NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
HEALTH ASSESSMENT MIDTERM
 1-5 questions
Building A Complete Health History (Week 1) Chapters 1 & 26

• Communication techniques used to obtain a patient’s health history Chapter 1

– Open ended questions: gives the patient discretion about the extent of the answer

– Direct question: seeks specific information

– Leading question: most risky, may limit information

– Courtesy, comfort, connection, confirmation

– CAGE questionnaire screening: designed to help diagnose alcoholism

– CRAFT screening: ETOH and substance abuse in adolescents (Car, Relax, Forgot, Friends, Trouble)

– TACE screening: drinks does it take to feel high, people Annoyed you about your drinking, Cut back drinking, Eye opener drink in the AM
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– Partner violence screen (PVS): hit kicked or punched, feel unsafe…

– Domestic Violence (HITS): Hurt you physical, Insult you, Threaten you, Scream at you?

– Spirituality (FICA): Faith, Importance, Community, Address

– Types of histories: Complete, inventory (touches up on major points), Problem (focused, acute life-threatening problem), Interim (designed to chronicle events that have occurred since last meeting)

• Recording and documenting patient information Chapter 26

– Write out abbreviations Copy and paste or carry forward (CPCF)

– International Classification of Disease (ICD): diagnostic coding system that classifies diseases and injuries and u used to track mortality and morbidity NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide

– Geriatric screening tool: Katz Index consists of six items (bathing, dressing, toileting, transferring, continence and feeding

– Geriatric screening tool: Lawton Instrumental ADL-scale consists of eight items in women (ability to use the telephone, shopping, cooking, housekeeping, doing laundry, taking own medication, making transports, and ability to handle finances)

