Case Study 1 Questions:

Name the most common triggers for Psoriasis and explain the different clinical types.

Psoriasis is a long-term autoimmune disease that can negatively impact the skin, nails, and joints, as noted by Gudjonsson et al. (2007). The most common triggers for psoriasis include stress, skin damage, and infection (Gudjonsson et al., 2007). There are several types of psoriasis that are known to exist. The first is plaque psoriasis, which is characterized by red and scaly patches on the skin (Gudjonsson et al., 2007). Another type is Guttate psoriasis, which causes small pink or red spots on the skin (Gudjonsson et al., 2007). Inverse psoriasis targets the skin folds in the underarms and groin areas, while pustular psoriasis results in small, pus-filled blisters on the skin (Gudjonsson et al., 2007). Finally, according to Gudjonsson et al. (2007), Erythrodermic psoriasis is a severe and rare form of the condition that can affect the entire body, causing redness, swelling, and skin shedding.

There are several types of pharmacological treatments for Psoriasis. Explain the different types, and indicate which would be the most appropriate approach to treat this relapse episode for K.B. 

There are several types of pharmacological treatments for psoriasis. Usually, as a nurse practiconer I would prescribe topical agents like corticosteroids but since those do not work for K.B anymore, I would look more into vitamin D analogs, retinoids, and calcineurin inhibitors (Menter et al., 2019). In addition, systemic agents include methotrexate, cyclosporine, and acitretin (Menter et al., 2019). Another pharmacological treatment for psoriasis can be biologic agent which target specific proteins involved in the immune response like tumor necrosis factor (TNF), interleukin (IL)-17, and IL-23. These agents can be  etanercept, adalimumab, infliximab, ustekinumab, secukinumab, ixekizumab, and brodalumab (Menter et al., 2019). For K.B severity of the disease, medical history, systemic agents or biologic agents may be appropriate for her moderate to severe psoriasis.

Include non-pharmacological options and recommendations for Psoriasis.

In addition to pharmacological treatments, there are also non-pharmacological options and recommendations for K.B psoriasis. Examples of non-pharmacological options is phototherapy like ultraviolet B (UVB) and ultraviolet A (PUVA) therapy (Menter et al., 2019). Phototherapy  can be effective for moderate to severe psoriasis (Menter et al., 2019). Other non-pharmacological options include stress reduction techniques like meditation or yoga  (Menter et al., 2019). Stress can exacerbate psoriasis and it’s important to teach K.B how to prevent and identify her life stressors. Lifestyle alterations can also help K.B. Maintaining a healthy weight, avoiding smoking or excessive alcohol consumption, and getting regular exercise can also be beneficial for managing psoriasis (Menter et al., 2019). In conclusion, it is important for patients with psoriasis to practice good skin care. It helps to keep the affected site for K.B areas clean and moisturized and important to avoid hot water or harsh soaps (Menter et al., 2019).

Medication review and reconciliation are always important for all patients. Describe and specify why in this particular case is important to know what medications the patient is taking.

Medication review and reconciliation is very important for K.B, especially since she recently had a flare up of her psoriasis after months of it working. According to a review article by Rallis et al. (2020), several medications like beta-blockers, lithium, antimalarials, nonsteroidal anti-inflammatory drugs (NSAIDs), and interferons are among the medications that have been associated with psoriasis flare-ups. 

What other manifestations could be present in a patient with Psoriasis?

The clinical manifestations that K.B present are lesions that have been confined to small regions on the elbows and lower legs. According to a review article by Parisi et al. (2020), K.B is at risk with psoriasis into developing cardiovascular disease, metabolic syndrome, depression, and anxiety, among other conditions. Psoriasis has also been associated with an increased risk of psoriatic arthritis, which can lead to joint damage and disability if left untreated (Parisi et al., 2020). In addition, patients with psoriasis may experience itching, pain, and discomfort, as well as social and psychological burdens like stigmatization, isolation, and reduced quality of life (Parisi et al., 2020). Its important to do a  comprehensive approach to the management of K.B psoriasis and should account the patient’s physical, psychological, social well-being, and any comorbidities or complications that may arise.

