreatitis episode?

<p>IV opioids (D)</p> Signup and view all the answers

Patients with acute pancreatitis should be NPO initially to allow the pancreas to rest.

<p>True (A)</p> Signup and view all the answers

What type of feeding is considered if prolonged fasting is necessary for a patient with acute pancreatitis?

<p>Enteral feeding (B)</p> Signup and view all the answers

Patients with acute pancreatitis may experience hyperglycemia due to decreased insulin production during inflammation.

<p>True (A)</p> Signup and view all the answers

What is the name of the bluish discoloration around the umbilicus that can occur in severe pancreatitis?

<p>Cullen's sign (C)</p> Signup and view all the answers

What are some of the key features of chronic pancreatitis?

<p>Recurrent pain, malabsorption, steatorrhea (fatty stools), weight loss, diabetes</p> Signup and view all the answers

Chronic pancreatitis can lead to diabetes due to the progressive loss of endocrine function.

<p>True (A)</p> Signup and view all the answers

What is the goal of pain management for a patient with acute pancreatitis?

<p>Reduce pain and discomfort (A)</p> Signup and view all the answers

Patients with acute pancreatitis should be encouraged to lie flat on their backs for pain relief.

<p>False (B)</p> Signup and view all the answers

What is the recommended diet for a patient with acute pancreatitis who is recovering?

<p>Low-fat, high-protein (A)</p> Signup and view all the answers

Patients with chronic pancreatitis should avoid alcohol completely.

<p>True (A)</p> Signup and view all the answers

What type of medication is recommended for patients with chronic pancreatitis to help with digestion?

<p>Pancreatic enzyme supplements (D)</p> Signup and view all the answers

Patients with chronic pancreatitis should always crush or chew their pancreatic enzyme supplements for better absorption.

<p>False (B)</p> Signup and view all the answers

What are some signs of complications that a patient with pancreatitis should watch for?

<p>Severe pain, jaundice, fever, signs of infection</p> Signup and view all the answers

Flashcards

Appearance of Psoriasis

Characterized by raised, reddish patches covered with silvery scales. Commonly found on the scalp, elbows, knees, and lower back.

Treatment for Psoriasis

Involves topical therapies, phototherapy, and systemic medications. Topical therapies include corticosteroids, Vitamin D analogs, coal tar, and salicylic acid. Phototherapy involves exposure to UV light under medical supervision. Systemic medications, used for moderate to severe cases, include oral medications like methotrexate and cyclosporine, and biologics like adalimumab, etanercept, and infliximab. Lifestyle adjustments such as stress management, moisturizers, and avoiding triggers are also important.

Concerns for a client with Psoriasis

Physical symptoms include pain and discomfort from lesions, risk of secondary infections from cracked or open skin. Quality of life concerns include visible plaques leading to self-consciousness and social withdrawal, itching or pain disrupting sleep and daily activities. Associated conditions include psoriatic arthritis, cardiovascular disease, obesity, diabetes, and depression. Psychological impact includes higher prevalence of anxiety and depression. Medication side effects can include immunosuppression and liver damage.

Pressure Injury Prevention

Includes frequent repositioning, support surfaces, skin care, nutritional support, and risk assessment tools. Frequent repositioning involves changing positions every 1-2 hours. Support surfaces use specialized mattresses or cushions. Skin care includes keeping skin clean and dry and applying barrier creams. Nutritional support involves adequate protein, vitamins, and hydration. Risk assessment tools like the Braden Scale identify high-risk patients.

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Pressure Injury Treatment

Involves staging the injury, cleaning and dressing, infection control, and advanced therapies. Staging determines the depth of the injury and guides treatment. Cleaning and dressing involve using saline or wound cleansers and selecting appropriate dressings (hydrocolloid, foam, or alginate). Infection control includes treating infected wounds with antibiotics. Advanced therapies include negative pressure wound therapy and skin grafts.

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Types of Exudate

Serous exudate is clear or light yellow and watery, indicating normal healing. Sanguineous exudate is red or bloody, indicating active bleeding or vascular injury. Serosanguineous exudate is pink or pale red and watery, common in healing wounds. Purulent exudate is thick, yellow, green, or brown, indicating infection. Fibrinous exudate is sticky, yellow-white, and often seen in chronic or severe inflammation.

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Signs of Infection in Exudate

Local signs include redness, warmth, swelling, pain around the wound, increased purulent drainage with a foul odor, and delayed healing. Systemic signs include fever, chills, increased heart rate, elevated white blood cell count, and markers of inflammation.