§ Functional impairment was defined as dependency on at least one domain of ADL (score <6) or IADL (a score <8 from women or <5 for men). Functional decline was defined as deterioration on at least one domain of ADL or IADL compared to baseline (decline ≥1 point). NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide. – Sullivan Book: § CPTP is a listening of descriptive terms and identifying code for reporting medical services and procedures   SOAP note documentation – S: subjective (what patient tells you) – O: objective (observations) – A: assessment (interpretation and conclusions) – P: plan (diagnostic testing, rationale for decisions) • Subjective vs objective information when documenting – S: pain (use pain score) – O: relate findings to the process of inspection, palpation, auscultation, percussion. “no masses on palpation” “tympanic membranes are pearly gray” – O: Use anatomic landmarks to add precision – O: Findings that vary by degrees are customarily graded or recorded in an incremental scale format (pulse amplitude, heart murmur intensity, muscle strength, DTR NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide. – Illustrations useful in describing the origin of pain and where it radiates and the size, shape and location of a lesion – HX of present illness: OLDCARTS: onset, location, duration, character, aggravating factors, relieving factors, temporal factors, severity of symptoms Ethical decision making and beneficence – Beneficence: doing good   Diversity and Health Assessment – Bullets 6, 7, 8   Cultural Awareness and Diversity Achieving cultural competence is a learning process that requires self-awareness, reflective practice, and knowledge of core cultural issues A culturally competent health care provider adapts to the unique needs of patients of backgrounds and cultures that differ from his or her own Culture, in its broadest sense, reflects the whole of human behavior, including ideas and attitudes; ways of relating to one another; manners of speaking; and the material products of physical effort, ingenuity, and imagination. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide The stereotype, a fixed image of any group that denies the potential of originality or individuality within the group Multiple studies have shown that health care providers activate these implicit stereotypes, or non-conscious bias, when communicating with and providing care to minority patients Members of racial and ethnic groups are not uniform. Each group is highly heterogeneous and includes a diverse mix of immigrants, refugees, and multigenerational Americans who have vastly different histories, languages, spiritual practices, demographic patterns, and cultures Culturally competent care requires that health care providers be sensitive to patients’ heritage, sexual orientation, socioeconomic situation, ethnicity, and cultural background When cultural differences exist, be certain that you grasp exactly what the patient means and know exactly what the patient thinks you mean in words and actions The definition of “ill” or “sick” is based on the individual’s belief system and is determined in large part by his or her enculturation.     Socioeconomic, spiritual, and lifestyle factors affecting diverse populations Age, gender, race, ethnic group and, with these variables, cultural attitudes, regional differences, and socioeconomic status influence the way patients seek medical care and the way clinicians provide care A patient who knows the English language, however well, cannot be assumed to know the culture. Poverty and inadequate education disproportionately affect various cultural groups (e.g., ethnic minorities and women); socioeconomic disparities negatively affect the health and medical care of individuals belonging to these groups Age, gender, race, ethnic group and, with these variables, cultural attitudes, regional differences, and socioeconomic status influence the way patients seek medical care and the way clinicians provide care. Black and Latino children in the United States also experience health disparities, including lower overall health status and lower receipt of routine medical care and dental care compared to white children NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide   Functional Assessments Functional Assessment for All Patients Quite simply, functional assessment is an attempt to understand a patient’s ability to achieve the basic activities of daily living.  This assessment should be made for all older adults and for any person limited by disease or disability, acute or chronic. A well-taken history and a meticulous physical examination can bring out subtle influences, such as tobacco and alcohol use, sedentary habits, poor food selection, overuse of medications (prescribed and nonprescribed), and less than obvious emotional distress. Even some physical limitations may not be readily apparent (e.g., limitations of cognitive ability or of the senses). NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide. Keep in mind that patients tend to overstate their abilities and, quite often, to obscure reality. When performing a functional assessment consider a variety of disabilities: physical, cognitive, psychologic, social, and sexual. An individual’s social and spiritual support system must be as clearly understood as the physical disabilities. There are a variety of physical disabilities, including: Mobility Difficulty walking standard distances: ½ mile, 2 to 3 blocks, 1/3 block, across a room Difficulty climbing stairs, up and down Problems with balance Upper extremity function Difficulty grasping small objects, opening jars Difficulty reaching out or up overhead, such as taking something off a shelf Housework Heavy (vacuuming, scrubbing floors) Light (dusting) Meal preparation Shopping Medication use Money management Instrumental activities of daily living Bathing Dressing Toileting Moving from bed to chair, chair to standing Eating Walking in home Any limitations, even mild, in any of these areas will affect a patient’s independence and autonomy and, to the extent of the limitation, increase reliance on other people and on assistive devices. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide. These limitations indicate the loss of physical reserve and the potential loss of physical function and independence that indicate the onset of frailty. The patient’s social support system and material resources are then integral to the development of reasonable management plans.   #9 Growth and Development Ch 6 of text book   Growth Hormone-Releasing Hormone stimulates the pituitary to release the growth hormone. 70% of secretion of the growth hormone occurs during sleep Critical brain growth between conception and 3 yrs old. Puberty- Dependent on the GH and androgens (Sex Steroids). They stimulate and increase in the growth Hormone. Lymphatic tissues reach adult size by 6 yrs old and double by 10-12 yrs old.   Pregnancy Weight        Child- 6-8lbs of wt       blood-3-4lbs      Maternal Fat/protein 4-6lbs Uterus 2lbs                    breast 1-2 lbs Fluid 2-3lb                       Amniotic fluid 2lbs   Older Adults Physical Stature decrease at 50 yrs 60 yrs – decrease HT, WT, BMI Increase Body Fat   Children and Adolescence Sexual Maturation Girls Early < 7 yrs  Delayed > 13 yrs
Sexual Maturation Boys
Early <9  Delayed > 14
 
BMI
Malnourished < 18 Normal 18.5-24.9 Overweight 25-29.9 Obese 30-39.9 Extreme >40
Measuring babies
Weight- Infants should be weight in Gm or KG to the nearest 10 gm
Normal newborn wt 2500-4000 gm * 5lbs 8oz – 8lbs 13 oz)
Lose 10 % of wt at birth and regain in 2 wks.
Birth weight doubles at 6 months and triples by 12 months
Head Circumference
Wrap measuring tape at occipital protuberance and supraorbital prominence.
Measure to the nearest 0.4cm
Place on the growth curve and compare with the standard.
Chest Circumference
Compare to head size
Wrap at nipple line
5 months – the head is  = or exceeds the chest size
5 months – 2yrs head = chest

2 yrs chest is > head.