Case Study 2 Questions:

Based on the clinical manifestations presented in the case above, which would be your diagnosis for C.J. Please name why you get to this diagnosis and document your rationale.

C.J clinical manifestations diagnosis pairs with conjunctivitis. Conjunctivitis, commonly known as “pink eye,” is characterized by inflammation of the conjunctiva. C.J explains the discharge is causing blurry vision and presents crusty and yellowing discharge and bilateral conjunctival erythema. According to a review article by Sheikh and Hurwitz (2021), clinical manifestations of conjunctivitis can include redness, itching, tearing, discharge, and blurred vision. In specific bacterial conjunctivitis may produce thick, yellow-green discharge.

Any additional diagnosis or complication noted? Explain.

When the tympanic membrane is opaque, bulging, and red, it typically indicates the presence of acute otitis media, which is an infection of the middle ear. According to a review article by Rosenfeld et al. (2021), acute otitis media is a common condition in which the opaque appearance of the tympanic membrane in acute otitis media due to fluid accumulation in the middle ear, which can cause the membrane to bulge outward (Rosenfeld, et al., 2021).. The redness is due to inflammation and increased blood flow to the area. C.J can further experience with acute otitis media ear pain, fever, and hearing loss. (Rosenfeld, et al., 2021).

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?

Per the clinical manifestations C.J is showing bacterial conjunctivitis. According to Sheikh and Hurwitz (2021), bacterial conjunctivitis is a common type of conjunctivitis that is typically caused by Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae. Clinical manifestations of bacterial conjunctivitis can include redness, swelling, and a thick, yellow-green discharge that may stick the eyelids together (Sheikh & Hurwitz, 2021). This perfectly explains C.J description. In addition, C.J is experiencing  discomfort and can later experience itching, burning, in the affected eye (Sheikh & Hurwitz, 2021). Some of the risk factors for bacterial conjunctivitis can be contact lenses , exposure to contaminated water or soil, close contact with individuals who have bacterial conjunctivitis, and underlying ocular surface disease (Sheikh & Hurwitz, 2021). Contact lenses can increase the risk of bacterial conjunctivitis due to the lenses providing a surface for bacteria to adhere and multiply on (Sheikh & Hurwitz, 2021).  Exposure to contaminated water and soil can introduce bacteria in the eye, especially in individuals who engage in outdoor activities or have poor hygiene practices. Close contact with someone who has bacterial conjunctivitis can also increase the risk of transmission.

Based on your answer to the previous question regarding the etiology of eye affection, which would be the best therapeutic approach to C.J.’s problem? Include any additional treatment or approach to any other diagnosis or complication present in this case.

It is important to help C.J with her new diagnosis of conjunctivitis and acute otitis media. Bacterial conjunctivitis can be treated with topical antibiotics like azithromycin or erythromycin ointment (Sheikh & Hurwitz, 2021).  In addition fluoroquinolone drops can also help C.J conjunctivitis (Sheikh & Hurwitz, 2021). There are some cases where the infection is severe or persistent.  Oral antibiotics may also be prescribed in those cases (Sheikh & Hurwitz, 2021). It is important as healthcare providers to properly diagnose bacterial conjunctivitis and distinguish it from other types of conjunctivitis like viral or allergic conjunctivitis, to ensure appropriate treatment and prevent complications (Sheikh & Hurwitz, 2021). With C.J acute otitis media, antibiotics will help to clear the infection (Rosenfeld, et al., 2021). In addition patients with acute otitis media they experience a lot of pain so pain management will help to relieve symptoms (Rosenfeld, et al., 2021).  In some cases, surgical intervention may be required, mainly for patients with recurrent or chronic acute otitis media (Rosenfeld, et al., 2021). It is important for us as healthcare providers to rapidly diagnose and treat acute otitis media to prevent complications such as hearing loss or the spread of infection to nearby body parts (Rosenfeld, et al., 2021).