You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your responses must be substantive and not just agreeing with someone's work. You need to add by explaining more, refuting a point or correcting a point. a minimum of 150 words and one reference with in text citation, one reference for each respond.
Discussion 1 (Luna)
Sensory and Integumentary Function
Name the most common triggers for psoriasis and explain the different clinical types.
The etiology of psoriasis generates sporadic flares with various time gaps, however, some stressors, such as drunkenness, skin damage, and hormonal changes, can trigger the condition. The syndrome is triggered by excessive alcohol consumption since it creates a conducive atmosphere. Overconsumption of alcohol causes severe inflammation which encourages psoriasis given the condition’s chronic inflammatory properties (Kimmel & Lebwohl, 2018). Skin injuries work similarly. Due to the inflammatory reaction associated with open wounds, patients with latent psoriasis may experience a return if the skin sustains injuries such as cuts, sunburn, or abrasions. Hormonal changes can trigger psoriasis as well. Some hormones, such as the vascular endothelial growth factor, alter inflammatory changes by inhibiting or encouraging leucocyte action and psoriasis’ chronic inflammation hyperproliferation(Kimmel & Lebwohl, 2018). Other triggers include smoking and stress.
Clinical Types Psoriasis is present in multiple guises in different populations. Plaque psoriasis is the most prevalent and appears to be red inflamed skin with white scales around elbows, knees, and the scalp (Zhukova & Kasikhina, 2018). Inverse psoriasis presents similar skin patches but lacks white scales and can be triggered by friction, sweat, or fungi. Guttate psoriasis appears in children as pink spots on the trunk which disappear within weeks without medical therapies. Other psoriasis types include pustular, erythrodermic, and nail psoriasis.
Treatment Question II
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.
The goal of psoriasis treatment is to prevent cell reproduction in the afflicted areas. Pharmacological therapy is one type of intervention. Corticosteroids are frequently used as a last option due to their widespread effectiveness. This drug’s anti-inflammatory and immunosuppressive properties reduce cell division rates by affecting gene transcription in the cell nucleus (Albanesi, 2019). Vitamin D analogs provide relief in psoriasis as well. Calcipotriene and calcitriol achieve slow cell growth by binding nuclear receptors involved in inflammation and division(Albanesi, 2019). Some non-pharmacological therapies achieve a similar effect but efficiency decreases with severity. Light therapy, which involves controlled exposure to forms of light like sunlight and ultra-violet rays, can slow down cellular growth and inhibit psoriasis with a repeated application (Albanesi, 2019). Fish oil, aloe vera cream, and essential oils all have a similar effect.
Included in question 2
A pharmaceutical intervention involving corticosteroids is the most appropriate therapy for K.B.’s condition. This intervention’s efficiency in previous topical prescriptions implies a higher likelihood of better outcomes in subsequent use. Moreover, the patient is experiencing widespread outbreaks covering large regions. Corticosteroids’ availability in a variety of forms including sprays, shampoos, gels, lotions, and creams provide multiple application methods to choose from which allows convenience and treatment adjustment with preference. These options will encourage application despite the wide surface area (Albanesi, 2019).
A 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?
The diagnosis of psoriasis and the development of treatment programs for better patient outcomes are aided by knowledge of active prescriptions. Given the nature of certain medicines provoking psoriasis, medication evaluation and reconciliation is critical in K.B.'s case. Exposure to certain beta-blockers, lithium, chloroquine and terbinafine has a triggering an exacerbating effect on dormant and active psoriasis (Dogra & Kamat, 2019). Knowledge of active prescriptions for K.B. can identify such drugs and inform better medication recommendations. This step improves the patient's outcome.
What other manifestations could present a patient with Psoriasis?
Patients with plaque psoriasis have a variety of symptoms. In addition to K.B.'s symptoms, the patient may have cracked skin and ridged nails. After a long period of rest, joints may become stiff and swollen, with numbness. K.B. may experience fever and malaise too. Broken skin in affected areas may ooze pus and produce a foul smell. The condition can develop into psoriatic arthritis if mismanaged (Dogra & Kamat, 2019).
Based on the clinical manifestations presented in the case above, which would be your eyes diagnosis for C.J. Please name why you get to this diagnosis and document your rationale.