 
#10, #11, #12 #13
Nutritional assessment, Macronutrients, Food Diary, BMI
Macronutrients

• *Macronutrient is required in significant amounts of the diet. Macronutrient includes proteins, carbohydrates, and lipids.

*Macronutrients are so named because they are required in LARGE AMOUNTS.

Micronutrients

The nutrient which is required in smaller amounts in the body is called micronutrients. Two categories of micronutrients are vitamins and minerals.

• Which of the following assessment findings might lead the examiner to suspect vitamin D deficiency?

Ans. Rickets, a disease manifested by spinal curvature and bowed legs NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Nutrition

• *The nutrients that are deficient in vegetarian diet are protein, Calcium, Iron, Vitamin B12, and vitamin D.

*Carbohydrates and proteins supply 4 calories per gram while fats supply 9 calories. Alcohol provides 7 calories per gram.

Carbohydrate

The body handles excess carbohydrate by storing as fat.
Protein

*Mrs. Webb is a 38-year-old patient who has been changing her lifestyle to eat in a healthy way and lose weight. During your health promotion education regarding her nutritional status, you explain the function of dietary protein as:

a. providing an energy source for the brain.

b. building and maintaining tissues.

c. participating in specific detoxifying metabolic pathways.

d. synthesizing and regulating hormones.

The correct Ans is b
*Which of the following are major functions of dietary protein?

Building and maintain tissues;

Regulating water and acid-base balance;

Working as a precursor for enzymes, antibodies, and several hormones
*The recommended minimum daily protein requirement for the normal adult is? Ans. 14%-20% of total calorie or 45 grams for adults.

Fat

*The recommended dietary fat intake for the normal adult is? About 20 to 35 grams per day.
*Advising a person to reduce which macronutrient will produce the greatest caloric reduction per gram of reduction?

o Ans. Fat
Which age group requires the highest percentage of dietary fat intake?

Ans. Before 2 years of age, fat intake may reach 35% 40% of calories.

Water

*Which one of the following would be assessed first in the patient with sustained respiration?

Ans. Hydration/ water

Rationale: A person can exist without food or vitamins for several weeks but without water for only a few days.
2-2.5 L water loss occurs daily by the body in a healthy person under normal circumstances.

Food Diary

• *The food diary is recorded as it happens, making this method the most accurate reflection of an individual’s food intake NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
#13 BMI

BMI is calculated by the weight in pounds multiplied by 703 divided by the height in inches squared.

*Monitoring a patient’s waist to hip ratio provides data concerning patient’s disease risk in cardiovascular term.
*When obesity occurs mostly in lifetime?

Obesity occurs during adolescents 70% of the time. Obesity occurs before skeletal growth or sexual maturation is complete.
*A scale is used to assess patient’s weight need to be calibrated every time before using.
*When monitoring serial measures, such as head circumference or abdominal girth, which procedure is best to ensure that the tape measure is placed in the same position each time?

Ans. Mark the borders of the tape at several intervals on the skin with a pen.
*You are using rule of thumb for advising a 150-pound person decrease calorie intake for weight loss. How many calorie intakes is appropriate per day?

ANS. 150 pounds/2.2 = 68 kg

68×25= 1700 calories.

Rule of thumb for weight loss equals 25 multiply each kg body weight.
*What medication may cause weight gain?

Steroids, oral contraceptives, antidepressants, and insulin
In a pregnant woman, 5-10 pounds of the total gained weight is considered fetus weight in a normal pregnancy. The remainder results from placenta, blood and fluid volume, amniotic fluid, uterus, breasts, and fat. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that contains mostly:

a.fruit and vegetables.

b.lean meat and fish.

c.sandwiches and diet drinks.

d.pasta and chicken.

Correct ANS: B

Carbohydrates are the only source of fuel for the brain and central nervous system. A diet low in carbohydrates, such as a diet mostly of meat and fish, could affect brain function. Fruits and vegetables, sandwiches and diet drinks, and pasta and chicken have moderate levels of needed carbohydrates.

When using “rule of thumb” estimates of energy needs of healthy adults, how many kcal/kg are required to maintain the individual’s current weight?

