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Clinical Manifestations Psoriasis (treatment) slow the rapid turnover of epidermis, to promote resolution of psoriatic lesions, and to control the natural cycles of the disease. Gentle removal of scales is an important principle of psoriasis treatment. This can be accomplished by taking baths with a...

Clinical Manifestations Psoriasis (treatment) slow the rapid turnover of epidermis, to promote resolution of psoriatic lesions, and to control the natural cycles of the disease. Gentle removal of scales is an important principle of psoriasis treatment. This can be accomplished by taking baths with added oils (e.g., olive oil, mineral oil), colloidal oatmeal preparations, or coal tar preparations. A soft brush may be used to gently scrub the psoriatic plaques. After bathing, the application of emollient creams containing alpha-hydroxy acids or salicylic acid can soften thick scales. Topically applied agents are used to slow the overactive epidermis. For patients who do not respond well to topical treatments, phototherapy using narrow-band ultraviolet-B (UVB) therapy may be effective as a single-therapy modality. Methotrexate, a systemic cytotoxic agent, is the first-line drug for treating moderate to severe psoriasis (Nicpon, 2017). Methotrexate appears to inhibit DNA synthesis in epidermal cells, thereby reducing the turnover time of the psoriatic epidermis. However, the medication can be toxic, especially to the liver, kidneys, and bone marrow. Herpes zoster I: The goals of herpes zoster management are to relieve the pain (with NSAIDs, acetaminophen or opioids) and to reduce or avoid complications, which include infection, scarring, and postherpetic neuralgia and eye complications. AS: assesses the patient’s discomfort and response to medication and collaborates with the primary provider to make necessary adjustments to the treatment regime. AP: Vesicles and rashes may be soothed by applying OTC calamine lotion or 5% aluminum acetate (Burow’s solution) wet dressings for 30 to 60 minutes four to six times daily. The patient is educated about how to follow proper hand hygiene techniques to avoid spreading the virus. K: Herpes zoster, also called shingles, is an infection caused by VZV. The disease is characterized by painful vesicular eruptions along the areas of distribution of dermatomes (sensory nerves) from one or more posterior ganglia. Pharmacology (acyclovir) Assessment Skin cancer Malignant Melanoma AS: An excisional biopsy specimen provides information on the type, level of invasion, and thickness of the lesion. A thorough history and physical examination should include a meticulous skin examination and palpation of regional lymph nodes that may drain the area surrounding the tumor. Chest x-ray, CBC, complete chemistry panel with creatinine, liver function tests, and lactate dehydrogenase (LDH) are usually performed. AP: The nurse educates patients at risk to examine their skin and scalp monthly in a systematic manner and to seek prompt medical attention if changes are detected. all patients should be educated about the risks of UV radiation exposure and methods to mitigate that risk (e.g., sunscreen, shade). A group particularly at risk is young adult athletes, especially women. The nurse educates patients with nevi how to self-assess for signs that may suggest malignant transformation, referred to as the ABCDEs of Moles. Prevention Squamous Cell I: biopsy needed. AS: skin assessment P: The goal of treatment is to eradicate the tumor. The treatment method depends on the tumor location; the cell type, location, and depth; the cosmetic desires of the patient; the history of previous treatment; whether the tumor is invasive; and whether metastatic nodes are present. Surgical incision. In patients who are not surgical candidates, alternatives such as radiation therapy, photodynamic therapy, or topical chemotherapeutic creams may be viable options. AP: The wound is usually covered with a dressing to protect the site from physical trauma, external irritants, and contaminants. The patient is advised to watch for excessive bleeding and tight dressings that compromise circulation. Follow-up examinations should be at regular intervals, usually every 3 months for a year, and should include palpation of the adjacent lymph nodes. Contact dermatitis. Allergic. Avoidance of offending material. Aluminum acetate (Burow Solution, Domeboro Powder) or cool water compress. Systemic corticosteroids (prednisone) for 7–10 days Topical corticosteroids for mild cases Oral