Integumentary Function – Psoriasis

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Psoriasis is a chronic skin disease that is characterized by deficiencies in the normal cycle of the epidermal development that lead to epidermal hyperproliferation, altered growth of the skin, inflammation, and vascular

dysfunction (Peters, Weissman, & Gill, 2000).

There are several types of psoriasis lesion that individuals can experience, and each may differ in the way they respond to treatment (Peters, Weissman, & Gill, 2000). The different types of psoriasis includes: plaque psoriasis

which is the most common type, and is characterized by dry scalling patches, guttate psoriasis is characterized by drop-like dots that develops in individuals recovering from a streptococcal or viral infection, erythrodermic psoriasis

characterized by exfoliation of fine scales that covers large areas accompanied by severe itiching, and pain (Peters, Weissman, & Gill, 2000). Other types of psoriasis are pustular psoriasis characterized as pus-like blisters that are not

infectious with fluids that contains white blood cells. Nail psoriasis that is seen on toe and finger nails; inverse psoriasis that is characterized by smooth, inflamed lesions mostly in flexural areas of the body, such as the armpits. Psoriatic

arthritis is characterized by an inflammation, swelling, and joint destruction, and scalp psoriasis that is a plaque type lesion (Peters, Weissman, & Gill, 2000).

The onset of psoriasis can be sudden or steady, and many patient such as K.B. will experience remissions, and exacerbations. The most common triggers for psoriasis are bacterial or viral infections on any part of the skin, dry air

or skin, use of certain medications such as beta blockers, and lithium. Other triggers are skin injuries, such as cuts, and insect bites, too little or too much sunlight, and excessive alchohol intake (Dlugasch & Story, 2021).

Although there is no cure for psoriasis, there are treatment available that will improve the symptoms. There three main approaches to treatment including topical treatments, phototherapy, and systemtic medications. Topical

treatments includes corticosteriods is the topical agent that is mostly used in treating psoriasis, and is used to reduce inflammation, itching, and scaling of lesions (Peters, Weissman, & Gill, 2000). Other topical treatments include

vitamin D, anthralin, retinoids, calcinerin inhibitors, salicylic acid, coal tar, mositurizers, and dandruff shampoo (Dlugasch & Story, 2021). Phototherapy is used in the treatment of moderate forms of psoriais, these therapies are

administered in the form of sunlight, natural or artificial, broadband ultraviolent B phototherapy, photochemotherapy, and excimer laser (Dlugasch & Story, 2021). Oral or injectible forms of treatment are usually prescribed for

individuals with serve symptoms or those who are resisitant to other forms of treatment (Dlugasch & Story, 2021). These systemic theraputic agents are retinoids, methotrexate, cyclosporine, hydroxyurea, phosphodiesterease 4 inhibitor,

immunomodular drugs, and janus kinase inhibitors. These medications are used for a short time due the potential for individuals to experience serious side effects (Dlugasch & Story, 2021). In addition to the treatment modalitied

mentioned, stress management, and referral to a therapist to address the patients’ psychological needs is important. Recommendation for treatment in this case would include phototherapy, systemic therapy, and psychotherapy to address

K.B. emotional needs.

The medications used to treat psoriasis has severe adverse effects such as phototoxicity, nephrotoxicity bone marrow depression, and others, as a result. In addition, there is a high probability of these drugs to interact with other

medications that could result in a negative outcome; therefore it important to reconcile the medications that patient is taking (Peters, Weissman, & Gill, 2000).

Other clinical manifestations as mentioned above may include psoriatic arthritis that is characterized by joint pain, nail changes to include yellow-brown spots, dents on the nails, and separation from the base. An individual may

also experience symptoms of cardiovascular disease, inflammatory bowel disease, hypertension, and other autoimmune disorders as there is an increased risk associated with psoriasis that may be manifested as skin lesions (Dlugasch &

Story, 2021)

 

 

Sample Solution

Combatants are people who are involved directly or indirectly with the war and it is lawful to kill ‘to shelter the innocent from harm…punish evildoers (Begby et al (2006b), Page 290).However, as mentioned above civilian cannot be harmed, showing combatants as the only legitimate targets, another condition of jus in bello, as ‘we may not use the sword against those who have not harmed us (Begby et al (2006b), Page 314).’ In addition, Frowe suggested combatants must be identified as combatants, to avoid the presence of guerrilla warfare which can end up in a higher death count, for example, the Vietnam War. Moreover, he argued they must be part of the army, bear arms and apply to the rules of jus in bello. (Frowe (2011), Page 101-3). This suggests Frowe seeks a fair, just war between two participants avoiding non-combatant deaths, but wouldn’t this lead to higher death rate for combatants, as both sides have relatively equal chance to win since both use similar tactics? Nevertheless, arguably Frowe will argue that combatant can lawfully kill each other, showing this is just, which is also supported by Vittola, who states: ‘it is lawful to draw the sword and use it against malefactors (Begby et al (2006b), Page 309).’ In addition, Vittola expresses the extent of military tactics used, but never reaches a conclusion whether it’s lawful or not to proceed these actions, as he constantly found a middle ground, where it can be lawful to do such things but never always (Begby et al (2006b), Page 326-31). This is supported by Frowe, who measures the legitimate tactics according to proportionality and military necessity. It depends on the magnitude of how much damage done to one another, in order to judge the actions after a war. For example, one cannot simply nuke the terrorist groups throughout the middle-east, because it is not only proportional, it will damage the whole population, an unintended consequence. More importantly, the soldiers must have the right intention in what they are going to achieve, sacrificing the costs to their actions. For example: if soldiers want to execute all prisoners of war, they must do it for the right intention and for a just cause, proportional to the harm done to them. This is supported by Vittola: ‘not always lawful to execute all combatants…we must take account… scale of the injury inflicted by the enemy.’ This is further supported by Frowe approach, which is a lot more moral than Vittola’s view but implies the same agendas: ‘can’t be punished simply for fighting.’ This means one cannot simply punish another because they have been a combatant. They must be treated as humanely as possible. However, the situation is escalated if killing them can lead to peace and security, within the interests of all parties.

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