W#15 Pathophysiology replies

Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). 

INSTRUCTIONS:

In your reply posts, use scholarly information to help compare information with your classmates!

Note: DO NOT CRITIQUE THEIR POSTS, DO NOT AGREE OR DISAGREE, just add informative content regarding to their topic that is validated via citations. 

– Utilize at least two scholarly references per peer post. 

Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the second one is the reply to my other peer Post #2.

– Minimum of 250 words per peer reply.

– TURNITIN Assignment.

Background: I live in South Florida, I am currently enrolled in the Psych Mental Health Practitioner Program, I am a Registered Nurse, I work in a Psychiatric Hospital.

POST # 1 DANIKA

The purpose of this initial post is to discuss the pathophysiology, common presenting symptoms, diagnosis, and treatment of cellulitis. Cellulitis is an acute infection of the dermis and subcutaneous layers of the skin frequently occurring in the lower extremities (VanMeter & Hubert, 2018). The condition can also be called erysipelas, but this term usually refers to superficial cellulitis of the face or extremities with lymphatic involvement (Sullivan & de Barra, 2018). Cellulitis occurs when bacteria break the skin barrier and enter the soft tissue (Spelman & Baddour, 2020). Gram positive cocci like Streptococcus spp and Staphylococcus aureus are the most common causes of cellulitis (Sullivan & de Barra, 2018). Predisposing factors include a skin barrier break (ulcer, wound, abrasion, insect bite, IV drug injection site), edema, obesity, and immunosuppression (Spelman & Baddour, 2020). Venous stasis, increased blood sugar, poor nutrition, and immunosuppression decrease wound healing. Common presenting symptoms include redness, swelling, pain, and heat at the affected area as the body’s immune response is activated (Sullivan & de Barra, 2018). Cellulitis may present with purulent drainage while erysipelas is nonpurulent. Both cellulitis and erysipelas are almost always unilateral. Systemic effects like fever, chills, and headache may be present (Spelman & Baddour, 2020). 

Diagnosis is based upon the previously mentioned clinical manifestations. If there is purulent drainage, a culture swab should be obtained to identify the bacteria (Spelman & Baddour, 2020). Antibiotic treatment is usually directed at Streptococcus spp and Staphylococcus aureus. A S. aureus infection is more likely to have pus (Sullivan & de Barra, 2018). Patients will be treated with empiric antibiotic therapy, most commonly oral cephalexin or IV cefazolin (Spelman & Baddour, 2019). Patients with systemic effects should receive IV antibiotic treatment (Spelman & Baddour, 2019). Spelman & Baddour (2019) note that worsening erythema might occur after antibiotic initiation and this is not to be confused with treatment failure. Increased local inflammation is due to the enzymes released by pathogens during destruction (Spelman & Baddour, 2019). It is important to optimize treatment by elevating the affected area and managing edema, blood sugar, and vascular disease (Sullivan & de Barra, 2018). 

Clinical Infectious Diseases has provided “Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America” and includes both screening and treatment guidelines (Stevens et al., 2014).

https://academic.oup.com/cid/article/59/2/e10/2895845

 References

Spelman, D., & Baddour, L. (2019). Cellulitis and skin abscess in adults: Treatment. Retrieved August 10, 2020, from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/cellulitis-and-skin-abscess-in-adults-treatment?search=cellulitis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Spelman, D., & Baddour, L. (2020). Cellulitis and skin abscess: Epidemiology, microbiology, clinical manifestations, and diagnosis. Retrieved August 10, 2020, from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/cellulitis-and-skin-abscess-epidemiology-microbiology-clinical-manifestations-and-diagnosis?search=cellulitis

Stevens, D. L., Bisno, A. L., Chambers, H. F., Dellinger, E. P., Goldstein, E. J., Gorbach, S. L., . . . Wade, J. C. (2014). Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 59(2), E10-E52. doi:10.1093/cid/ciu296

Sullivan, T., & de Barra, E. (2018). Diagnosis and management of cellulitis. Clinical medicine (London, England), 18(2), 160–163. https://doi.org/10.7861/clinmedicine.18-2-160

Running head: PLANTAR WARTS 1

PLANTAR WARTS 2

POST # 2 ALCINA

The purpose of this paper is to present information on plantar warts and will include pathophysiology, signs and symptoms, diagnostics, treatment plan as well as current treatment guidelines, etiology and prevention.