C.J.'s condition is consistent with bacterial conjunctivitis. After sleeping, the patient has a yellowish discharge that creates a crust. This symptom and the red eyes caused by increased capillary vasodilation and visibility resulting from increased blood density due to inflammatory responses in the eyes are consistent with conjunctivitis infection (Wirfs, 2020). Fast symptom progression within 24 hours and a throbbing ear suggest an advanced infection that spreads deeper into the sinus cavity causing redness and swelling inside the ear. The presence of a discharge eliminates several conditions, including viral conjunctivitis, foreign objects, and blocked tear ducts, whose presentations exclude discharge(Wirfs, 2020). Bacteria can cause pus discharge at the injection site, which contains damaged inflammatory compounds and dead bacteria. Pus discharge and bilateral conjunctival erythema indicate inflammatory activity which follows a bacterial infection. This combination of factors sums up a bacterial conjunctivitis diagnosis.
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. C.J.'s illness appears to be the result of a bacterial infection, according to the information available. The presence of a yellowish discharge eliminates viral etiology because viral infections cause little or no discharge (Marinos et al., 2019). Similarly, the presentations eliminate an allergic cause. Allergic reactions are temporary, often improving within hours and upon removal of the stimuli (Wirfs, 2020). These reactions also rely on the trigger to cause the infection. The lack of a possible trigger in the C.J.’s routine and sustained effects, which worsened within 24 hours, disqualified allergic cause. Several factors support a bacterial etiology including bilateral conjunctival erythema. Erythema indicates acute anterior inflammation which targets bacterial infections. Eye discharge supports a bacterial cause as well. This discharge results from the inflammatory activity and contain bacteria and tissue debris from this process. Redness and bulge in the tympanic membrane are an effect of the infection and the associated immune response processes.
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's problem.
The best treatment plans take into account the nature and identification of the pathogenic bacteria, but for mild to moderate infections, some programs' broad aim suffices. For eight days, C.J. may use topical antibiotics such as tobramycin, fluoroquinolone, and chloramphenicol four times every 24 hours. As an alternative, chloramphenicol and fusidic acid have similar results. The goal of this treatment is to get rid of the bacteria that is causing the problem. Some treatments fail to achieve this elimination, leading symptoms to worsen and the illness to spread. Every two days, patients should be examined to assess the efficacy of the treatment plan and to check for such progression. Besides that, the condition’s easy transmission necessitates isolation from work for four days to allow microbial clearance or recovery (Wirfs, 2020).
C.J. needs to implement additional steps for better outcomes, including hygienic strategies. Patients may need to clean their eyes several times a day to prevent the accumulation and formation of crust. Besides crust, pus may irritate the eyes and tear. Regular cleaning prevents such discomfort and associated complications. In addition, hygiene can help prevent contamination and the introduction of new bacteria types. Some bacteria, such as Chlamydia trachomatis, are contagious and are transmissible via contact. A patient’s contamination with such pathogens can lead to new infections which may fall without a treatment scope. The resulting sustained inflammatory state and symptom presentation will contribute to a poor outcome. Therefore, patient hygiene as part of treatment plans is crucial for microbial remission (Wirfs, 2020).
Albanesi, C. (2019). Immunology of Psoriasis. In Clinical Immunology. https://doi.org/10.1016/b978-0-7020-6896-6.00064-8
Dogra, S., & Kamat, D. (2019). Drug-induced psoriasis. Indian Journal of Rheumatology, 14(5). https://doi.org/10.4103/0973-3698.272159
Kimmel, G. W., & Lebwohl, M. (2018). Psoriasis: Overview and Diagnosis. https://doi.org/10.1007/978-3-319-90107-7_1
Marinos, E., Cabrera-Aguas, M., & Watson, S. L. (2019). Viral conjunctivitis: a retrospective study in an Australian hospital. Contact Lens and Anterior Eye, 42(6). https://doi.org/10.1016/j.clae.2019.07.001
Discussion 2 ( Javier)
Case Study #1: Integumentary Function
Common triggers for Psoriasis
Psoriasis is a skin condition that is known to produce scaly patchy rashes throughout a person’s torso and extremities. Common triggers for psoriasis flare-up are infections, extreme weather changes hot or cold, sunburns, any opening to the skin like cuts, scrapes or insect bites, stress, alcohol consumption, medications for HTN, and others (Mayo Clinic, 2022). The most common type of psoriasis is plaque psoriasis which causes dry raised, red patches covered in gray scales (Mayo Clinic, 2022). Nail psoriasis presents on both fingernails and toenails it can cause pitting, discoloration, onychosis, or become brittle. Guttate psoriasis is commonly caused by a bacterial infection and is characterized by small lesions. Inverse psoriasis is caused by fungal infections and commonly affects areas where there is increased sweat such as the groin, breast, or sacral regions. Pustular psoriasis is less common, and it presents as pus-filled lesions commonly found on hands or feet (Mayo Clinic, 2022). Erythrodermic psoriasis is the least common, causing the entire body to break out in peeling, red dermatitis. Psoriatic arthritis causes swollen fingers, toes, and joints it can also eventually lead to irreversible joint damage (Mayo Clinic, 2022).
