Nursing Psoriasis, Essay Example

Introduction

In this document a discussion concerning a childhood condition will be undertaken as explanations regarding its pathophysiology and epidemiology are explored. Further, a protocol explaining the diagnosis, management and followup care will be recommended. Finally, an exploration into how culture impacts management of psoriasis pediatric patients will be conducted.

Explain the disorder you selected, including its pathophysiology and epidemiology.

Psoriasis is a medical condition characterized by skin lesions; Koebler pneumonia;Auspitz’s sign; puriitis and sleep irregularities. There are two classifications of the condition. One is known as non-pustular and the next pustular. Non pustular is also called psoriasis vulgaris and psoriatic erythroderma, respectively. As indicated in the description non pustularpsoriasis lesions contain plaques while pustular has varying degrees of noninfectious pus formation occurring in raise bumps on the skin’s surface (Johnson & Armstrong, 2012).

Pathophysiology: There have been no specific causes identified as to the etiology of psoriasis. However, scientists have created theories pertaining to the pathophysiology oftheories.Psoriasis has been classified an excessive growth disorder related to skin cell reproduction. The pathogenesis involves faulty epidermis and keratinocytessynthesis.  A second theoretical assumption is psoriasis being an immune-mediated disorder wherebythe excessive skin cell reproduction becomes a secondary reaction of dysfunction in the immune system. Essentially, T cells that were designed to protect the body against foreign invasionbecome very active, migrating towards the dermis, triggering cytokines release, which is a  specific tumor necrosis factor-alpha TNF?. Consequently, inflammation along with skin cell rapid production occurs. Subsequent T cells activation is initiated (Johnson & Armstrong, 2012).

Epidemiology          

People of white European ancestry are mostly affected by this disease, being relatively infrequent among people of African descent. However, there is a very high prevalence among Native Americans. Epidemiologists have reported that a third of all psoriasis cases have a family history indicative of this condition.  Importantly, researchers have identified a distinct genetic locus linking the disease with a hereditary factor (Johnson & Armstrong, 2012).

Further studies implicating monozygotic twins show a strong predisposition of 70% development of psoriasis in the other twin if one is affected. There is a 20% concordance for dizygotic twins. Significantly, it is highly suggestive from findings that dual factors are implicated in the epidemiology. They are both environmental as well as genetic predispositions. Currently, psoriasis is most common among youths between the ages of 15-20 and in countries which are closest to the equator (Treloar, 2010).

Explain a protocol for the diagnosis, management, and follow-up care of this disorder.

The protocol for diagnosis, treatment and followup of psoriasis embodies periodic screening of high risk populations since it affects a person from an early age and there is no cure for the disease. While early detection wouldnot produce a cure, it is essential in relievingeffects produced by of the psoriasis lesions. Relevant management strategies should also be essential protocol factor. There are two types of psoriasis one produces pus while the other does not. Therefore, while topical applications are frequently used as a first line management during mildoutbreaks, clinicians ought to evaluate the extent of lesions’ manifestation before prescribing ointments. Patients ought to follow-up with primary care and clinics every month initially and as specified by dermatologists(Hankin, Bhatia& Goldenberg, 2010).

Phototherapy is recommended moderate stages of the disease.  Systemic agents are administered in severe phases. When systemic treatment is recommended or prescribed these patients must have regular liver function tests for evaluating the effects of medications.  The traditional medication protocol for advanced stages of psoriasis has been methotrexate, cyclosporine and retinoids, which is a synthetic vitamin A supplements. Immunosuppressant therapy is contained in Methotrexate and cyclosporine administration (Kupetsky & Keller, 2013).

Explain how culture might impact the care of patients who present with the disorder you selected.

Culture plays a vital role in patients’’ response to modern medicine treatment regime inclusive of phototherapy and systemic interventions. Across the world and nations Native Americans/ Amerindians seem most affected. In United States of America Native Americans are highly resistant to modern medicine. Their cultural beliefs consist of theories that politicians and the health care system is trying to exterminate them from the society through plagues and medicine. As such many of them seek alternative medicine from their native health care practitioners (Kupetsky & Keller, 2013).

Caucasian Americans and person of European ancestry accept treatment through their healthcare providers. Culturally even though the disease has it stigmatizing effects they manage to reconcile its impact during their interactions with other in the community who have been challenged by disease. Since it is not infectious, but hereditary it is not spread by contact even in the pustular type. However, it can affect a person self-esteem knowing that they have a skin lesion. Some cultures even associate psoriasis with some form of leprosy (Kupetsky & Keller, 2013).

Conclusion

The foregoing discussion embraced an exploration of psoriasis as occurring predominantly among Native Americans and persons of European decent. A high incidence was discovered among children/youths 15-20 years old. Since there is no cure treatment extends throughout the person’s lifetime. The protocol for diagnosis, management and followup encompass routine screening in high risk populations; evaluation of lesions and regular visits to the primary care and dermatologist, respectively. Treatment acceptance is reflected in cultural differences with patients of European descent more acceptable to modern medicine regime than Native Anmericans.

Reference

Hankin, C.  Bhatia, D., & Goldenberg, G. (2010). A Comparison of the Clinical Effectiveness and Cost-Effectiveness of Treatments for Moderate to Severe Psoriasis.Drug Benefit Trends 21: 17–27.

Johnson, N.,& Armstrong, W. (2012). Clinical and Histologic Diagnostic Guidelines for Psoriasis: A Critical Review.Clinical Reviews in Allergy & Immunology 44 (2): 166–72.

Kupetsky, E., & Keller, M. ( 2013). Psoriasis vulgaris: an evidence-based guide for primary care. Journal of the American Board of Family Medicine : JABFM 26 (6): 787–801.

Treloar, V. (2010). Integrative dermatology for psoriasis: Facts and controversies. Clinics in Dermatology, 28 (1): 93–9.