GROUP1 BSN1-D

Abreu, Rayne Demi Anne C.

Aspiras, Eya
Baday, Laurrina Emeever
Balanon, Christian
Baltazar, Arianne Chyn
Lymphatic System Case Study

1. What is the case of the patient?

According to the data, K.B. is 40 years of age with a 5-year history of Psoriasis. Her
outbreak of Plaque Psoriasis affected large regions on her arms, legs, elbows, knees, abdomen,
scalp, and groin. At age 35, she was diagnosed with limited Plaque-type Psoriasis and uses
topical treatment with high-potency corticosteroids in her skin to reduce inflammation and
irritation. Lesions have been confined to a small region in her elbows and lower legs. When she
was 14 years old, she acquired rheumatic fever that led to some complications associated with
rheumatic heart disease. Her mother recently passed away from ovarian cancer after a long
disease that brought stress to her life. Out of her 5 siblings, her younger sister also developed
signs of heart disease from rheumatic fever. In her social history, K.B. smokes 4-5 cigarettes each
day and drinks alcohol only socially. There have been increasing tensions and anxiety at work
because rumors are circulating about the possible layoffs. With this, she is taking ibuprofen for
occasional headaches and Rolaids for the ‘heartburns’ she feels when eating lettuce as she was
counseled by her primary care provider for having stomach cramps. The patient’s skin itches
terribly despite applying a non-medicated moisturizer several times a day. In line with this, with
the help of all the information presented and results coming from her physical examination and
laboratory tests, K.B. is suffering from Psoriasis.

2. Make an algorithm of the disease process.

3. What are the normal and abnormal physiological processes in the patient’s case?

NORMAL
 VITAL SIGNS: Bp: 90/60mmHg and
120/80mmHg, adults normal weight should
range in 106 lbs(male) and 100 lbs(female),
BMI: 18.5 to 24.9
ABNORMAL
 VITAL SIGNS: Bp:145/90, Wt:165 lbs, BMI:
30.2 (Obese Class I)
 ADDITIONAL HISTORY: Skin “itches terribly”

 ADDITIONAL HISTORY: Skin is smooth, with no
cuts on the surface.
 SKIN: Scalp, abdomen, groin, arms, and legs
have healthy smooth skin without bright red
lesions with silvery-white scales.
 HEENT: Scalp is clear with a healthy
distribution of hair.
 HEART: Heart has 2 sounds, S1(a lub) and
S2(dub), it provides adequate circulation of
the blood through the body.
 SKIN: Confluent plaque-type psoriasis with
extensive lesions on patient’s upper and
lower extremities, scalp, abdomen, and
groin; approximately 40% of total body
surface area is involved, Bright red lesions
with sharply defined borders, Silvery-white
scales, Lesions on the arms, legs, and
abdomen.
 HEENT: Extensive lesions on the scalp
 HEART: Murmur sound can be distinctly
heard

 ABDOMEN: Has healthy smooth skin without  ABDOMEN: Extensive scaly lesions and
scaly lesions and excoriations on the skin. excoriations on the skin

 MUSCULOSKELETAL EXTREMITIES: Elbows,  MUSCULOSKELETAL EXTREMITIES: Psoriatic

knees, forearms, and calves show healthy lesions on elbows, knees, forearms, and
smooth skin without psoriatic lesions. Healthy calves, Yellow spots in the nail plates on
nails show a pink nail bed color. fingers.
 4. Interpret the laboratory and imaging results of the patient if available.

LABORATORY AND BLOOD RESULTS

*RED indicates the result is not within the normal value/range.

INVESTIGATION Result Reference Value Unit Interpretation

Primary Sample Type: Blood
SODIUM LEVEL
Sodium (Na) 144 135 - 145 meq/L Within the normal range

POTASSIUM LEVEL
Potassium (K) 4.0 3.5 – 5.0 meq/L Within the normal range

CHLORIDE LEVEL
Chloride (Cl) 102 96 – 106 meq/L Within the normal range

CALCIUM LEVEL
Calcium (Ca) 6.9 8.5 – 10.5 mg/dL Within the lower range of
normal, suggesting hypocalcemia.
Hypocalcemia is a risk factor of
psoriasis. Calcium deficiencies
cause fragile, thin skin because
calcium plays a role in
keratinocyte differentiation and
proliferation, essential to restore
epidermal barrier.

BICARBONATE
Bicarbonate (HCO3) 26 22 - 30 meq/L Within the normal range

Blood Urea Nitrogen

Blood Urea Nitrogen 15 7 - 20 mg/dL Within the normal range
(BUN)

Serum Creatinine Level

Cr 1.1 0.5 - 1.1 mg/dL Within the normal range

Fasting Blood Glucose

Glu, fasting 94 70 - 99 mg/dL Within the normal range

HEMOGLOBIN
Hemoglobin (Hb) 11 13.8 - 17.2 g/dL Within the lower range of
normal, suggesting mild anemia.
Chronic inflammation caused by
psoriasis can contribute to the
development of anemia by
interfering with the production of
RBCs that affect the lifespan of
RBCs.

HEMATOCRIT
Hematocrit (Hct) 32 35 - 47 % Within the lower range of
normal. Similar to hemoglobin, a
decreased hematocrit level may
also indicate anemia.

PLATELET COUNT
Platelet count 260,000 150,000 - mm3 Within the normal range
400,000

WBC COUNT
Total WBC count 7,500 4,500 – 11,000 mm3 Within the normal range
RBC COUNT
Total RBC count 4.0 3.8 - 5.2 mm3 Within the normal range

Aspartate
Aminotransferase
AST 23 10 - 36 IU/L Within the normal range

Alanine
Aminotransferase
ALT 39 7-56 IU/L Within the normal range

Alkanine Phosphate
Alk phos 114 48 - 147 IU/L Within the normal range

BILIRUBIN
Total Biliburin 1.1 0.3 – 1.2 mg/dL Within the normal range

ALBUMIN LEVEL
Alb 3.8 3.5 - 5.0 g/dL Within the normal range

PROTEIN 7.3 6.0 – 8.3 g/dL Within the normal range

CHOLESTEROL 289 125 - 200 mg/dL Higher-than-normal cholesterol

level. Psoriasis and heart health
are still currently being
investigated. Thus, patient’s
elevated cholesterol levels might
be caused by poor lifestyle, such
as smoking which can increase
the LDL cholesterol.