Treatments for Psoriasis
There are multiple treatment options for those who suffer from psoriasis, including topical treatments, traditional P.O. medication, and even non-pharmaceutical options. Some of the topical options include topical treatments, corticosteroids, retinoids, vitamin D, salicylic acid, or moisturizers. Several systemic medications used to treat psoriasis include methotrexate, cyclosporine, and retinoids (Mayo Clinic, 2022). Non-pharmacological options include using light therapy to kill the overactive white blood cells that are attacking the healthy skin cells and halt the rapid cell growth (Sullivan, 2020). The recommended treatment for K.B. would be topical corticosteroids and retinoids because her outbreak is acute and localized to her elbows and knees at the moment.
Medication review and reconciliation
Medication reconciliation is essential to do with every patient, but for patients living with psoriasis, a variety of medications can trigger outbreaks such as lithium, antimalarial, and HTN medications. For instance, cyclosporine can cause kidney problems and HTN while methotrexate can cause acute liver damage and reduced blood counts (Sullivan, 2020). Therefore, it is crucial to have a complete list of medications currently being taken by the patient to develop the best course of treatment.
Signs and symptoms of Psoriasis
Other manifestations a patient with psoriasis can present with consist of swollen or stiff joints, dry skin, thickened nails, and generalized itching, burning, or soreness (Sullivan, 2020).
Case Study #2: Sensory Function
C.J. is presenting with classic symptoms of conjunctivitis. In both bacterial and viral conjunctivitis, the person usually experiences eye crusting and adhesion of the eyelids upon waking and blurry vision with eye discomfort (A. Azari & Arabi, 2020). His tympanic membrane appears to be opaque, bulging, and red which is a symptom of an ear infection (A. Azari & Arabi, 2020). Receiving bilateral bacterial conjunctiva erythema may also cause otitis media and C.J is currently presenting with all the.
Etiology of the eye affection
Despite conjunctivitis presenting as different etiologies, C.J. currently has the signs & symptoms correlated with bacterial conjunctivitis. Viral conjunctivitis is normally brought on by another acute infection such as a cold or the flu. If C.J. would have also complained of symptoms such as cough, fever, and sore throat, that might have been a possibility. Allergic conjunctivitis presents with watery discharge from the eye not, not yellow, or purulent (A. Azari & Arabi, 2020). Gonococcal conjunctivitis is usually caused by the Neisseria gonorrhea bacteria which is a sexually transmitted infection. This form of conjunctivitis is more commonly observed in newborn babies when born vaginally through a woman with active gonorrhea (Delugash and Story, 2020). One study showed that 14% of adult patients with chlamydial conjunctivitis were positive for C. trachomatis when a fluorescent antibody staining of the middle ear aspirate was done to confirm the diagnosis (A. Azari & Arabi, 2020). Without any further information, one would conclude the most likely cause for C.J. based on his symptoms would be bacterial conjunctivitis since the onset source is from his eyes and ears.
Best therapeutic approach
The most appropriate therapeutic approach for C.J. would be a course of antibiotics for both the eye and also ear infection. C.J. also needs to be educated to perform good hand hygiene practices and wipe down any surface he encounters regularly as bacterial conjunctivitis is highly contagious. Washing his eyes regularly and applying artificial eye drops might also help with the discharge and discomfort associated with bacterial conjunctivitis.
1. Azari, A., & Arabi, A. (2020). Conjunctivitis: A systematic review. Journal of Ophthalmic and Vision Research. https://doi.org/10.18502/jovr.v15i3.7456
Delugash, L., Story, L. (2020). Applied Pathophysiology for the Advanced Practice Nurse.
Goh, B. T., Hadley, J. M., Lomax, N. J., Patel, H. C., & Viswalingam, N. D. (2006, June). Otitis media in adults with chlamydial conjunctivitis. Sexually transmitted infections. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564741/.
Texas Joint Pain Management (2020). Osteoarthritis vs rheumatoid arthritis – explaining the pain. https://www.texasjointpain.com/osteoarthritis-vs-rheumatoid-arthritis/ (Links to an external site.)
Neurological Function: Case Study Questions
Risk factors for Alzheimer’s disease
The risk factors for Alzheimer’s are advancing age, a strong family history, genetics, and a previous head injury (Alzheimer’s Association, 2022a). Those who are 65 years old and over have a greater risk for Alzheimer’s and as individuals get even older, the risk increases. Families with a strong history of the disease are also likely to have other family members later developing it. The closer and more direct the relationship, the more likely an individual would later develop the disease (Alzheimer’s Association, 2022a). There are also genes that may place an individual at risk for Alzheimer’s. Risk genes (APOE-e4) are more likely to lead to Alzheimer’s as compared to deterministic genes (Alzheimer’s Association, 2022b).