30 kcal/kg is required for weight maintenance. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.

#14 Pernicious anemia:
-B12 deficiency is usually the result of impaired B12 uptake caused by a lack of intrinsic factor that is caused by a loss of parietal cells in the stomach lining. The loss of these cells can be caused by partial or full gastrectomy, Crohn’s disease, autoimmune disorders such as DM1 and immunocompromised diseases such as HIV
-A smooth red tongue with a slick appearance may indicate NIACIN or Vit. B12 deficiency.

Pernicious Anemia can result in Vitamin B12 deficiency!!! (image attached in group)
 
Examination techniques and equipment #15
 
Student Laboratory Manual
Seidel’s Guide to physical Examination 8th edition Page 10, 11 and 168.
 
Tape measure – use to examine multiple raised lesions.
Transilluminate – An appropriate examination technique to assess vesicle in the skin. It also a source of light with a narrow beam.
Otoscope – use to visualize the lower and middle turbines of the nose.
Inspection – is applied throughout the entire examination and interview process.
Auscultation– is carried out  last except when examining kidney or abdomen . it is also used to listen for sounds produced by the body
Fist – use for indirect finger percussion involves striking  the middle finger of the nondominant hand
Deep abdominal palpation of the  kidney is used to assess tenderness over the kidney.
Ulnar surface of the hand is used to palpate Mass in the  skin
Diaphragm – pressed lightly against skin to detect high frequency.
Scoliometer- measures the degree of rotation of the spine to screen for scoliosis. Pg. 49  8th edition.
Pneumatic attachment of an otoscope – use to evaluate the cone of light reflex in adult and kids.
Red – free light -seen through the ophthalmoscope to estimate the size and location of lesion. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
 
Dorsal surface of the hand – sensitive to vibration
Amsler grid– use to screen patient at risk for macular degeration
Pederson speculum– use for women with small vaginal opening
Near-vision (Rosenbaum) or Jaeger chart–  Use for screening near vision
Dermatoscope– is a skin surface microscope used to inspect the surface of pigmented skin lesions
Bell of stethoscope– detects low frequency sound.
Wood lamp-black light used to detect fungal infection.
Pan-optic ophthalmoscope– larger field of view in eye examination.
Palpation- gathering information through touch.
Monofilament– help identify a patient with decreased sensation and increased risk for injury
 
Percussion Tone Expected
 
Stomach- Tympanic
Sternum-flat
Liver-Dull
Lung with patient with Pneumonia-Dull
Abdomen with lung tumor-Dull
 

Diagnostic Assessment tools and tests to include tuning forks, BP monitoring, use of stethoscope, otoscope, ophthalmoscope
Tuning Fork

i. Weber Testà Place base of tuning fork on top of the head and see if the patient hears it equally in both ears. If not, this is considered conductive hearing loss and they will hear the sound in the impaired ear.

ii. Rinne Test à Base of the tuning fork is placed on the mastoid bone, count how long they hear it. Then move it in front of the ear and count how long they hear that. Normally the sound is heard longer through air than through bone. In conductive hearing loss, sound is heard through bone as long as or longer than it is through air (BC>AC). In sensorineural hearing loss, sound is heard longer through air (AC>BC). NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.

b. Ophthalmoscope

i. Examine patient right eye with your right eye

ii. Visualize the RED reflex (caused by light illuminating the retina, opacities will stand out)

c. Otoscope

i. External auditory canal and tympanic membrane (should be translucent, pearly gray color) (middle ear)

1. Adult: pull ear up and back

2. Child: pull ear down and back

 
 
#17 Covers skin, pharmacology,GI, Nervous system, and MUCH MORE
information located in the files of this group. A large table.

