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Unformatted text preview: Management of Patients with Dermatologic problems Chapter 56 Care of Patients with skin conditions Nursing care for pts with dermatologic problems includes administering topical and systemic medications, managing wet dressings, and other special dressings, and providing therapeutic baths. The 4 major objectives of therapy are: 1. To prevent additional damage 2. Prevent secondary infection 3. Reverse the inflammatory process 4. Relieve the symptoms Psoriasis- A chronic noninfectious inflammatory disease of the skin in which epidermal cells are produced at a rate that is about 6 to 9 times faster than normal. May be aggravated by emotional stress, trauma, and seasonal and hormonal changes The cells in the basal layer of the skin divide too quickly and the newly formed cells move so rapidly to the skin surface that they become evident as profuse scales or plaques of epidermal tissue. The psoriatic epidermal cell may travel from the basal cell layer of the epidermis to the stratum corneum (skin surface) and be cast off in 3 to 4 days, which is in sharp contrast to the normal 26 to 28 days. As a result of the increased number of basal cells and rapid cell passage, the normal events of cell maturation and growth cannot take place. This abnormal process does not allow the normal protective layer of the skin to form. Psoriasis has a tendency to improve and recur periodically throughout life. Clinical Manifestations of Psoriasis- Lesions appear as red, raised patches of skin covered with silvery scales The scaly patches are formed by the buildup of living and dead skin resulting from the vast increase in the rate of skin- cell growth and turnover. If the scales are scraped away, the dark red base of the lesion is exposed, producing multiple bleeding points. These patches are not moist and may be puritic The sites of the body that tend to be affected are: the scalp, the extensor surface of the elbows and knees, the lower part of the back, and the genitalia Bilateral symmetry is a feature of psoriasis In some cases, the nails are involved, with pitting, discoloration, crumbling beneath the free edges, and separation of the nail plate When it occurs on the palms and soles, it can cause pustular lesions called palmar pustular psoriasis Complications of Psoriasis The disease may be associated with asymmetric rheumatoid factor- negative arthritis of multiple joints The arthritic development can occur before or after the skin lesions appear The relationship b/w the two is not understood Another complication is an exfoliative psoriatic state in which the disease progresses to involve the total body surface, called erythrodermic psoriasis....
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- Spring '08