Nursing Care Plan (NCP) for Psoriasis

Lesson Objective for Psoriasis Nursing Care Plan

Upon completion of this nursing care plan for psoriasis, nursing students will be able to:

• To comprehensively understand psoriasis, including its pathophysiology, etiology, and effective management strategies from a nursing perspective. The plan will cover various aspects such as patient assessment, diagnosis, nursing interventions, rationales, and evaluation methods, aiming to enhance the knowledge and skills of nursing professionals in managing psoriasis.

 

Pathophysiology for Psoriasis

Psoriasis is a chronic autoimmune skin disorder characterized by the rapid growth of skin cells leading to thick, red, scaly patches on the skin. It’s driven by an immune system dysfunction where T cells attack healthy skin cells mistakenly. This abnormal immune response leads to an increased production of skin cells, T cells, and other immune responses, causing inflammation and rapid turnover of skin cells. The build-up of these cells on the skin’s surface forms plaques or lesions.

 

To understand psoriasis, let’s use an analogy: 

• Imagine your skin as a lawn where skin cells are grass seeds. Normally, these seeds grow at a steady pace, and old grass is removed as new grass takes its place. This keeps your lawn looking healthy and even. However, in psoriasis, it’s as if the grass seeds start growing super fast and all at once. Instead of growing steadily and evenly, these seeds sprout quickly, piling up on each other. Because the old grass (old skin cells) doesn’t have time to be removed properly before new grass (new skin cells) comes in, you end up with thick, rough patches on your lawn (your skin).
• This rapid growth and buildup of cells are caused by the immune system. In psoriasis, the immune system, which normally protects your body from infections and diseases, mistakenly attacks healthy skin cells. It’s like having a lawn sprinkler system that’s supposed to water the grass but instead ends up flooding the lawn rapidly.
• This immune response leads to the rapid growth of new skin cells, inflammation, and the red, scaly patches typical of psoriasis. These patches can be itchy, sore, and sometimes painful, just like how an overgrown or uneven lawn can be difficult to walk on.
• So, in simple terms, psoriasis happens because of an overactive immune system speeding up skin cell growth, leading to a buildup of cells on the skin’s surface, causing the scaly, itchy patches.

 

Etiology of Psoriasis

• Genetic Factors: 
  • Psoriasis has a strong genetic component and often runs in families.
• Immune System Dysfunction: 
  • T cells attack healthy skin cells, causing inflammation.
• Environmental Triggers: 
  • Infections, cold weather, smoking, and heavy alcohol consumption. All can potentially lead to physical or psychological stress.
• Medications: 
  • Certain medications, like lithium and beta-blockers, can trigger or worsen psoriasis.

 

Desired Outcome for Psoriasis

• The patient demonstrates an understanding of psoriasis management.
• Reduction in the severity and extent of skin lesions.
• Effective control of symptoms, including itching and discomfort.
• No complications related to psoriasis or its treatment.

 

Subjective Data for Psoriasis

• Patient’s description of symptoms (itching, pain).
• Emotional impact (stress, embarrassment).
• Perception of triggers (stress, weather changes).
• Family history of psoriasis or other autoimmune disorders.
• Impact on daily activities and quality of life.

 

Objective Data for Psoriasis

• Physical examination of skin lesions (plaques, scales, redness).
• Assessment of joint involvement (psoriatic arthritis).
• Evaluation of nail changes (pitting, discoloration).
• Extent and severity of skin involvement.

 

Nursing Assessment for Psoriasis

• Assess skin lesions for severity, distribution, and impact on patient’s life.
• Evaluate patient’s understanding of the disease and its management.
• Monitor for signs of infection in affected areas.
• Assess for psychological impact, including signs of depression or anxiety.

 

Nursing Diagnosis for Psoriasis

• Impaired Skin Integrity related to excessive skin cell production as evidenced by:
  • Scaling
• Chronic Pain related to inflammation and skin lesions as evidenced by:
  • Patient reports of daily pain.
• Risk for Infection related to open lesions and compromised skin barrier.
• Disturbed Body Image related to visible skin lesions as evidenced by:
  • Not looking at skin lesions.

 

Nursing Interventions and Rationales for Psoriasis

• Skin Care: Guide in gentle skin care routines using mild soaps and moisturizers.
  • Rationale: To maintain skin integrity and prevent dryness and cracking.

• Education on Trigger Avoidance: Instruct on identifying and avoiding personal triggers.
  • Rationale: Reducing exposure to triggers can decrease flare-ups.

• Medication Management: Assist with administration and education about prescribed medications like topical treatments or systemic therapies. 
  • Rationale: To control symptoms and slow down cell turnover.

• Psychosocial Support: Provide emotional support and referral to counseling if needed.
  • Rationale: Psoriasis can have a significant emotional and psychological impact.

• Lifestyle Modifications: Encourage healthy lifestyle choices such as quitting smoking, reducing alcohol consumption, and managing stress. 
  • Rationale: These factors can exacerbate psoriasis.

 

Evaluation of Psoriasis Care

• Monitor the effectiveness of skin care routines and medication regimen.
• Evaluate the patient’s understanding and adherence to management strategies.
• Assess improvement in skin integrity and reduction in symptoms.
• Re-evaluate the patient’s emotional and psychological well-being.

 

References:

• NURSING.com: Offers nursing-focused insights and care plans for psoriasis.
• Mayo Clinic: Provides comprehensive information on psoriasis symptoms, causes, and treatments.
• NIH.gov: Features up-to-date research and clinical guidelines on psoriasis.