Case Study 1: K.B. with Psoriasis

Question 1: Triggers and Clinical Types of Psoriasis

Triggers for Psoriasis:

• Stress: Emotional stress can exacerbate psoriasis.
• Infection: Strep throat or skin infections can trigger a psoriasis flare-up.
• Injury to the Skin: Cuts, scrapes, or sunburn can trigger psoriasis at the site of injury (known as the Koebner phenomenon).
• Certain Medications: Some medications, such as beta-blockers and lithium, can worsen psoriasis.
• Climate: Cold, dry weather can worsen psoriasis symptoms.

Clinical Types of Psoriasis:

1. Plaque Psoriasis: The most common type, characterized by raised, red, scaly patches.
2. Guttate Psoriasis: Small, red, scaly spots, often triggered by a strep throat infection.
3. Inverse Psoriasis: Smooth, red patches in skin folds, such as the groin, under the breasts, and underarms.
4. Pustular Psoriasis: Small, pus-filled blisters.
5. Erythrodermic Psoriasis: A severe form with widespread redness and scaling.

Question 2: Treatment Approach for K.B.’s Psoriasis

Given the severity and extent of K.B.’s psoriasis, a combination therapy approach would be most appropriate. This may include:

• Topical Corticosteroids: High-potency corticosteroids can help reduce inflammation and scaling.
• Topical Vitamin D Analogues: These can help slow skin cell growth and reduce inflammation.
• Topical Retinoids: These can help reduce scaling and inflammation.
• Phototherapy: Exposure to ultraviolet light can help slow skin cell growth.
• Systemic Therapy: For severe cases, systemic medications like oral retinoids, cyclosporine, or biologics may be necessary.

Non-pharmacological interventions, such as stress management techniques, regular exercise, and a healthy diet, can also help manage psoriasis.

Question 3: Medication Review

It’s important to review K.B.’s medications to identify any potential drug interactions or side effects that could exacerbate her psoriasis. Some medications, such as beta-blockers and lithium, can worsen psoriasis. Additionally, certain medications may interact with psoriasis treatments, affecting their efficacy or increasing the risk of side effects.

Case Study 2: C.J. with Eye and Ear Infection

Question 1: Diagnosis

Based on the clinical presentation, the most likely diagnosis for C.J.’s eye condition is acute bacterial conjunctivitis. This diagnosis is supported by the presence of a yellowish discharge, conjunctival erythema, and blurry vision.

Question 2: Etiology

The most likely etiology of C.J.’s eye infection is a bacterial infection. This is supported by the presence of a purulent discharge, which is a characteristic sign of bacterial conjunctivitis. Viral conjunctivitis typically presents with a watery discharge and less severe symptoms.

Question 3: Therapeutic Approach

Given the likely bacterial etiology, the most appropriate treatment for C.J.’s eye infection would be topical antibiotic eye drops. These drops can help eliminate the bacteria and reduce inflammation. It’s important to note that it’s crucial to consult with a healthcare provider to get a proper diagnosis and treatment plan.

Regarding his ear infection, a middle ear infection is likely due to the bulging and red tympanic membrane. This typically requires oral antibiotics to treat the bacterial infection.

NUR 512 Discussion: Measuring and Monitoring Quality of Care

To measure and monitor the quality of care delivered by an Advanced Practice Nurse (APN), several key strategies can be employed:

1. Performance Measures:

   • Clinical Quality Measures: These measure the quality of care provided, such as adherence to clinical guidelines, appropriate medication prescribing, and timely diagnosis.
   • Patient Satisfaction Surveys: These assess patient satisfaction with the care received, including communication, compassion, and overall experience.
   • Patient Outcomes: Monitor patient outcomes, such as reduced morbidity and mortality rates, improved functional status, and enhanced quality of life.

2. Quality Improvement Initiatives:

   • Continuous Quality Improvement (CQI): Use data to identify areas for improvement and implement changes to enhance care delivery.
   • Root Cause Analysis: Investigate adverse events to identify underlying causes and implement corrective actions.
   • Evidence-Based Practice: Stay up-to-date with the latest evidence and incorporate it into clinical practice.

3. Peer Review and Feedback:

   • Peer Review: Participate in peer review processes to assess the quality of care provided by colleagues.
   • Self-Reflection: Regularly reflect on your own practice and identify areas for improvement.

4. Patient Education and Engagement:

   • Educate patients about their health conditions and treatment options.
   • Empower patients to take an active role in their own care.

By implementing these strategies, APNs can ensure high-quality care and improve patient outcomes.