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. 2. 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 4. 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.
Explain how to measure and monitor the quality of care delivered and the outcomes achieved by an Advanced Practice Nurse.
Full Answer Section
- Climate: Cold, dry weather can worsen psoriasis symptoms.
Clinical Types of Psoriasis:
- Plaque Psoriasis: The most common type, characterized by raised, red, scaly patches.
- Guttate Psoriasis: Small, red, scaly spots, often triggered by a strep throat infection.
- Inverse Psoriasis: Smooth, red patches in skin folds, such as the groin, under the breasts, and underarms.
- Pustular Psoriasis: Small, pus-filled blisters.
- Erythrodermic Psoriasis: A severe form with widespread redness and scaling.
Question 2: Treatment Approach for K.B.'s Psoriasis
Treatment Approach:
Given the severity and extent of K.B.'s psoriasis, a combination therapy approach would be most appropriate. This may include:
- Topical Corticosteroids: High-potency corticosteroids can help reduce inflammation and scaling.
- Topical Vitamin D Analogues: These can help slow skin cell growth and reduce inflammation.
- Topical Retinoids: These can help reduce scaling and inflammation.
- Phototherapy: Exposure to ultraviolet light can help slow skin cell growth.
- Systemic Therapy: For severe cases, systemic medications like oral retinoids, cyclosporine, or biologics may be necessary.
Non-pharmacological interventions, such as stress management techniques, regular exercise, and a healthy diet, can also help manage psoriasis.
Question 3: Medication Review
It's essential to review K.B.'s medications to identify any potential drug interactions or side effects that could exacerbate her psoriasis. Some medications, such as beta-blockers and lithium, can worsen psoriasis. Additionally, certain medications may interact with psoriasis treatments, affecting their efficacy or increasing the risk of side effects.
Question 4: Other Manifestations of Psoriasis
Psoriasis can affect various parts of the body, including:
- Skin: Plaques, scales, and itching
- Joints: Psoriatic arthritis, leading to joint pain and stiffness
- Nails: Pitting, discoloration, and thickening of nails
- Eyes: Conjunctivitis and uveitis
Case Study 2: C.J. with Eye and Ear Infection
Question 1: Diagnosis
Based on the clinical manifestations, the most likely diagnosis for C.J.'s eye condition is acute bacterial conjunctivitis. This diagnosis is supported by the presence of a yellowish discharge, conjunctival erythema, and blurry vision.
Question 2: Etiology
The most likely etiology of C.J.'s eye infection is a bacterial infection. This is supported by the presence of a purulent discharge, which is a characteristic sign of bacterial conjunctivitis. Viral conjunctivitis typically presents with a watery discharge and less severe symptoms.
Question 3: Therapeutic Approach
Given the likely bacterial etiology, the most appropriate treatment for C.J.'s eye infection would be topical antibiotic eye drops. These drops can help eliminate the bacteria and reduce inflammation. It's important to note that it's crucial to consult with a healthcare provider to get a proper diagnosis and treatment plan.
Regarding his ear infection, a middle ear infection is likely due to the bulging and red tympanic membrane. This typically requires oral antibiotics to treat the bacterial infection.
Measuring and Monitoring Quality of Care for Advanced Practice Nurses
To measure and monitor the quality of care delivered by an Advanced Practice Nurse (APN), several key strategies can be employed:
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Performance Measures:
- Clinical Quality Measures: These measure the quality of care provided, such as adherence to clinical guidelines, appropriate medication prescribing, and timely diagnosis.
- Patient Satisfaction Surveys: These assess patient satisfaction with the care received, including communication, compassion, and overall experience.
- Patient Outcomes: Monitor patient outcomes, such as reduced morbidity and mortality rates, improved functional status, and enhanced quality of life.
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Quality Improvement Initiatives:
- Continuous Quality Improvement (CQI): Use data to identify areas for improvement and implement changes to enhance care delivery.
- Root Cause Analysis: Investigate adverse events to identify underlying causes and implement corrective actions.
- Evidence-Based Practice: Stay up-to-date with the latest evidence and incorporate it into clinical practice.
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Peer Review and Feedback:
- Peer Review: Participate in peer review processes to assess the quality of care provided by colleagues.
- Self-Reflection: Regularly reflect on your own practice and identify areas for improvement.
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Patient Education and Engagement:
- Educate patients about their health conditions and treatment options.
- Empower patients to take an active role in their own care.
By implementing these strategies, APNs can ensure high-quality care and improve patient outcomes.