Question

23-year-old Josh has been suffering from extreme psoriasis for eight years. He’s tried all sorts of creams to no avail but has found that sunlight has a positive effect. Pixie warns against over-exposure to sunlight and suggests Josh stops smoking and cuts down on alcohol. If he does this he might be eligible for biological treatment, in which medication is administered to attack psoriasis from inside his body, rather than applying ointments and creams externally.

Cyclosporin, a potent drug, has proved to be effective. After a few tests, Josh is good to go. Cyclosporin is used in the short term to get the condition under control, after which more traditional treatments can be used to manage his psoriasis.

Six weeks after starting the medication, Josh’s body is unrecognisable. The aggressive, scaly psoriasis has calmed down and his home life has improved.

1, Using the Deliberative Nursing Process of Ida Orlando, what are your assessments, nursing diagnosis, plan of care. nursing intervention and evaluate the effectiveness of your care tp your chosen case .

2. How would be the nurse's action help the individual in the case find meaning to the experience from the medical condition> Explain your answer thoroughly. following the format for discussion - introduction, body and conclusion.

Answer 1

Psoriasis:

Psoriasis is non contagious skin disease whose main symptom is gray or silver flacky patches on the skin which are red and inflamed underneath when scratched.

1. Nursing Care plan for  Psoriasis based on Ida Orlando's Deliberate Nursing process:

Assessment:

* Assess the condition of skin, colour changes inflammatory changes etc :

to get the baseline information about the severity of the disease process

* Monitor vital signs

: To know his health status

* Assess the level of anxiety

Nursing Diagnosis

1. Impaired skin integrity related to epidermal and dermal inflammation secondary to Psoariasis

2. Disturbed body image related to embarrassment over appearance and self perception of uncleanliness

3. Deficient knowledge about disease process and its treatment

Plan of care / Nursing Interventions:

* Assess the skin colour changes :

to identify any exaggerations

* Administer medications as per Doctor's order

: to reduce the inflammatory process

* Keep the infected areas clean and dry :

to prevent the secondary infection

* Give the patient enough time to ventilate his feelings ; his anger , doubt, fear etc.

: to express the acceptance of the patient .

* Suggest appropriate coping mechanism  

: To get copied with fear and anxiety

* Assist the patient to adapt positive life style changes such as abstaining from smoking and alcohol

: To help with the treatment process and to improve positive health habits

* Encourage Patient - family interactions

: to provide ongoing support to the patient.

Evaluation ( of outcome)

* Patient's area of inflammation decreases in size and has increased granulation tissue.

* Patient verbalizes the acceptance of his disease condition and the body image and also expresses the willingness to adapt positive life style changes

* Patient describes the measures to prevent the recurrence of Psoriasis

* Patient demonstrates motivation to learn about disease process and the treatment methods.

2. Psoriasis is a chronic and recurrent skin inflammatory disease charecterised by epidermal proliferation and. The disorder commonly affects the young adults and occurs as partial remissions and exacerbation. Nurse's action can help the iindividuals with Psoriasis to find meaning the experiences from the medical condition and to copy with the disease condition effectively, also to get motivated for positive life style changes to prevent the recurrence of the disorder.  

Nurse theorists Ida Jean Orlando developed ' Deliberate Nursing process' . That includes the stages of Assessment, plan of care , intervention and evaluation of the outcomes. She emphasised that nurse has to validate the inferences of patient and analyse it , before drawing her own conclusions. Subjective data and objective data can help the nurse to identify the diagnosis/ problems of the patient. For this stage , nurses require a good relationship with the patient that is to assess the patient thoroughly. Her theory stresses the need of Dynamic nurse and patient relationship. For a patient with Psoriasis, after assessing his condition ; disease process , anxiety , patient's self image , fear etc, the nurse can formulate the effective nursing diagnosis by identifying the patient's actual and potential problems. After discussing and involving in plan of care , she can implement the planned care for the patient. After assisting in treatment process, the nurse has to evaluate the effectiveness of the care provided. Nurse has to teach the client about the disease process ; its causative or aggressive factors , stages etc ,   motivate him to adapt preventive measures like avoidance of smoking , alcohol, stress etc. Also the nurse can help the patient to improve his self esteem and coping ability.  

Nurse can do a wonderful part of the treatment process by helping the patient to go through the treatment process ,  to adapt healthy changes and to learn the experience from the disease condition.