antihistamines to relieve pruritus Irritant: Identification and removal of source of irritation Application of hydrophilic cream or petrolatum to soothe and protect. Topical corticosteroids and compresses for weeping lesions. Antibiotics for infection and oral antihistamines for pruritus. AP: Patch testing and environmental history of exposure to contact allergens are required to verify the diagnosis. Patch testing is the standard test for identification of culprit allergens in persons with allergic contact dermatitis. The patch test most commonly used is the thin-layer rapid use epicutaneous (TRUE) test. Pediculosis capitis I: Griseofulvin for 4–6 wks or terbinafine for 2–4 wks. Shampoo hair or eyebrows twice weekly with selenium sulfide shampoo for 2 wks. AP: The nurse informs the patient that head lice may infest anyone and are not a sign of uncleanliness. Because the condition spreads rapidly, treatment must be started immediately. Epidemics among those living in close quarters (e.g., dormitories, military barracks, camps) may be managed by having everyone shampoo their hair on the same night. Cohabitants and family members should be warned not to share combs, brushes, and hats; they should be inspected for head lice daily for at least 2 weeks. Acne vulgaris Chronic dermatitis characterized by ( white or blackheads ) wash twice a day with cleansing soaps and OTC products with benzoyl peroxide or syslitc acid monitor and manage complications/ be positive/ and reassure. ( nicoles version just fix it if you want) imma hightlihgt my parts) Impetigo Superficial infections of the skin caused by staph and other similar bacterials bullous impetigo deep seated infection caused by S. Aures and cause buallae ( fluid filled blisters) contagious and may spread to other parts to the body INTERVENTIONS bathe in antibacterial soap hand hygiene separate towel and clothes eruption in lesion is touches hand hygiene Keloids Benign overgrowth of fibrous tissue at the sit of a scar or trauma ( common on dark blackies) treatment surgical excision corticosteroid chemo laser therapy radiation Musculoskeletal Diagnostic Exams (MRI) Magnetic Resonance Imaging- noninvasive imaging technique that uses magnetic fields and radio waves to create high-resolution pictures of bones and soft tissues. It can be used to visualize and assess torn muscles, ligaments, and cartilage; herniated discs; and a variety of hip or pelvic conditions. X-ray- determine bone density, texture, erosion; widening, narrowing, irregularity; reveal fluid, irregularity, spur formation, narrowing and changes in bone structure. DEXA Scan-Hip- DXA measures BMD and predicts fracture risk through accurate monitoring of bone density changes in patients with osteoporosis who are undergoing treatment Myelography- provides information about the electrical potential of the muscles and the nerves leading to them. The test is performed to evaluate muscle weakness, pain, and disability CT (Computed Tomography)- may be performed with or without the use of oral or intravenous (IV) contrast agents, shows a more detailed cross-sectional image of the body. Visualize and assess tumor, ligaments, severe traumato the chest abdomen, pelvis, head, or spinal cord. Bone Scan-performed to detect metastatic and primary bone tumors, osteomyelitis, some fractures, and aseptic necrosis, and to monitor the progression of degenerative bone diseases Idium Imagining Osteoporosis Characteristics- degenerative disease of the bone characterized by reduced mass, deterioration of matrix, and diminished architectural strength. most prevalent with fractures requiring hospitalization. Bone density peaks between 18 and 25 years of age After peak years, bone resorption exceeds bone building activity. Bone density decreases. Cancellous bone is lost first, followed by compact bone Bone mass decreases rapidly in postmenopausal women as serum estrogen levels diminish. Complications Development of kyphosis. Loss of height Porous, brittle, fragile bones Fracture easily under stress Prevention Primary osteoporosis occurs in women after menopause (usually by age 51) reduced use of caffeine, tobacco products, carbonated soft drinks, and alcohol Early identification of at-risk teenagers and young adults, increased calcium and vitamin D intake, participation in regular weight-bearing exercise, and modification of lifestyle Secondary osteoporosis is the result of medications or diseases that affect bone metabolism Use of corticosteroids can cause osteoporosis Affecting drugs should be discontinued. Pharmacology Alendronate