Reply to classmates post

Reply to classmates post , at least 125 words each and 1 scholarly reference within last 5 years for each

Post 1

Psoriasis is a chronic inflammatory skin disease thats normally passed down through genetics and autoimmune pathogenic traits. About 2% of the world population has psoriasis and shows more favor to Caucasians and Scandinavians at 11%. There are different types of psoriasis. There is Psoriasis vulgaris that presents with erythematous scaly plaques, generalized pustular psoriasis, localized pustular psoriasis and inverse psoriasis which affects the folds of the skin (axillary, intergluteal, groin). About 90% of psoriasis cases corresponds to chronic plaque type. The clinical manifestation are sharply demarcated, erythematous, pruritic plaques covered in silver scales. Inverse psoriasis also called flexural psoriasis, affects intertriginous location and characterized by slightly erosive erythematous plaques and patches. Pustular psoriasis is multiple coalescing sterile pustules. It can be localized or generalized (Rendon & Schakel, 2019).
Sustained inflammation that leads to uncontrolled keratinocyte proliferation and dysfunctional differentiation. Excessive activation of parts of the adaptive immune system is thought to be central to the causes of psoriasis. A variety of cell types that includes plasmacytoid dendric cells, keratinocyte, natural killer t cells and macrophages secrete cytokines that active myeloid dendric cells. The cytokines lead to downstream keratinocyte proliferation, increased expression of angiogenic mediators and endothelial adhesion molecules and infiltration of immune cells into skin lesions (Armstrong & Read, 2020).
Although theres no known way to prevent psoriasis there are steps to help reduce flare ups. It is important to education patient on stress. Stress can make psoriasis worse and vice versa. Patients need to learn techniques to relax such as deep breathing, massage and medication. There was a study that showed meditation tapes can help lower stress and ones who receive light therapy. Also a gentle bath or shower daily can help with soothe psoriasis. It is also important to not touch and pick on your flare ups because it may cause infection. Continue treatment from your physician is important.

Post 2
Intravenous Immunoglobulin (IVIG) is a medication that can be used to treat and control symptoms of multifocal motor neuropathy (MMN).  IVIG contains immunoglobulins prepared by human plasma pooled from many donors (Whalen, 2018, p. 1382). The mechanism of action for IVIG is not well defined and there are multiple ways that IVIG is thought to treat multifocal motor neuropathy (MMN). In my first discussion post for this week I talked about how MMN is immune-mediated and is thought to occur due to anti-GM1 antibodies being present. These antibodies cause a disruption in ion channels resulting in conduction block. The conduction block causes the symptoms of MMN that patients will slowly develop over time including asymmetrical weakness. 
There are three different possible mechanisms of action for IVIG for treatment of MMN: First, IVIG may exert anti-idiotypic effects that reduce levels of circulating anti-GM1 IgM antibodies and interfere with B-cell receptors on GM1-specific clones. Second, IVIG may induce inhibitory receptors on B cells as has been shown in patients with chronic inflammatory demyelinating polyneuropathy. Finally, IVIG may interfere with anti-GM1 IgM-mediated complement deposition in nerves (van der Pol, Cats, & van den Berg, 2010, p. S81).
Hints for monitoring: According to Arumugham & Rayi (2020), IgG levels in blood serve as an essential yardstick to guide IVIG therapy (p. 14). Another effective guide to the effectiveness of IVIG therapy is the clinical response. The clinical response of IVIG determines the dosing and frequency of the medication since most patients will continue IVIG therapy indefinitely. Patients with blood type A, B, or AB should be monitored carefully for hemolytic transfusion reaction during high-dose therapy as they may contain anti-A or anti-B blood group antibodies (Arumugham & Rayi, 2020. p. 15). As an infusion nurse, this is why I sit there and check vitals every 15 minutes for the first hour, then every half hour for the next hour and then every hour until completion.
Side effects: headache, fever, chills, myalgias and hypotension/hypertension which can be resolved by slowing the rate of infusion (Whalen, 2018). More serious side effects which are rare include aseptic meningitis, acute renal failure and thrombotic events (Whalen, 2018).
Drug interactions: inhibitors of the renin-angiotensin system (RAS) such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and direct renin inhibitors should be avoided while receiving IVIG therapy (Arumugham & Rayi, 2020). In addition, Measles, mumps, and rubella (MMR) vaccine should not be administered in children who are receiving IVIG therapy, as the IgG could counter the attenuated virus in the vaccine preparation and render them inactive. Thus vaccines should be delayed for at least nine months after the IVIG therapy or vice versa (Arumugham & Rayi, 2020, p. 13).

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