Nursing Clinical Practice Guide
Clinical Scenario: Mr. Johnson, a 60-year-old with a long history of plaque psoriasis, is admitted for an elective knee replacement. During your shift assessment, you note thick, red, scaly plaques covering about 30% of his elbows, knees, and scalp. He mentions the plaques are itchy and he's embarrassed by them.
Nursing Intervention Strategy:1. Assessment: Use the Psoriasis Area and Severity Index (PASI) as a reference to document location, erythema (redness), induration (thickness), and scaling. Assess for signs of infection (increased warmth, pain, purulent drainage). Inquire about joint pain/stiffness (screening for psoriatic arthritis). Assess the psychosocial impact.2. Nursing Diagnosis: Impaired Skin Integrity, Chronic Pain, Disturbed Body Image, Risk for Infection.3. Planning & Implementation: - Skin Care: Collaborate to establish a daily routine. Encourage lukewarm (not hot) baths with colloidal oatmeal or bath oils to soften scales. Gently pat dry. Apply prescribed topical medications (e.g., corticosteroid cream) to damp skin to enhance absorption, followed by a thick, fragrance-free emollient (moisturizer) over entire body. - Prevent Koebner Phenomenon: Be extremely careful with adhesive dressings, blood pressure cuffs, and IV securement on unaffected skin to avoid triggering new lesions at sites of trauma. - Education & Support: Educate that psoriasis is not contagious. Discuss stress management techniques. Provide resources for support groups (National Psoriasis Foundation).4. Evaluation: Monitor for reduction in scale thickness and erythema, decreased pruritus (itching), and patient verbalization of improved coping and body image.
Nursing Procedure & Medication Flow
Applying Topical Corticosteroids for Psoriasis:1. Assessment: Check provider's order for drug name, strength, frequency, and application site.2. Preparation: Gather supplies (medication, non-sterile gloves, tongue depressor if from a jar).3. Procedure: a. Don gloves. b. Assist patient with gentle cleansing of the area; pat dry. c. Apply a thin layer (a pea-sized amount can cover an area the size of two palms) only to the affected plaques. Rub in gently until absorbed. d. For potent steroids, educate on site rotation to prevent skin atrophy (thinning). e. Remove gloves and perform hand hygiene.4. Patient Education: Do not cover with occlusive dressings unless specifically ordered. Do not use on face, groin, or axillae unless prescribed for those sensitive areas. Report any signs of skin infection or worsening irritation.
A Word from Your Senior Nurse
"Nursing is not just about carrying out physician orders — it's about being the frontline guardian for your patients! In clinical practice, a patient with psoriasis might be hospitalized for something completely unrelated (like our Mr. Johnson for his knee). Your skilled skin assessment and knowledgeable care prevent complications like infection from cracked plaques and address the profound psychosocial burden this visible disease carries. When studying for your boards, don't just memorize 'silvery scales' — connect it to the real person. Understand the chronicity, the triggers, and the holistic care needed. That mindset will not only earn you a great score on the NCLEX but will make you a truly confident, compassionate nurse!"