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Treating Different Exudate Types

Serous or serosanguineous exudate requires regular wound care and protection. Sanguineous exudate needs assessment for bleeding and pressure application. Purulent exudate requires culture to identify bacteria, antibiotics, and antimicrobial dressings. Excessive exudate requires absorbent dressings.

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Status Asthmaticus

A severe asthma attack that doesn't respond to standard treatments like inhaled bronchodilators and corticosteroids. It's characterized by severe airway obstruction and inflammation, unrelenting bronchospasm, and potential respiratory failure if untreated. It's a life-threatening condition requiring immediate intervention.

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Pneumothorax in Asthmatics

Occurs when air escapes into the pleural space, causing lung collapse. A tension pneumothorax, which is more severe, involves air trapping with each breath, compressing the heart and other lung.

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Pathophysiology of Asthma in Emergencies

Involves bronchoconstriction, inflammation, and mucus hypersecretion. Bronchoconstriction tightens the smooth muscles around the airways. Inflammation causes swelling of the airway walls. Mucus hypersecretion blocks the already narrowed airways.

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Clinical Manifestations of Asthma in Emergencies

Include severe dyspnea, wheezing, use of accessory muscles, tachypnea, tachycardia, cyanosis, silent chest, and altered mental status. Severe dyspnea is difficulty breathing. Wheezing may diminish due to little airflow. Accessory muscles and nasal flaring indicate increased effort. Tachypnea is rapid breathing. Tachycardia is rapid heart rate. Cyanosis is blue lips or fingertips. A silent chest indicates no airflow. Altered mental status includes confusion and lethargy.

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Emergency Treatment for Asthma

Includes airway management, oxygen therapy, bronchodilators, corticosteroids, magnesium sulfate, epinephrine, and treatment of pneumothorax. Airway management ensures the airway stays open; intubation might be needed. Oxygen therapy provides high-flow oxygen. Bronchodilators like albuterol relax the airway muscles. Corticosteroids reduce inflammation. Magnesium sulfate relaxes airway muscles. Epinephrine is used for anaphylaxis or severe bronchospasm. Treatment of pneumothorax includes immediate needle decompression and chest tube placement. Continuous monitoring of oxygen saturation, ABGs, and vital signs is essential.

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Key Interventions During Asthma Emergency

Involve rapid escalation, patient reassessment, and readiness for intubation. Rapid escalation means involving specialists and critical care teams. Patient reassessment involves continuous evaluation of response to treatment. Readiness for intubation means being prepared to intubate if necessary.

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Recognizing Acid-Base Imbalances

The normal pH range is 7.35-7.45. The normal partial pressure of carbon dioxide (PaCO₂) is 35-45 mmHg. The normal bicarbonate level (HCO₃⁻) is 22-26 mEq/L.

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Common Acid-Base Imbalances

Respiratory acidosis is caused by hypoventilation or airway obstruction, leading to low pH and high PaCO₂. Respiratory alkalosis is caused by hyperventilation or anxiety, leading to high pH and low PaCO₂.

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Managing Respiratory Acidosis

Focuses on improving ventilation and correcting acidosis. This includes supplemental oxygen, bronchodilators like albuterol, and corticosteroids like methylprednisolone.

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Managing Respiratory Alkalosis

Involves calming anxiety, promoting slow, deep breaths, and correcting electrolyte imbalances if present.

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Metabolic Acidosis

Caused by a buildup of acid in the blood or a loss of bicarbonate. This can be due to diabetic ketoacidosis, kidney failure, or severe diarrhea.

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Metabolic Alkalosis

Caused by a loss of acid or a gain of bicarbonate. This can be due to prolonged vomiting, diuretic use, or excessive antacid use.

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Peritonitis: Key Features

Inflammation of the peritoneum caused by infection, perforation, or trauma. Symptoms include severe abdominal pain, rigidity, rebound tenderness, fever, nausea/vomiting, and tachycardia.

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Plan of Care for Peritonitis

Involves NPO, isotonic IV fluids, IV antibiotics, and possible surgical intervention. Monitor for signs of sepsis.

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Appendicitis: Key Features

Inflammation of the appendix, often due to obstruction. Symptoms include right lower quadrant pain, rebound tenderness, nausea, fever, and elevated WBCs.

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Plan of Care for Appendicitis

Prepare for appendectomy, pain management, IV fluids, and antibiotics. Post-op care includes advancing diet as tolerated and watching for infection signs.

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Gastroenteritis: Key Features

Inflammation of the stomach and intestines caused by infection, toxins, or foodborne illness. Symptoms include diarrhea, vomiting, abdominal cramps, and dehydration.

