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PSORIASIS Psoriasis is a chronic non contagious autoimmune disease that affects the skin and joints. It causes rapid skin cell reproduction resulting in red, dry patches of thickened skin.

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CAUSES: It is not known. But it is believed to have genetic component. Factors may aggravate Smoking Stress Alcohol consumption Withdrawal of systemic corticosteroids

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TYPES: 1.Plaque Psoriasis (Psoriasis vulgaris): It is most common form of psoriasis. It affects 80-90% of people. Appears as raised areas of inflamed skin covered with silvery white patches called plaques 2. Flexural Psoriasis (Inverse Psoriasis): It appears as smooth inflamed patches of skin. It occur skin folds particularly around the genitals and armpits.

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3. Guttate Psoriasis: Characterized by numerous small round spots. The numerous spots of psoriasis appear over large areas of the body. 4. Pustular Psoriasis: Appears as raised bumps that are filled with non infectious pus. The skin under and surrounding the pustules are red and tender It can be localized to the hands and feet and generalized with wide spread patches on any part of the body

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5. Nail Psoriasis: Produce a variety of changes in the appearance of finger and to nails. Discoloring under the nail plate Pitting of the nails, Line going across the nails Thickening of the skin under the nails 6. Psoriatic Arthritis: Involves joint and connective tissue inflamed. 7. Erythrodermis Psoriasis: Involves wide spread inflammation and exfoliation of the skin over most of the body surface. It is accompanied by severe itching, swelling and pain

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SIGNS AND SYMPTOMS: Small flattened bumps of skin Large thickened plaques of raised skin Red patches Pink dry skin Liquid filled yellowish small pustular lesions Prominent itching Joint pain Stiffness

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DIAGNOSIS: History collection Physical examination Lab investigations are rarely indicated Patients may have mild hyper uremia MRI and X RAY of the joints for psoriatic arthritis PROCEDURES: Skin biopsies can confirm the diagnosis of plaque psoriasis

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TREATMENT MEDICAL TREATMENT: Topical treatment Ointment & creams containing coal tar and anthralin Corticosteroids (desoximetasone) Salicylic acid and lactic acid. Dandruff shampoo and moisturizers

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Phototherapy (light therapy) Daily short non burning exposure to sunlight UV-b with a wave length of 290-320nm Photo chemotherapy Psoralen and UV A phototherapy (PUVA). Combines the oral or topical administration of psoralen drug with exposure of UV-A light. Systemic agents Immune suppressants (methotrexate, cyclosporine) Retinoid

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COMPLICATIONS: Pain Severe itching Secondary skin infections Side effects of treatment

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NURSING MANAGEMENT Impaired skin integrity related to lesions secondary to psoriasis High risk for infections related to lesions Body image disturbance related to scaly lesions Self esteem disturbances or hopelessness related to appearance can occur


MALIGNANT MELANOMA DEFINITION: Malignant melanoma is a neoplasm of melanocytes or of the cells that develop melanocytes

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ETIOLOGIC FACTORS: UV radiation Genetic factors Immune suppression Sun sensitivity Atypical moles

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TYPES: Lentigo maligna Consist of malignant cells but does not show invasive growth Normally found in elderly Lentigo maligna melanoma Evolved from lentigo maligna Found on chronically sun damaged skin Superficially spreading melanoma Most common form of cutanious melanoma It is tends to occur on sun exposed skin especially on the backs of males and lower limbs of females

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Acral lentigous melanoma Observed in palms and under nails also found in mucous membranes Mucosal melanoma Develop from mucosal epithelium that lines the respiratory gastro intestinal and genito urinary tract Nodular melanoma Grows in vertical direction forms and grows very fast It is small black or amelanotic pink nodule that simply enlarges

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Polypoid melanoma A rare cutanious condition A variant of nodular melanoma Desmoplastic melanoma Cutenious condition A deeply infiltrating type Amelanotic melanoma Skin lesions are often irregular and may be pink red or have light brown or gray color at the edges Soft tissue melanoma Melanoma of soft parts Recurrence is common

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INCIDENCE Queensland Australia has the highest incidence in the world Melanoma is common in white than in blacks and Asians It is slightly more common in males than females SIGNS & SYMPTOMS: Asymmetry Border Color Diameter Enlarging

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STAGING OF MELANOMA: Stage – IA Melanoma cells are found only in out layer Lesions less than or equal to 1mm thick No evidence of ulceration or metastasis Survival rate is 95% Stage – IB: Lesions less than or equal to 1mm thick with ulceration but without lymph node involvement Tumors is 1.01-2mm thick without ulceration or lymph node involvement Survival rate is 91%

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Stage – IIA: Melanomas greater than 1mm but less than 2.01mm thickness with no evidence of metastasis but with evidence of ulceration or lesions 2.01-4mm thickness without ulceration or lymph node involvement Survival rate is 77-79% Stage – IIB: Melanomas 2.01-4mm thick with ulceration but no lymph node involvement or lesions Melanoma 4mm thick without ulceration or lymph node involvement Survival rate is 63-67%

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Stage- IIC Lesions greater than 4mm thick with ulceration but no lymph node involvement Survival rate is 45% Stage- IIIA Patient with any depth lesions No ulceration and one positive (micro metastasis) lymph node Survival rate is 70%

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Stage- IIIB Patient with any depth lesions with ulceration and one positive lymph node or 2-3 positive lymph nodes for micro metastasis Survival rate is 50-53% Patient with any depth lesions no ulceration and one lymph node positive for macro metastasis Survival rate is 46-59%

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Stage- IIIC Patient with any depth lesions with ulceration and 1-4 lymph node positive for macro metastasis Survival rate is 24-29% Stage – IV: Melanoma metastatic to skin subcutaneous tissue or lymph node The melanoma cells have spread to occur organs. Survival rate is 19%

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DIAGNOSTIC STUDIES LAB STUDIES: CBC count Chemistry panel Lactate dehydrogenises (LDH)

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IMAGING STUDIES: Chest x-ray CT or MRI of brain Chest CT scan CT abdomen CT pelvis PET scan Procedures: Biopsy of suggestive lesion Elective lymph node dissection Sentinel lymph node biopsy

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TREATMENT: Medical Care: Adjuvant therapy Chemotherapy & immunotherapy Radiation therapy SURGICAL MANAGEMENT: WLE + sentinel node biopsy

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NURSING MANAGEMENT: NURSING DIAGNOSIS Impaired skin integrity related to lesions and its treatment Disturbed body image related to embarrassment, over appearance and self perceptions of uncleanness. Deficient knowledge of disease and its treatment

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