# A nurse is caring for a client with moderate plaque psoriasis. Which nursing intervention should be prioritized to promote healing and prevent complications?

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> subject: Adult Health

## 문제

A nurse is caring for a client with moderate plaque psoriasis. Which nursing intervention should be prioritized to promote healing and prevent complications?

## 보기

1. Apply occlusive dressings to all affected areas to maintain moisture
2. Encourage frequent hot baths with antibacterial soap to prevent infection
3. Teach proper application of prescribed topical medications and moisturizers **✔ 정답**
4. Recommend complete sun avoidance to prevent skin irritation

**정답: 3**

## 해설

Teaching proper application of prescribed topical medications and moisturizers is prioritized as it directly manages inflammation and skin barrier function, unlike occlusive dressings (may trap moisture excessively), hot baths (can dry skin), or complete sun avoidance (sunlight can be beneficial in moderation).

## 심화 해설

Understanding the Priority for Psoriasis Care

The correct intervention is to teach proper application of prescribed topical medications and moisturizers. In managing moderate plaque psoriasis, the priority nursing action centers on patient education to ensure effective self-management, which directly promotes healing and prevents complications such as exacerbation of lesions or secondary infection.

Why This Is the Priority

Psoriasis is a chronic, systemic inflammatory condition, and its management relies heavily on consistent, correct topical therapy. The primary goal is to reduce inflammation, control scaling, and maintain skin barrier integrity. Patient education is the cornerstone of achieving this, as it directly addresses the behavioral and motivational factors that influence treatment adherence. A qualitative study exploring health-promoting lifestyles in patients with psoriasis identified that a lack of knowledge and skills was a significant barrier, while clear instruction and understanding served as key facilitators [2]. By teaching the proper technique—applying medication in a thin layer only to active plaques and using emollients liberally to hydrate the surrounding skin—the nurse empowers the patient to actively control their disease process, minimize flare-ups, and prevent the skin from cracking and becoming a portal for infection.

Analysis of Incorrect Options

*   Option 1: Apply occlusive dressings to all affected areas to maintain moisture. This is not a standard, first-line intervention for all plaques. Occlusion can increase the potency and systemic absorption of topical corticosteroids, raising the risk of local side effects (atrophy, striae) and hypothalamic-pituitary-adrenal (HPA) axis suppression. Its use is selective and under specific medical direction, not a generalized nursing priority.

*   Option 2: Encourage frequent hot baths with antibacterial soap to prevent infection. This intervention is harmful. Hot water and harsh antibacterial soaps strip the skin of natural oils, disrupt the already compromised skin barrier, and can trigger or worsen psoriatic flares (the Koebner phenomenon). Patients are advised to bathe in lukewarm water with gentle, fragrance-free cleansers.

*   Option 4: Recommend complete sun avoidance to prevent skin irritation. This is incorrect. While sunburn must be strictly avoided, controlled exposure to natural sunlight or physician-directed phototherapy is a recognized and effective treatment for psoriasis. It slows the rapid turnover of keratinocytes. Complete avoidance would deprive the patient of a therapeutic modality.

Connecting to the Evidence: The Role of Education and Support

The rationale for prioritizing patient education is strongly supported by current research on the comprehensive care needs of individuals with psoriasis. The disease burden extends beyond physical symptoms to significant psychological and social distress, which can impair a patient's motivation and ability to perform consistent self-care . A protocol for a randomized controlled trial on telenursing highlights that structured education and support for caregivers are crucial because they directly impact the patient's care quality and health outcomes . This reinforces that nursing interventions must go beyond performing tasks and focus on building the patient's and family's capability and opportunity to manage the condition. When a nurse provides clear, tailored teaching on topical therapies, they are directly mitigating the identified barrier of insufficient knowledge and strengthening the patient's motivation to adhere to the treatment plan, which is the most direct path to healing and preventing complications [2].References (research sources)

- [2]Barriers and facilitators to adopting health-promoting lifestyles in patients with psoriasis in China: a qualitative study using the COM-B and SEM.Research articleXing L, Yu H, Wang S, Huang S, Liu H, Song J. (2025) · DOI: 10.3389/fpubh.2025.1695306

## 임상 시나리오

Topical Therapy Education for Plaque PsoriasisPrioritizing Self-Management to Promote Healing
The cornerstone of nursing intervention is patient education on proper medication application. Instruct the patient to apply a thin layer of prescribed topical corticosteroids only to active plaques, avoiding unaffected skin to prevent atrophy.

Emollients should be applied liberally and frequently to all skin, especially immediately after bathing while skin is still damp, to lock in moisture and restore the skin barrier. This reduces scaling and prevents painful cracking.

CautionAvoid hot water and harsh or antibacterial soaps, as they strip natural oils and exacerbate dryness. Occlusive dressings are not a standard intervention for all plaques; they are reserved for localized, thick lesions and require monitoring for folliculitis and maceration. Do not recommend complete sun avoidance; controlled, brief sun exposure can be beneficial.

## 핵심 개념

- **Plaque Psoriasis** — The most common form of psoriasis, characterized by well-defined, erythematous plaques covered with silvery scales, resulting from chronic inflammation and keratinocyte hyperproliferation.
- **Topical Corticosteroids** — First-line anti-inflammatory agents for mild-to-moderate psoriasis that reduce erythema, scaling, and pruritus; must be applied in a thin layer only to active plaques to prevent skin atrophy.
- **Emollients (Moisturizers)** — Lipid-rich formulations that hydrate the stratum corneum, restore skin barrier function, and reduce scaling; applied liberally and frequently to the surrounding skin, not just plaques.
- **Occlusive Dressings** — Impermeable coverings that enhance drug penetration and hydration but are used cautiously only on localized, thick plaques due to the risk of folliculitis, maceration, and systemic absorption.
- **Koebner Phenomenon** — The development of new psoriatic lesions at sites of skin trauma, such as scratching, sunburn, or friction, highlighting the need for gentle skin care and irritation avoidance.

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