JINGCO, JHERYN KYLE E.

BSN 4Y2-1

CASE STUDY ON PLAQUE PSORIASIS

PATIENT STATUS
A 54-year-old Filipino female patient was admitted with multiple reddish raised lesions
with scaling almost all over the body and scalp since the 1st month of the year 2020. The patient
reports that she has just returned from a twelve-day trip from Baguio City back then. During the
trip, she had significant frigid exposure, due to the cold weather of the City and she also have
some stress related problem. It expanded and prominent plaques cover her elbows and thighs,
and there is a patch on her scalp. Her lesions cover about fifteen percent of her body. She
occasionally applies moisturizing lotion or witch hazel if it becomes too irritating. All other body
systems are normal.

NURSING ASSESSMENT
 Past Medical History
- “Some rashes,” German measles and Pneumonia otherwise non- contributory
 Social History
- Recent trip to Baguio City for a vacation.
 Vaccination
- Vaccine against Diphtheria-Tetanus-Whooping cough + Haemophilus influenzae type B
+ Polio [DTaP-Hib-IPV] (Hebrew)
- Vaccine against Measles-Mumps-Rubella (German measles) + Varicella (chicken pox)
[MMRV]
- Vaccine against pneumococcus bacteria [PCV]
- Vaccine against Hepatitis B
- Vaccine against Hepatitis A
 Medication: None
 Allergies: None
 Examination
Vital Signs:
Temperature: 36°C
Heart rate: 60-99 beats for minute
Pulse: 60-99 beats per minute
Blood pressure: 120/80 mmHg
Respiratory rate: 12-16 breaths for minute
Oxygen saturation: 95-100%
PH: 7.3-7.5
 Anthropometry
Weight: 50 kg
Height : 5'1
BMI: 20.8 this is considered normal.
 General
Skin, abdomen, chest, cardiovascular, neurological, and musculoskeletal are all normal.
Subtle Dysmorphic Features: None
  Laboratory Test
- Erythrocyte Sedimentation Rate is a test that gives a rough index of inflammation. The
sed rate is not specific and can be elevated with many other conditions such as other
autoimmune syndromes, infection, tumor, liver disease or pregnancy
- Skin biopsy. Rarely your doctor may take a small sample of skin (biopsy) that’s
examined under a microscope to determine the exact type of psoriasis and to rule out
other disorders. A skin biopsy can generally be done in a doctor’s office after application
of a local anesthetic

NURSING DIAGNOSIS
 Deficient knowledge of disease and its treatment
 Impaired skin integrity related to lesions and inflammatory response
 Disturbed body image related to embarrassment over appearance and self-perception of
uncleanliness

NURSING MANAGEMENT
1. Administer prescribed medications, which may include coal tar therapy, and topical
corticosteroids.
2. Discuss and assist with the administration of additional medical treatments, which may
include coal tar shampoos, intralesional therapy (i.e. injection of medication directly into
lesion), systemic cytotoxic medication, photochemotherapy, occlusive dressing.
3. Enhance skin integrity
4. Prevent infection.
5. Provide client and family teaching.
- Advise the client receiving systemic cytotoxic (e.g. methotrexate) therapy, which inhibits
deoxyribonucleic acid synthesis in epidermal cells to speed the replacement of psoriatic
cells, to continue taking the medication even if nausea and vomiting occur, to increase
fluid intake to prevent nephrotoxicity, and to avoid alcoholic beverages.
- Instruct the client to avoid sun exposure during photochemotherapy. This regimen of
phototherapy with ultraviolet A (PUVA) light decreases cellular proliferation. PUVA
therapy results in photosensitivity and the client should avoid exposure to sunlight during
this time.
- Be knowledgeable about treatment, and give the client written instructions.