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Plan of Care for Gastroenteritis

Involves oral or IV rehydration, electrolyte replacement, antiemetics, and dietary adjustments.

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Ulcerative Colitis: Key Features

Chronic inflammation of the colon with continuous lesions. Symptoms include bloody diarrhea, urgency, abdominal pain, weight loss, and fatigue.

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Plan of Care for Ulcerative Colitis

Involves medications like aminosalicylates, corticosteroids, and immunosuppressants, and monitoring for complications such as toxic megacolon and perforation.

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Diverticulitis: Key Features

Inflammation or infection of diverticula (small pouches) in the colon. Symptoms include left lower quadrant pain, fever, constipation, bloating, and elevated WBCs.

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Plan of Care for Diverticulitis

Involves bowel rest, antibiotics, pain control, and possible surgery for complications.

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Nutritional Considerations for Inflammatory Bowel Disease

Acute phase involves NPO or clear liquid diet. Maintenance phase involves high-fiber diet (except during diverticulitis flares), avoiding trigger foods, and adequate hydration.

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Symptoms of Sepsis

Include fever or hypothermia, tachycardia, tachypnea, altered mental status, hypotension, elevated lactate levels, WBCs, and oliguria.

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Study Notes

Psoriasis

  • Appearance: Silvery, erythematous, and scaly/thick plaques. Common locations include scalp, elbows, knees, and lower back.

  • Treatment:

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

  • Concerns for clients with psoriasis:

    • Physical symptoms: Pain, discomfort, risk of secondary infections.
    • Quality of life: Social impact, disrupted sleep/activities due to itching/pain.
    • Associated conditions: Psoriatic arthritis, cardiovascular disease, obesity, diabetes, depression.
    • Psychological impact: Increased anxiety and depression.
    • Medication side effects: Immunosuppression, liver damage.

Pressure Injuries (Decubitus Ulcers)

  • Prevention: Frequent repositioning, support surfaces (mattresses, cushions), proper skin care (clean, dry, barrier creams), nutritional support (protein, vitamins, hydration). Risk assessment tools (Braden Scale).

  • Treatment:

    • Staging: Determine stage (I-IV) to guide treatment.
    • Stages I-II: Protective measures, clean, moist dressings.
    • Stages III-IV: Debridement, infection control, advanced wound care.
    • Unstageable: Debride necrotic tissue to assess.
    • Wound care: Saline or wound cleansers, appropriate dressings (hydrocolloid, foam, alginate).
    • Infection control: Antibiotics if needed, antimicrobial dressings.
    • Advanced therapies: Wound vac, skin grafts.

Wound Exudate

  • Types:

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

  • Signs of infection: Local (redness, warmth, swelling, pain, foul odor, delayed healing); Systemic (fever, chills, increased heart rate, elevated WBCs, CRP, ESR).

Asthma

  • Status Asthmaticus: Severe asthma attack unresponsive to standard treatments, severe airway obstruction/inflammation, life-threatening, requiring immediate intervention.

  • Pathophysiology: Bronchoconstriction, inflammation, mucus hypersecretion.

  • Clinical manifestations/emergency treatment: Severe dyspnea, wheezing (may diminish), accessory muscle use, tachypnea, tachycardia, cyanosis, silent chest (no airflow), altered mental status.

    • Airway management: Ensure airway patency; intubation (if necessary).
    • Oxygen therapy: High-flow oxygen.
    • Bronchodilators: Nebulized short-acting beta-agonists (e.g., albuterol), possibly with ipratropium.
    • Corticosteroids: IV methylprednisolone, or oral prednisone.
    • Magnesium sulfate: IV for severe cases.
    • Epinephrine: IM epinephrine for anaphylaxis/severe bronchospasm.
    • Pneumothorax treatment: Immediate needle decompression (tension pneumothorax), chest tube.
    • Monitoring: Oxygen saturation, ABGs, vital signs.
    • Key interventions: Rapid escalation (respiratory therapists, intensivists), continuous patient reassessment, readiness to intubate.

Acid-Base Imbalances

  • Normal ranges: pH (7.35-7.45), PaCO₂ (35-45 mmHg), HCO₃⁻ (22-26 mEq/L).

Other Conditions (Abdomen, GI, etc.)

