Nursing: Immune Disorders in Paediatrics and Geriatrics

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Nursing: Immune disorders in paediatrics and geriatrics
Psoriasis
Psoriasis is a skin disorder that consists of a focal formation of an inflamed raised plague, which sheds scales that come from excessive epithelial cell skin growth (Mahajan & Handa, 2013). This disease is defined by skin cellular changes on the hyperplasia of keratinocytes of the epidermal, infiltration of T lymphocytes, leucocytes and neutrophils that affect the skin and vascular hyperplasia (Mayo Clinic, 2015)
Pathophysiology of psoriasis
Psoriasis pathogenesis is not understood clearly. The triggers of the diseases include traumatic insult, stressful life events, and infectious episodes. Environmental and generic factors also cause the disease. Once triggered, there will be a substantial leukocyte to the dermis and epidermis that is infiltrated by activated T cells (Mahajan & Handa, 2013). These T cells seem to be able to induce keratinocyte proliferation. What supports this is histologic examinations and immune histochemically staining of the psoriatic plagues, which show high numbers of T cells containing psoriasis lesions. A deregulated inflammatory process has high production of cytokines which explains many clinical features of psoriasis. High levels of TNF-a correlate with flares of psoriasis. The hyperactivity of T- cells and resultant proinflammatory mediators like IL-17/23 are boosters in the pathogenesis of psoriasis. The skin of patients with psoriasis have vascular engorgement that is caused by superficial dilation of blood vessels and alteration of the epidermal cells. Improper cell maturation is caused by epidermal hyperplasia that causes increased turnover rates for cells (Mahajan & Handa, 2013).
Parakeratosis occurs when cells that would lose their nuclei in the stratum granulosum retain the nuclei. This, plus the affected cells that fail to release the required numbers of lipids that would cement adhesions of corneocytes, would result to the formation of a poorly adherent stratum corneum that causes flaking, and scaly representations of psoriasis lesions. Patients with psoriasis would have conjunctival impression cytology that is shown by high amount of squamous metaplasia, nuclear chromatin changes and neutrophil clumping (Meffert, 2016).
Pathophysiological changes in Pediatric and geriatrics patients
Pediatric patients have excess adiposity and increased central adiposity despite of the psoriasis severity. Psoriasis in Pediatric patients is more pruritic and common in girls. The lesions are thinner, softer and less scaly (Dhar et al, 2011). The common type disease is plague while erythroderma, arthroplasty and pustular psoriasis are rare. Psoriasis in Pediatric patients in facilitated by infections and it manifests to acute guttate psoriasis (Ryan et al, 2014).
Geriatrics patients have a high prevalence to comorbid medical conditions and age related pharmacokinetics and pharmacodynamics of system medications (Ryan et al, 2014). These patients are aged and their skin has changed, and it has limited capability of protecting itself. The collagen is reduced by one percent per year, making the skin thin. Loss of collagen results in wrinklin...