Hubert and VanMeter report that plantar warts or verrucae spread from shedding of the skin that has been infected with the human papilloma virus or HPV (2018).

Hellwig and Zeltser indicate that plantar warts grow on the soles of the feet and appear to be flat and fleshy papules that can grow on the heels are hard to the touch and painful when walking puts pressure on them (2020).

Diagnostics of plantar warts include a medical exam of the feet and providers may slice a small part of the wart with a scalpel and send to the lab for analysis (Mayo Clinic, 2020).

Current treatment for plantar warts according to Hubert et al. include laser removal, liquid nitrogen to freeze the wart or ASA (acetylsalicylic acid) compounds that can be applied topically (2018).

Dr. Kormos indicates that plantar warts are caused by the human papilloma virus that enters the body via small cuts on the foot or heels (2017).

Witchey and colleagues indicate that individuals are exposed to HPV in the environment but not everyone becomes infected because the immune system prevents the spread of the virus with humeral immune responses (2018). Keratinocytes are skin cells that can be infected by the HPV virus; once the virus enters the cells, it establishes itself and starts to replicate (Witchey et al., 2018). The skin of the feet shed and along with it so does the virus which can land on other parts of the sole of the foot, shoes, towels or on surfaces that are warm and moist waiting to infect others (Witchey et al., 2018). Infection by the virus happens by direct contact with surfaces and persons that have virus and micro traumas on the feet allow for the virus to enter the body via the basal epithelial layer where stem cells are located and actively dividing (Witchey et al., 2018). The virus incubates on the host epithelial cells for up to 20 months utilizing the keratinocytes to replicate its DNA and producing only HPV E1 and HPV E2 proteins which prevents the immune system from detecting the virus on the basal stem cells allowing HPV to continue to replicate by increasing the local numbers of keratinocytes which overproduce keratin and develop into a wart (Witchey et al., 2018). As the wart keeps growing it tunnels up the skin and becomes hard causing pain when walking and in some rare occasions skin cancer may develop (Witchey et al., 2018).

Plantar warts are mostly benign and many times resolve on their own, however, some people require medical treatment by cryotherapy (liquid nitrogen to freeze the wart) (Kormos, 2017).

To prevent plantar warts, one must keep the feet free of cuts and avoid contact with the virus by wearing shoes when walking in public places and plastic sandals in public restrooms (Hellwig et al., 2020). The quadri-valent vaccine for HPV has produced good results in reducing the number and size of plantar warts in people with co-morbidities in hopes to prevent skin cancer (Hayashi et al., 2020).

Another recommendation is for medical providers to teach their patients to assess their feet and their children feet for warts especially for athletes who are at higher risk for contracting HPV as they share public bathing areas (Kormos, 2017).

References

Hayashi, A., Matsumoto, K., & Mitsuishi, T. (2020). Three cases of recalcitrant cutaneous warts treated with quadrivalent human papillomavirus (HPV) vaccine: the HPV type may not determine the outcome. The British Journal of Dermatology, 182(5), 1285–1287. https://doi.org/10.1111/bjd.18645

Hellwig, J. M. S. . R., & Zeltser, R. M. D. . F. (2020). Plantar warts. Salem Press Encyclopedia of Health.

Hubert, R.J. & VanMeter, K.C. (2018). Gould’s pathophysiology for the health professions. Elsevier Saunders.

Kormos, W. (2017). What are the best ways to treat plantar warts? Harvard Health Publishing.

https://www.health.harvard.edu/diseases-and-conditions/what-are-the-best-ways-to-treat-plantar-warts

Mayo Clinic. (2020).Plantar warts.

https://www.mayoclinic.org/diseases-conditions/plantar-warts/diagnosis-treatment/drc-20352697#:~:text=In%20most%20cases%2C%20your%20doctor,it%20to%20a%20laboratory%20for

Witchey, D. J., Witchey, N. B., Roth-Kauffman, M. M., & Kauffman, M. K. (2018). Plantar warts: Epidemiology, pathophysiology, and clinical management. The Journal of the American Osteopathic Association, 118(2), 92–105. https://doi.org/10.7556/jaoa.2018.024