NCP for Psoriasis - 4 Nursing Diagnosis

Nursing Care Plan for Psoriasis

Psoriasis is a skin disease whose sufferers experience skin replacement process is too fast. The emergence of this disease sometimes for a longer period. In contrast to the normal human skin changes that usually lasts for three to four weeks, the skin changes in patients with psoriasis take place quickly is about 2-4 days, (it can even happen faster) that a lot of skin cell turnover and thickened.

Psoriasis can be found in all parts of the world with morbidity (incidence rate) is different. In terms of age, Psoriasis can be at any age, but usually more often found in adults.

Psoriasis is a skin disorder characterized by plaque, patches, scaly known papulosquamous disease. (Price, 1994).

The cause of psoriasis is unknown until now. Allegedly inherited polygenic. Although the majority of patients with psoriasis arises spontaneously, but in some patients found the existence of precipitating factors, among others:

1) Trauma
Psoriasis first arise in places that are exposed to trauma, scratching, incision, a former vaccination, and so on. The likelihood that this is a mechanism Koebner phenomenon. Typical in psoriasis arises 7-14 days after trauma.

2) Infection
In children, especially hemolytic streptococcal infections often cause guttate psoriasis. Psoriasis also arise after other bacterial infection and certain viral infections, but disappeared after infection healed.

3) Climate
Some cases tend to heal in the summer, while in the rainy season will recur.

4) Endocrine factors
The highest incidence at puberty and menopause. Psoriasis tends to improve during pregnancy and relapse and resistance to treatment after birth. Sometimes generalized pustular psoriasis arise during pregnancy and after high-dose progesterone treatment.

5) Sunlight
Although sunlight generally useful for patients with psoriasis, but in some patients the strong sunlight can stimulate the onset of psoriasis. Photochemical treatment has similar effects in some patients.

6) Metabolic
Hypocalcemia may cause psoriasis.


Patients usually complain of mild itching in places of predilection, namely the scalp, the border area with the face, extremities on the extensor, especially the elbows and knees, and the lumbosacral region. Skin disorders consisting of patches of elevated erythema (plaque) with scales on it. The scales are layered, rough, and white like mica, and transparent. In psoriasis there is the phenomenon of droplets of wax, Auspitz and Köbner.


Symptoms of psoriasis include:
Complained of mild itching.
Patches of erythema elevated, scaly thereon.
There is a phenomenon of the droplets of wax.
Cause nail abnormalities.


Nursing Diagnosis for Psoriasis

1. Impaired sense of comfort related to disease-related symptoms
characterized by: the itching, burning sensation on the skin, anxiety, clients seemed agitated, and disruption of sleep patterns.

2. Impaired skin integrity related to chemical irritation, mechanical factors, nutritional factors
characterized by: tissue damage of the skin (scaly skin, poor skin turgor, cracks, patches, itching).

3. Disturbed body image related to the biophysical, disease, and perceptual
characterized by: insecure, self-conscious, feelings of isolation, the interaction is reduced.

4. Anxiety related to changes in health status
characterized by: a client anxiety, fear, sleep disturbances, often sweating.

Altered Nutrition related to Nausea and Vomiting

Alteration Nutrition: Less Than Body Requirements related to Nausea and Vomiting

Nutrients are substances in food that are needed for the organism to grow and develop properly in accordance with its function.

Nutrients in adequate amounts and in accordance with the need for providing energy for the body to be able to grow and develop, and repair damaged tissue. Nutritional deficiencies will make the body of the organism does not grow and develop, it can even cause disease to end in death. Disruption of the body's metabolic processes are early symptoms of nutritional deficiencies.

Definition of nutrition, according to some experts is as follows:

• Nutrition is the process of taking important nutrients. (Nuwer, 2008).
• Nutrients are organic substances required by the organism for normal functioning of the body systems, growth and maintenance of health. (Wikipedia).

After knowing the definition of nutrients, there are several types of nutrients that it needs to be absorbed by us every day. Such as carbohydrates, this is a kind of nutritional composition consisting of the elements carbon, hydrogen and oxygen. This type of substance found in rice, corn, wheat, tubers. There are fat as the types of nutrients that are needed by our bodies, fat acts as an energy source that is compacted. There is a protein that is an important constituent of all cells in the body. Vitamin is also a means of nutrition is no less important to regulate the body's metabolism. Meneral and water is also a kind of important nutrients for the body.

Understanding of nutrition is not just limited to the nutritionists or health researchers only. However, this definition also extends in particular to the health of the world. Nutrition for health is a kind of critical intake found in foods often consumed by us. Contains vital substances such as vitamins, minerals, carbohydrates and others. Knowledge of the nutrients it needs to be recognized as a regulator of eating patterns. The nutritional requirements for the human body is certainly very important as supporting a variety of activities and health. The nutrients needed by the body also had higher levels of clear and useful to the body. There are several types of foods that actually do not really have a clear nutritional. It would be very concerned if we always vulnerable consumption in a long time. After all essential nutrients is a necessity that should not be missed. Nutrition serves to keep your metabolism in the body because there is a substance in nutrients and important things to be absorbed. The function of internal organs of the body will also be maintained if the fulfillment of these nutrients stable and clear presence.

Nausea and vomiting is a symptom that is frequently encountered. Nausea is an uncomfortable sensation in the upper abdomen that creates a feeling like vomiting. While vomiting is the release of stomach contents through the mouth.

