A nursing student is reviewing the care plan for an 18-year-old female client with severe psoriasis. Which of the following are possible nursing diagnoses for this client?

Disturbed body image
Impaired comfort
Impaired skin integrity
Powerlessness

Explanation

• Psoriasis is a chronic autoimmune skin disease with exacerbations and remissions. Normally high cell runover causes thickened and sore patches of itchy, red skin with silvery or white scales or flakes. These areas often appear on the elbows, knees, the scalp, the back, palms, and feet, and even on the face. Some clients with psoriasis also develop a form of arthritis called psoriatic arthritis, which causes joint pain.

• Treatments for psoriasis include topical applications corticosteroids such as hydrocortisone and betamethasone, oral retinoids such as acitretin (Soriatane), and UV light therapy. Immunosuppressive drugs such as cyclosporine and methotrexate and injectable biologic medications (tumor necrosis factor-alpha blockers) are used to treat severe psoriasis, but carry serious side effects and risk of infection.

Nursing diagnoses for the client with psoriasis may include: 

• Disturbed body image r/t lesions on the body 

• Impaired comfort r/t irritated skin

• Powerlessness r/t lack of control over condition with frequent exacerbations and remissions

• Impaired skin integrity r/t lesions on the body

• Ineffective health maintenance r/t deficient knowledge regarding treatment modalities.

• Acute pain is related to biologic, chemical, or physical injury, but must be evidenced by observed or reported pain with an anticipated or predictable end. The discomfort of psoriasis is chronic, not acute.

• Complicated grieving occurs after the death of a significant other and is r/t the death, the emotional disturbance, or insufficient support. Though this client may be in distress, it is not complicated grieving. 



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