Nursing Process-Psoriasis

NURSING PROCESS: PSORIASIS

Assessment 
The nursing assessment focuses on how the patient is coping with the psoriatic skin condition, the appearance of the normal skin, and the appearance of the skin lesions, as described previously.
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NURSING DIAGNOSES
Based on the nursing assessment data,

• Deficient knowledge about the disease process and treatment
• Impaired skin integrity related to lesions and inflammatory response
• Disturbed body image related to embarrassment over appearance and self-perception of uncleanliness

Planning and Goals 

Major goals for the patient may include increased understanding of psoriasis and the treatment regimen, achievement of smoother skin with control of lesions, development of self-acceptance, and absence of complications.

Nursing Interventions 

PROMOTING UNDERSTANDING

• The nurse explains with a sensitivity that, although there is no cure for psoriasis and lifetime management is necessary, the condition can usually be controlled. 
• The patient is cautioned about taking any nonprescription medications because some may aggravate mild psoriasis. 
• Reviewing and explaining the treatment regimen is essential to ensure compliance.
• Most patients need a comprehensive plan of care that ranges from using topical medications and shampoos to more complex and lengthy treatment with systemic medications and photochemotherapy, such as PUVA therapy. 
• Patient education materials that include a description of the therapy and specific guidelines are helpful but cannot replace face-to-face discussions of the treatment plan.

INCREASING SKIN INTEGRITY 

• To avoid injuring the skin, the patient is advised not to pick at or scratch the affected areas. 
• Measures to prevent dry skin are encouraged because dry skin worsens psoriasis.
• Water should be warm, not hot, and the skin should be dried by patting with a towel rather than by rubbing. 
• Softening the skin can prevent fissures.

IMPROVING SELF-CONCEPT AND BODY IMAGE 

• A therapeutic relationship between health care professionals and the patient with psoriasis is one that includes education and support. 
• After the treatment regimen is established, the patient should begin to feel more confident and empowered in carrying it out and in using coping strategies that help deal with the altered self-concept and body image brought about by the disease. 
• Introducing the patient to successful coping strategies used by others with psoriasis and making suggestions for reducing or coping with stressful situations at home, school, and work can facilitate a more positive outlook and acceptance of the chronicity of the disease.

PROMOTING HOME AND COMMUNITY-BASED CARE 

• Teaching Patients Self-Care Printed patient education materials may be provided to reinforce face-to-face discussions about treatment guidelines and other considerations. For example, the patient and the family caregiver may need to know that the topical agent anthralin leaves a brownish-purple stain on the skin but that the discoloration subsides after anthralin treatment stops. 
• The patient should also be instructed to cover lesions treated with anthralin with gauze, stockinette, or other soft coverings to avoid staining clothing, furniture, and bed linens. 
• Photochemotherapy (PUVA), which is reserved for moderate to severe psoriasis, produces photosensitization, which means that the skin is sensitive to the sun until methoxsalen has been excreted from the body in about 6 to 8 hours. 
• Patients undergoing PUVA treatments should avoid exposure to the sun. 
• The skin must be protected with sunscreen and clothing. 
• No other creams or oils are to be used except on areas that have been shielded from ultraviolet light. 
• Contraceptives should be used by sexually active women of reproductive age.

EVALUATION
EXPECTED PATIENT OUTCOMES 
Expected patient outcomes may include the following:
1. Demonstrates knowledge and understanding of the disease process and its treatment.
    a. Describes psoriasis and prescribed therapy.
    b. Verbalizes that trauma, infection, and emotional stress may be trigger factors.
    c. Maintains control with appropriate therapy.
    d. Demonstrates proper application of topical therapy

2. Achieves smoother skin and control of lesions.
    a. Exhibits no new lesions.
    b. Keeps skin lubricated and soft

3. Develops self-acceptance
    a. Identifies someone with whom to discuss feelings and concerns.
    b. Expresses optimism about outcomes of treatment

4. Absence of complications.
    a. Has no joint discomfort.
    b. Reports control of cutaneous lesions with no extension of disease.