Nausea and vomiting are symptoms. Therefore, nausea and vomiting caused by various medical conditions (diseases) of the underlying. Knowing the causes of nausea and vomiting are very important for the management of nausea or vomiting appropriately.

Medical condition or disease causes nausea and vomiting, among others:

• Motion sickness.
• Young pregnant (nausea occurring in approximately 50% -90% of all pregnancies, vomiting in 25% -55%).
• Originator drug vomiting.
• Taste very pain.
• Emotional stress (such as fear).
• Excessive eating (satiety).
• Gallbladder disease, for example gallstones.
• Food poisoning.
• Viral infection of the gastrointestinal tract (diarrhea).
• Reaction to the odor or a particular smell.
• Sore throat (kids).
• Heart attack.
• Concussion or brain injury.
• Brain tumor.
• Gastric ulcer.
• Some forms of cancer.
• Bulimia or other psychological illnesses.
• Gastroparesis or slow emptying of the stomach (a condition that is often seen in people with diabetes).
• Swallowing poison or drink alcohol excessively.

Causes of vomiting may differ according to age.
Vomiting in children is most often caused by a viral infection, food poisoning, milk allergy, motion sickness, overeating, coughing, or intestinal blockage, and a disease in which the child has a high fever.

Time of nausea or vomiting may indicate the cause. When it comes shortly after a meal, nausea or vomiting may be caused by food poisoning, gastritis (inflammation of the lining of the stomach), gastritis, or bulimia.

Nausea or vomiting 1-8 hours after a meal may also indicate food poisoning. However, foods containing certain bacteria, such as salmonella (the cause of typhoid fever), it could take longer, causing the symptoms of nausea and vomiting. Continuous vomiting can cause a dangerous condition that is dehydration, especially vomiting in infants and children. Moreover, they have not been able to say what they are feeling. Therefore, parents should know the signs of dehydration in children.

Here is how to overcome the nausea and vomiting in general regardless of age and cause:

• Drink plenty of water gradually (a little but often).
• Avoiding solid food until the vomiting episode has passed.
• Stop all medications (which can irritate the stomach and make vomiting worsened). But, do not discontinue any medication before consulting a doctor.
• If there is vomiting and diarrhea lasting more than 24 hours, oral rehydration solution such as ORS should be used to prevent and treat dehydration.
• Pregnant women who experience morning sickness can eat some crackers before getting out of bed or eating a high-protein snack before bed (meat or cheese).
• Vomiting associated with cancer treatment (chemotherapy) can often be treated with other types of drug therapy. There are also prescription and non-prescription medications that can be used to control vomiting associated with pregnancy and motion sickness. However, you should consult a physician before using these drugs.

You should seek emergency medical care, if vomiting is accompanied by:

• There was blood in the vomit (bright red or black "coffee grounds").
• Severe headache or stiff neck, fear the occurrence of meningitis.
• Weak lethargy, confusion, or decreased consciousness.
• Severe abdominal pain.
• Fever higher than 38.5 C.
• Diarrhea.
• Frequency of breath and very rapid and weak pulse.

Nausea and Vomiting related to Pregnancy

Although the cause is unknown, nausea and vomiting during pregnancy related to changes in the hormonal levels in the body of a pregnant woman. When a pregnant woman, there will be increased levels of human chorionic gonadotropin (HCG), which is derived from the placenta. This hormone serves to maintain adequate production of the hormones estrogen and progesterone from ovaries, resulting in pregnancy to be healthy.

In addition, the effect of this hormone is thought to cause nausea and vomiting in the first three months of pregnancy (first trimester) and will fall back after the fourth month. Therefore, nausea and vomiting usually goes away by itself after entering the fourth month. Besides HCG, the hormone estrogen is considered also cause nausea and vomiting in pregnant women.

Signs and symptoms

Level 1 (mild)

• Nausea and vomiting constantly affecting the general condition.
• Feeling weak.
• No appetite.
• Body weight decreased.
• Feel pain in the epigastric.
• Pulse increased by about 100 per minute.
• Decreased blood pressure.
• Reduced skin turgor.
• Tongue dries.
• Sunken eyes.

Level 2 (moderate)

• Looks weaker and apathetic.
• Skin turgor started ugly.
• Tongue dry and looked dirty.
• Pulse small and quick.
• Body temperature rises (dehydration).
• Eyes began to jaundice.
• Weight down and sunken eyes.
• Drop in blood pressure, hemoconcentration, oliguria and constipation.
• Acetone smell of respiration and occurs acetonuria.

Level III (severe)

• General condition is more severe (decreased consciousness from somnolence to coma).
• Severe dehydration.
• Pulse small, fast and smooth.
• Increased body temperature and blood pressure drop.
• Fatal complications occur in the nervous system known as Wernicke encephalopathy with symptoms of nystagmus, diplopia and mental decline.
• Jaundice which indicate heart trouble.

Prevention

Avoiding strong-smelling food, cigarette smoke or perfume smelling that can trigger nausea and vomiting.
Some dietary supplements may help reduce nausea and vomiting as a drink ginger or vitamin B6.
Eat a desired food when the body is able to receive it.
Do not lie down immediately after eating, should sit upright for a while to avoid bloating or nausea.
Avoid lots of drinking at meals, wait 30 minutes after eating a new drinking water. Outside of mealtime, are expected to drink more.
Eat small meals but frequently (every 2-3 hours) to prevent nausea without risk of malnutrition.
A diet that is complete and balanced.
Enough rest.
Consultation obstetrician if nausea and vomiting continues.