A 40-year-old white female presents to the clinic with chief… A 40-year-old whi

A 40-year-old white female presents to the clinic with chief… A 40-year-old white female presents to the clinic with chief complaint of “flare up” of psoriasis.  She was diagnosed with plaque psoriasis 5 years ago that responded well to topical treatment with corticosteroids. This is her third flare up since diagnosis, and is now reporting “more rash”.Past MHx: rheumatic fever age 14 and rheumatic heart disease. Gravida 1 Para1, vaginal birth without complications. No other significant medical history hospitalizations or surgeries.Family Hx: father alive and well, mother recently passed away from ovarian cancer. Three brothers and two sisters, all healthy. Social Hx: works full-time as insurance agent, married, one son. Smokes 1/2 ppd, consumes wine with meals 2-3 times a week, no illicit drug use. Recent family tensions related to the passing of her mother.Medications:  ibuprofen prn headache, Rolaids prn “heartburn”.      Allergies:  NKDAReview of Systems: reports recent sporadic insomnia but gets “6 hours most nights”; reports feeling “nervous and stressed” lately due to loss of mother and “changes at work”; appetite “okay”, denies changes in bowel or bladder pattern; denies chest pain or SOB; denies joint stiffness or pain.  Reports her skin “itches terribly despite using a non-m,edicated moisturizer several times a day!”. Physical Exam and Vital Signs:BP 145/90  P 75  R 14  T 98.50 F   Ht 62 inches   Wt 165 lbs   BMI 30.17General: alert, mildly anxious, but NAD.Skin: confluent plaque-type lesions on the upper and lower extremities, scalp, abdomen, and groing- approximately 40% of total body surface area involved; lesions bright red with sharply defined borders exept where confluent and are covered with loose, silvery white scales; no pustules or vesicles present; lesions on the arns/legs/abdomen consistent with scratching (i.e. excoriations).HEENT: extensive lesions on scalp as noted above; PERRLA, EOMI, TMs intact, external ear canal clear, pharynx clear.   Neck: no lymphadenopathy, bruits or thyromegaly.Lungs: CTA bilaterally, A/P.      Heart: RRR with grade 2 murmur, no rub/gallop.    Abdomen: positive bowel sounds, soft, NT, no organomegaly or mass, extensive scaly lesions with excoriation as previously noted.Genetalia: normal. Musculoskeletal/Extremities: no swelling, warmth, redness or tenderness of joints; scaly lesions on elbows/knees/forearms/calves as previously noted, yellow spots in nail plates on fingers, peripheral pulses 2 throughout.  Neurologic: oriented X3, cranial nerves II-XII intact, DTRs 2 bilaterally, gait steady.  Answer the following questions based on the information provided above: 1. Explain the etiology and pathogenesis of psoariasis, including the dysfunction in cell turnover.2. What is the etiology of the erythema papules seen with this disorder?3. What risk factors are present in the case presented?4. What is the significance of the exam findings of the nails?5. Psoriasis is itself a risk factor for what? Health Science Science Nursing NURS 6320 Share QuestionEmailCopy link Comments (0)

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