  • Peritonitis: Inflammation of peritoneum due to infection, perforation, or trauma. Symptoms: Severe abdominal pain, rigidity, rebound tenderness, fever, nausea/vomiting, tachycardia. Care: NPO, isotonic IV fluids, IV antibiotics, possible surgery.
  • Appendicitis: Inflammation of appendix due to obstruction. Symptoms: RLQ pain (McBurney's point), rebound tenderness, nausea, fever, elevated WBCs. Care: Appendectomy, pain management, IV fluids, antibiotics.
  • Gastroenteritis: Inflammation of stomach and intestines. Symptoms: Diarrhea, vomiting, abdominal cramps, dehydration. Care: Oral/IV rehydration, electrolyte replacement, antiemetics, dietary adjustments.
  • Ulcerative Colitis: Chronic inflammation of colon with continuous lesions. Symptoms: Bloody diarrhea, urgency, abdominal pain, weight loss, fatigue. Care: Medications (aminosalicylates, corticosteroids, immunosuppressants), monitor for complications.
  • Diverticulitis: Inflammation/infection of diverticula in the colon. Symptoms: LLQ pain, fever, constipation, bloating, elevated WBCs. Care: Bowel rest, antibiotics, pain control, possible surgery.
  • Sepsis: Systemic inflammatory response to infection. Symptoms: Fever/hypothermia, tachycardia/tachypnea, altered mental status, hypotension (late), elevated lactate, WBCs, oliguria. Care: Isotonic fluids, broad-spectrum antibiotics.
  • Crohn's Disease: Chronic inflammation affecting any part of GI tract (mouth to anus). Challenges: Strictures, fistulas, abscesses; malnutrition. Symptoms: Persistent diarrhea (may be bloody), abdominal cramping (often RLQ). Care: Medications, low-residue diet when flaring, and high-calorie/high-protein when improving, avoid trigger foods, stress reduction, regular follow-ups and lab monitoring.
  • Cirrhosis: Liver scarring and damage. Symptoms/Appearance: Jaundice, ascites, peripheral edema, caput medusae, muscle wasting, fatigue, abdominal pain, confusion/lethargy (hepatic encephalopathy). Labs: High AST, ALT, bilirubin, low albumin, prolonged PT/INR, high ammonia, electrolyte imbalances, anemia, thrombocytopenia, leukopenia, monitor kidney function. Management: Ascites management (paracentesis, low sodium, diuretics), hepatic encephalopathy management (lactulose, monitor mental status), prevent bleeding (avoid NSAIDs, monitor PT/INR, vitamin K), nutrition, vitamin supplements, monitor for complications (infection, bleeding). Teaching: Avoid alcohol, low-sodium, recognize encephalopathy/infection signs, medication adherence, and follow-ups.
  • Hepatitis: Inflammation of the liver. Transmission varies by type (A, B, C, D, E). Care varies by type, acute vs. chronic. Prevention emphasizes hand hygiene, vaccination (for A, B) and safer practices.
  • Peptic Ulcer Disease (PUD): Ulcers in the stomach or duodenum. Causes: H. pylori infection, NSAID use, alcohol. Treatment: Lifestyle modifications (no alcohol, smoking, NSAIDs, stress reduction, smaller meals), medications (PPIs, H2-blockers, antacids, sucralfate), H. pylori treatment (triple/quadruple therapy). Management of Hemorrhage:IV fluids, blood transfusions if needed, endoscopic intervention (cauterization, injection therapy), medications (IV PPIs). Education: Medication adherence, avoid triggers, monitor for complications.
  • Irritable Bowel Syndrome (IBS): Functional disorder affecting the large intestine. Symptoms: Abdominal pain, bloating, changes in bowel habits (diarrhea, constipation). Triggers: Stress, certain foods (low FODMAP diet). Management: Dietary modifications (low-FODMAP, high fiber), stress management therapy.
  • Cholecystitis: Inflammation of gallbladder; often due to gallstones. Symptoms: RUQ pain, nausea, vomiting, fever, jaundice (severe). Care: NPO, IV fluids, pain management, antibiotics, surgical intervention (cholecystectomy).
  • Pancreatitis: Inflammation of the pancreas. Symptoms: Severe epigastric pain radiating to back, nausea, vomiting, fever, abdominal tenderness, jaundice (obstruction); severe signs: Cullen's sign (bluish discoloration), Grey Turner's sign (flank bruising). Care: Pain management (IV opioids), fluids (aggressive IV hydration), nutrition (NPO initially, then low-fat, high-protein, high-carbohydrate), pulmonary care (prevent atelectasis), Blood Glucose Management, enzyme replacements, follow-up.

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Description

Explore the key features and treatment strategies for psoriasis, including its appearance, topical and systemic therapies, and lifestyle adjustments. Understand the physical and psychological concerns that individuals with psoriasis may face. This quiz will enhance your knowledge of managing this chronic skin condition effectively.

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