Skin lesion characteristics
Maculeà flat discoloration, usual <1 cm in diameter (freckle/ measles) b. Patchà flat area of skin discoloration, larger than a macule (vitiligo) c. Papuleà raised lesion, <1 cm same or different color than surrounding skin (raised nevus) d. Vesicleà fluid filled, <1 cm (varicella/ chicken pox) e. Plaqueà raised lesion, >1 cm may be same or different color from surrounding skin (Psoriasis)

f. Purpuraà lesions caused by RBCs leaving circulation and becoming trapped in skin (Petechiae, ecchymosis)

g. Pustuleà vesicle like lesion with purulent content (impetigo, acne)

h. Whealàcircumscribed area of skin edema (Hive)

i. Noduleà raised lesion, >1 cm usually mobile (epidermal cyst)

j. Bullaà fluid-filled, >1 cm (blister with 2nd degree burn)

k. Excoriationà marks from scratches (pruritic skin disease)

l. Lichenificationà skin thickening resembling callus formation (chronic dermatitis)

m. Fissureà narrow linear crack into epidermis (split lip, athletes’ foot)

n. Erosionà partial focal loss of epidermis, heals without scarring (areas exposed after bullous lesion opens)

o. Ulcerà loss of epidermis and dermis, heals with scarring (pressure sore)

p. Scaleà raised, flaking lesion (dandruff, psoriasis)

q. Atrophyà loss of skin markings and full skin thickness (area tx excessively with higher potency corticosteroids) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.

 
#18- ABCD assessment of skin lesions:
A -asymmetry of lesion.

B- border (regular or irregular)

C- Color (is it uniform or varying colors)

D- Diameter (anything larger than 6mm)
Images posted in group
 
#19 Anatomy and physiology of skin layers

Epidermis

i. Outermost portion (stratum corneum & cellular stratum)

ii. Avascular

iii. Stratum Corneum: packed dead squamous cells, contain keratin, keratin cells formed in stratum germinativum (where melanocytes synthesize melanin)

iv. Cellular stratum: in thicker layers of palms and soles

b. Dermis

i. Very vascular connective tissue layer (supports and separates epidermis from adipose)

ii. Elastin, collagen and reticulum fibers, sensory nerve fibers NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide

c. Hypodermis

i. Loose connective tissue filled with fatty cells (generates heat/insulation/ shock absorption)

ii. Connected to underlying organs

d. Appendages

i. Eccrine sweat glandsà regulate body temp through water secretion

ii. Apocrine sweat glandsà found in axilla, nipple, areolae, genital, eyes and external ears

iii. Sebaceous glandsà lipid rich substance, stimulated by sex hormones (testosterone)

 
The skin is the largest organ of the body, with a total area of about 20 square feet. The skin protects us from microbes and the elements, helps regulate body temperature, and permits the sensations of touch, heat, and cold.

Skin has three layers:

Epidermis

Your skin’s top layer, the epidermis, is super thin on some parts of your body (your eyelids) and thicker on others (the bottoms of your feet). The epidermis is the layer of skin in charge of:

• Making new skin cells: This happens at the bottom of the epidermis. The skin cells travel up to the top layer and flake off, about a month after they form.

• Giving skin its color: The epidermis makes melanin, which is what gives your skin its color (find out more about this in What gives skin its color?).

• Protecting your body: The epidermis has special cells that are part of your immune system and help you stay healthy.

Dermis

A lot happens in the next layer, the dermis. The jobs of the dermis include:

• Making sweat: There are little pockets called sweat glands in the dermis. They make sweat, which goes through little tubes and comes out of holes called pores. Sweating keeps you cool and helps you get rid of bad stuff your body doesn’t need.

• Helping you feel things: Nerve endings in the dermis help you feel things. They send signals to your brain, so you know how something feels if it hurts (meaning you should stop touching it), is itchy or feels nice when you touch it.

• Growing hair: The dermis is where you’ll find the root of each tiny little hair on your skin. Each root attaches to a tiny little muscle that tightens and gives you goose bumps when you are cold or are scared.

• Making oil: Another type of little pocket, or gland, in your skin makes oil. The oil keeps your skin soft, smooth and waterproof. Sometimes the glands make too much oil and give you pimples. (See Acne: Pimples and Zits.

• Bringing blood to your skin: Blood feeds your skin and takes away bad stuff through little tubes called blood vessels.

Subcutaneous fat

The bottom layer of skin is the subcutaneous fat layer. This layer plays an important role in your body by:

• Attaching the dermis to your muscles and bones: This layer has a special connecting tissue that attaches the dermis to your muscles and bones.