Risedronate (Bisphosphonates) Treatment of osteoporosis in women who are postmenopausal Treatment of osteoporosis in men, and in women taking coritcosteroids Take in am on empty stomach Stay sitting up right for 30 minutes Effects of alendronate may be diminished in older adult patients who take proton pump inhibitors Increases bone mass and increases testosterone Estrogen selective estrogen receptor modulators (Evista) Calcium carbonate supplements Vitamin D for institutionalized Bisphosphonates bone resorption inhibitor Calcitonin Risk factors Ethnicity: Asian and Caucasian women African American women through sickle cell disease and poor calcium intake Assessment May appear undetectable on x-ray until significant demineralization DEXA Dowager’s hump Loss of height Complaints of back pain Tenderness and voluntary restriction of spinal movement suggest compression fracture CT MRI Interventions Weight bearing exercises Vitamin D Calcium carbonate supplements Calcitonin Aerobic exercises (non-swimming) walking Avoid alcohol and tobacco Resting periods between activity (supine or side lying) Knee flexion while lying to promote relaxation of the back muscles Osteomalacia Characteristics- inadequate mineralization of bone. Skeleton softens and weekends causing pain, tenderness to touch, bowing of legs, and pathologic fractures. Spinal kyphosis and bowed legs Body dysmorphia Waddling gait Pathologic fractures Pathophysiology Vitamin D deficiency causing insufficient bone mineralization. Primary- lack of sunlight and or bad diet Secondary- malabsorption, live and pancreatic disorders, renal failure, certain drugs Diagnostic findings X-ray (demineralized bone is evident) Looser’s zones Muscle weakness and bone pain Interventions Alleviate pain with medications Can be resolved if underlying cause is found Vitamin D intake Sunlight exposure Adequate calcium and phosphorous intake Deformities may be treated with braces or surgery Osteomyelitis Characteristics: infection of the bone that results in inflammation, necrosis, and formation of new bone. Staph Aureus Inflammation Vascularity Bone necrosis Manifestations chills, high fever, rapid pulse, general malaise Tender to touch Pulsating pain surface area that lies over the infected bone is swollen, warm, painful, and tender to touch Chronic- nonhealing ulcer that overlies the infected bone Intermittently and spontaneously drain pus Diabetic osteomyelitis can occur without any external wounds. It may present as a nonhealing fracture Any foot ulcer (2cm in diameter) that overlies the infected bone with a connecting sinus is highly suspicious for osteomyelitis Prominent with people diagnosed with diabetes due to neuropathy Diagnostic findings x-ray for soft tissue edema Bone scans MRI Blood cultures Prevention of osteomyelitis is the goal. Elective orthopedic surgery should be postponed if the patient has a current infection (e.g., urinary tract infection, sore throat that may suggest a Streptococcal infection Medical management hydration, diet high in vitamins and protein, correction of anemia) are instituted Affected bone immobilized to prevent fracture Broad spectrum antibiotics 3-4 weeks If antibiotics don't work surgery may be required to remove necrotic material Nursing interventions Tell patient to wear shoes Check feet and education to check feet Administer broad spectrum antibiotics through IV Monitor labs Restrict weight bearing exercises Contact precautions Bone Cancer (Osteogenic Sarcoma) Characteristics- Most common type of primary bone tumor. It is a relatively large lesion causing pain and swelling. Manifestation Pain: mind to severe Obvious bone growth Weight loss Fever Pathological fractures Spinal compression may occur Neurological deficits (progressive pain, weakness, gait abnormality, paresthesia, paraplegia, urinary retention, loss of bowel or bladder control) Diagnostic Findings Elevated Serum ALP levels CT Medical history Physical examination Myelography Arteriography MRI Biopsy Pathophysiology tumor in the bone causes the normal bone tissue to react by osteolytic response (bone destruction) or osteoblastic response (bone formation). Adjacent normal bone responds to the tumor by altering its normal pattern of remodeling. Treatment Surgery Radiation and chemotherapy Surgical management Wide excision Radical resection Bone defects are corrected by total joint replacements, custom metallic implants, and allografts from the iliac crest, rib, or fibula. Bone graft. Interventions Be aware of vocabulary patient can confuse benign with malignant Assess neurovascular