Head injuries can also later lead to Alzheimer’s. This head injury may occur due to a stroke, a sports injury (boxing and other high-contact sports), or automobile accidents (Alzheimer’s Association, 2022a). A heart-head connection can also lead to Alzheimer’s. This can be noted in instances where an individual has cardiovascular disease. This includes hypertension, coronary artery disease, and other issues which can elevate blood pressure (National Health Services, 2021). Those with Down Syndrome can also be at risk for Alzheimer’s. Those who may have a tendency towards loneliness and depression also carry a higher risk for Alzheimer’s (National Health Services, 2021).
Similarities and differences between Alzheimer’s, Vascular dementia, Dementia with Lewy bodies, and Frontotemporal dementia
Alzheimer’s, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia are all types of dementia. These diseases, therefore, affect the memory of the individual, including their behavior and problem-solving skills (Alzheimer’s Society, 2022). They mostly also affect older adults.
Alzheimer’s is the most common of these diseases (Alzheimer’s Society, 2022). It is caused by neurofibrillary tangles as well as plaques in the amyloid (Better Health Victoria, 2022). These tangles and plaques give rise to cognitive issues as seen in the disorder (Better Health Victoria, 2022). In vascular Dementia, the blood vessels of the brain are mostly affected. There are issues and damage to the blood vessels which can then lead to cognitive issues (Better Health Victoria, 2022). The Lewy bodies are protein groupings that are noted in the nerve cells of the brain and they lead to symptoms of dementia (Alzheimer’s Society, 2022). Frontotemporal dementia mostly impacts the frontal and temporal lobes of the brain (Better Health Victoria, 2022). These symptoms cause changes in the individual’s behavior and in their personality (Better Health Victoria, 2022). Aside from memory loss, their self-control and judgment are also often compromised.
Explicit and implicit memory
Implicit memory also refers to unconscious memories. These can be hard to express as they are mostly emotional. They often affect current attitudes but sometimes individuals may not be conscious that their memory is affecting their behavior (McLaughlin, 2020). Memories like playing games or playing music are for example part of unconscious memories and usually become second nature to individuals (McLaughlin, 2020). Individuals often have a specific reaction to stimuli due to their implicit memory. These memories can therefore manipulate their reactions and behavior (McLaughlin, 2020). Classical conditioning is associated with implicit memories (McLaughlin, 2020).
Explicit memory notes the presence of more conscious memories, intentionally remembered and consciously expressed (McLaughlin, 2020). These are memories that are anchored on personal experiences and actual events taking place which are recalled by the individual (McLaughlin, 2020). As for semantic memories, these refer to more specific data and ideas (McLaughlin, 2020). Autobiographical memories are more related to events.
Diagnosis and criteria for Alzheimer’s disease
The diagnostic criteria set by the National Institute of Aging and the Alzheimer’s Association cover primary clinical standards related to mild cognitive impairment. This would refer to the symptomatic stage. Updates in the stages of Alzheimer’s now include three new stages (National Institute of Aging, n.d). In the preclinical stage, there are changes in the brain as seen in the amyloid buildup and differences in nerve cells (National Institute of Aging, n.d). No symptoms are present as yet. For mild cognitive impairment, symptoms are present. Most symptoms are related to thinking issues not matching the individual’s knowledge and age (National Institute of Aging, n.d). They are still independent. The disease progresses at this point, with symptoms becoming more pronounced. The memory loss worsens and there is a greater difficulty in finding the right words to use. The individual’s independence is now affected (National Institute of Aging, n.d).
Best Therapeutic Approach
CJ needs diagnostic tests to establish if she has Alzheimer’s. When this is confirmed, she needs to be prescribed the appropriate medications. These medications would help manage the symptoms. Cholinesterase inhibitors work to stem the progression of the disease. Memantine helps with memory and learning. Antidepressants help manage mood and anxiety while antipsychotics can also help reduce aggression (Salamon, 2020). Cognitive Stimulation Therapy can be applied to CJ to help promote mental engagement (Salamon, 2020). Reality Orientation Time Therapy can also improve the individual’s awareness of her surroundings, where she is, what she is doing, what day it is, and what she has done (Salamon, 2020).
Alzheimer’s Association (2022a). Causes and risk factors for Alzheimer's disease. https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors
Alzheimer’s Association (2022b). Is Alzheimer's Genetic?
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