• Helping the blood vessels and nerve cells: Blood vessels and nerve cells that start in the dermis get bigger and go to the rest of your body from here.

• Controlling your body temperature: The subcutaneous fat is the layer that helps keep your body from getting too warm or too cold.

• Storing your fat: This fat pads your muscles and bones and protects them from bumps and falls.
#20 Abnormal nail findings in older adults
Nail changes associated with aging are common in the elderly and include characteristic modifications of color, contour, growth, surface, thickness, and histology. The calcium content of the aging nail increases and iron decreases.

keratinocytes of the nail plate are increased in size with an increased number of ‘pertinax bodies’ (remnants of keratinocyte nuclei)

• nail bed dermis also shows thickening of the blood vessels and elastic tissue, especially beneath the pink part of the nail.

• Nail growth decreases by approximately 0.5% per year between 20 and 100 years of age.

• Prominent longitudinal ridges were the most common change

• Brittleness of the nail is a common condition related to aging.

• Onychauxis which is an age-associated thickening of the nail plate

• changes in nail contour, increased transverse curvature

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2965930/

White banding (Terry Nails) is a nail disorder that is specifically linked to age – p. 158.

Pathophysiology: associated with cirrhosis, CHF, adult-onset diabetes mellitus, and age.

Appearance: transverse white bands cover the nail except for narrow zone at the distal tip
Onychomycosis is a fungal infection that causes the nail plate to crumble – p. 156.

Pathophysiology: this is not specifically related to older adults but is associated with loss of manual dexterity (interfere with exercise or walking).

Appearance: distal nail plate turns yellow or white as hyperkeratotic debris accumulates, causing the nail to separate from the nail bed
 
#21 PSORIATIC SKIN LESIONS
Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.

Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly.

There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help
here are several types of psoriasis. These include:

• Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques might be itchy or painful and there may be few or many. They can occur anywhere on your body, including your genitals and the soft tissue inside your mouth.

• Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.

• Guttate psoriasis. This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.

The lesions are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.

• Inverse psoriasis. This mainly affects the skin in the armpits, in the groin, under the breasts and around the genitals. Inverse psoriasis causes smooth patches of red, inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.

• Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips.

It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.

• Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely.

• Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes swollen, painful joints that are typical of arthritis. Sometimes the joint symptoms are the first or only manifestation of psoriasis or at times only nail changes are seen. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. Although the disease usually isn’t as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.

Causes

The cause of psoriasis isn’t fully understood, but it’s thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body.

T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.

But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.

Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.

The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly — in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.

Just what causes T cells to malfunction in people with psoriasis isn’t entirely clear. Researchers believe both genetics and environmental factors play a role.

Psoriasis triggers

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:

• Infections, such as strep throat or skin infections

• Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn

• Stress

• Smoking

• Heavy alcohol consumption

• Vitamin D deficiency

• Certain medications — including lithium, which is prescribed for bipolar disorder, high blood pressure medications such as beta blockers, antimalarial drugs, and iodides

Risk factors

Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:

• Family history. This is one of the most significant risk factors. Having one parent with psoriasis increases your risk of getting the disease, and having two parents with psoriasis increases your risk even more.

• Viral and bacterial infections. People with HIV are more likely to develop psoriasis than people with healthy immune systems are. Children and young adults with recurring infections, particularly strep throat, also may be at increased risk.

• Stress. Because stress can impact your immune system, high stress levels may increase your risk of psoriasis.

• Obesity. Excess weight increases the risk of psoriasis. Lesions (plaques) associated with all types of psoriasis often develop in skin creases and folds.

• Smoking. Smoking tobacco not only increases your risk of psoriasis but also may increase the severity of the disease. Smoking may also play a role in the initial development of the disease.
Complications

If you have psoriasis, you’re at greater risk of developing certain diseases. These include:

• Psoriatic arthritis. This complication of psoriasis can cause joint damage and a loss of function in some joints, which can be debilitating.

• Eye conditions. Certain eye disorders — such as conjunctivitis, blepharitis and uveitis — are more common in people with psoriasis.

• Obesity. People with psoriasis, especially those with more severe disease, are more likely to be obese. It’s not clear how these diseases are linked, however. The inflammation linked to obesity may play a role in the de

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