status ROM of extremity Weight bearing restrictions after surgery Monitor for osteomyelitis after surgery Monitor for delayed wound healing (due to chemotherapy, radiation therapy, inadequate nutrition) Osteoarthritis Characteristics- noninflammatory degenerative disorder of the joints. It is the most common form of joint disease. Sometimes degenerative joint disease. Idiopathic- no prior event or disease related to OA Secondary- resulting from previous injury or inflammatory disease. Does not involve autoimmunity or inflammation. No systemic symptoms associated with it Can be end result of an autoimmune disorder Joint pain, loss of function characterized by progressive deterioration Cartilage disintegrates, bone and cartilage “float” into joint causing crepitus Morning stiffness of 15-20 minutes Patho Progressive loss of cartilage Leads to damage of underlying bone which leads to formation of osteophytes (bone spurs)- which cause bone formation and causes friction on bones Joint space narrows “wear and tear” r/t aging Risk factors: Older age Female gender Obesity- most common modifiable risk factor Occupations such as sports activities Previous injury Diagnostics Blood test and examination of joint fluid Used to rule out RA X-ray: shows narrowing of the joint space/ osteophyte foramtion Thickened subchondral bone Laboratory: ESR (higher the number the more inflammation) and nsCRP (measure inflammation) MRI CT studies Assessment Pain, stiffness, functional impairment Morning stiffness lasts LESS than 30 minutes. Joint enlargement Decreased range of motion. Enlarged proximal interphalangeal (Bouchard’s nodes) Enlarged distal interphalangeal (Heberden’s nodes) (by the nail bed) Crepitus is palpated. Joint effusion (sign of inflammation) Atrophy of the distal and proximal skeletal muscle. Medical Interventions/Management Exercise in the form of aerobic exercises and lower extremity strength training. Weight loss. Decreases excess load on joints. OT and PT therapy. (occupational and physical therapy) Wedged insoles, knee braces. Orthotic devices (Splint and braces.) Walking aids (canes) CAM (complementary, alternative, and integrative health therapies) ex. Massages, yoga, pulsed electromagnetic fields, transcutaneous electrical nerve stimulation (TENS), music therapy, herbal, dietary supplements, acupuncture, wearing copper bracelets or magnets, T’ai chi. Pharmacological Interventions Acetaminophen (Tylenol) pain. COX-2 enzyme blocker used with caution due to associative risk cardiovascular disease. Tramadol (nonopioid) for pain. Intra-articular corticosteroids (ONLY USED 3 TIMES a YEAR). Topical analgesic (capsaicin and methylsalycylate) Topical diclofenac sodium gel (joint pain in the hands and knees) Nursing Interventions/Management Pain management (non and pharmacological) Patient education of disease process and s/s. Weight loss exercises to lessen pain and disability. Canes/ assistive devices for ambulation (can causes stigma and should be explored) Walking should begin in moderation and increase gradually. Plan exercise when the pain is less severe and to use an analgesic agent prior Open discussion on CAM therapy to maintain safe effective practices. TOTAL HIP REPLACEMENT CEMENTED- great for older population and can bear weight immediately- shelf life of 10 years NONCEMENTED- last longer and cannot bear weight immediately at all and cannot bear partial weight until 1 year or complete bone growth. Rheumatoid arthritis Characteristics- autoimmune disease of unknown origin. Common connective tissue disease, destructive to joints. Chronic, progressive inflammatory autoimmune disease. Affects synovial joints. Transformed autoantibodies (rheumatoid factors) form, attack healthy tissue causing inflammation. Rheumatoid nodules Joint inflammation detected on palpation Rheumatic factor can suggest Bilateral and symmetrical stiffness, tenderness, and swelling Weight loss Temperature changes in the joints Clinical Manifestation Based on point system, patient needs a point of 6 or higher to be diagnosed Rheumatoid factors (can suggest RA but not definitive) Symmetrical joint pain Morning stiffness lasting longer than 1 hour Swelling Warmth Erythema Lack of function aa Systemic Lupus Assessment Erythematous rashes Cutaneous erythematous plaques at scalp, face, neck Areas of hyperpigmentation or depigmentation. Sensitivity to sunlight or artificial ultraviolet light Alopecia Ulcerations at mouth and throat signify GI involvement. Pericardial friction rub (myocarditis and pleural effusions) Papular, erythematous, purpuric lesions Fractures ( no types of bone fracture pictures, and we need to know the type of cast) CSM Assessment Cast Care Spica cast syndrome -assist with hygiene and skin care. May develop superior mesenteric artery syndrome aka spica cast syndrome. compression of the third portion of the duodenum between the aorta and superior mesenteric artery. partial and complete obstruction of duodenum may accor within days or weeks of application of cast. Psychological- acute anxiety reaction characterized by behavioral changes and autonomic responses(aka increased respiratory rate/ diaphoresis/ dilated pupils/ increased heart rate and bp. ). Provide an environment where the patient feels more secure. administration of pain and antianxiety meds. Physiologic manifestations happen due to decreased physical activity / gi mobility decreases/ intestinal gases accumulate. Abdominal distention /discomfort / nausea/ bibous vomiting. Patient treated with a ng tube with suction. Iv fluid therapy. In more serious like cutting blood flow you need to cut a window in the cast or bivalve. ( noteign bowel sounds every 4-8 hours and report any abdomen discomfort and distention nausea and vomiting to the primary provider. compartment syndrome–increased pressure of a confined space compromises blood flow and tissue perfusion. Complications (DVT-Treatment, Fat Embolism, Infection) -Fat embolism - fat emboli enter circulation (usually long and pelvic fractures) -fat globules diffuse into vascular compartment -hypoxia/neurological compromise/ petechial rash/ first pulmonary and hypoxia/tachypnea/dyspnea/ tackycardia/ substernal chest pain/low grade fever/cracked and chest x ray may show ARDS. DVT Emergency Care Traction Nursing interventions-assess for skin breakdown/nerve damage and circulatory impairment Skin breakdown inspect skin every 8 hrs ( remove foam boots/ palpate are of traction tapes for tenderness / frequent repositioning to alleviate pressure and discomfort. and check advance mattress to reduce injury formation) Nerve Damage avoid the area on the peroneal nerve at the point where the neck of the fibula passes just below the knee. causes foot drop. Burning of sensation under traction bandage or boot. dorsiflexion shows function of the peroneal nerve. Circulatory impairment assess circulation of foot within 15-30 min then every 1-2 hrs. Peripheral pulses,color,capillary refill, temp. manifestation of DVT is unilateral calf tenderness, warmth, redness, and welling. encourage patients to perform active foot exercises every hour. Do not use heels or elbow to push themselves up in bed. Neurovascular status compares it to unaffected extremity every hour for the first 24 hrs and then every 4 hours after.active flexion every hour 10 times while awake to decrease venous stasis. use anti embolism stockings, compression devices, anticoagulants. inspect sites every 12 hours. Hip fx -Women have higher risk. give pain meds attention. early mobilization. 24-48 hrs relief ofp ian and prevention of complications are important. Nurse encourages deep breathing and dorsiflexion and plantar flexion every 1-2 hours. anti embolism and pneumatic compressions devices are used. and anticoagulants are given. keep a pillow between patients legs. use anticoagulants.monitor patient hydration nutritional status and urine output. turn the patient on the uninjured side. keep a pillow in betweens. No more than 90 degree. Compartment Syndrome -Assess neurovascular function Five P’s -pain pallor (cold to touch and moist) pulselessness ( late sign) paresthesia paralysis Patients often describe this pain as pain that is deep and burning. Assess pain and neurovascular status of affected limb. Pain management is essential and is accomplished with opioid analgesia.. heart level not above. removing constrivitive dressing by redress or opening the cast. Amputation(they cut off limb) -psych help and adls learned again. Phantom Pain -servering of peripheral nerves. psych support for missing limb. Preventing Contractures -positioning caused by positioning and protective flexion withdrawal.. Sprain- An injury to the ligaments and tendons that surround a joining. A twisting motion or hypertension. -A strain is an injury to a muscle or tendon from overuse, over stretching or excess stress. Muscle pull. Nursing management Prevent from further injury. Support of the affected are. Sling/brace/splinting/taping/compression bandages/ RICE (Rest/ice/compression/elevation ) ice for 24-72 hrs and no more than 20 minutes at a time. use nsaids for pain management. Neurovascular status.