Part 1 Your response to your peers by extending, refuting/correcting, or adding additional nuance to their posts. Patient Interview Skin and Breast Psoriasis            Psoriasis is a condition of skin causing red and crusty, as well as flaky patches of the skin that is covered with the scales that are silvery. The patches usually appear on individual’s knees, lower back, elbows, as well as scalp; nonetheless, may appear anywhere on the body (Armstrong & Read, 2020). Psoriasis may start at any age, however, it most frequently develops in adults below thirty-five years. Psoriasis severity differs greatly from individual to individual, and for some individuals, it is just a minor irritation, nevertheless, for other individuals, it can greatly affect their quality of life (Rendon & Schäkel, 2019).            The underlying cause of psoriasis is a problem in immune system which causes faster regeneration of skin in comparison to the normal rates. The malfunctioning of the immune system may occur due to environmental factors and genetics (Rendon & Schäkel, 2019). Individuals having psoriasis have augmented the production of skin cells. As a result, the skin cells build up and creates patches linked to psoriasis. The immune system protects the body against infection and disease, however, it attacks skin cells that are healthy by mistake among people having psoriasis (Armstrong & Read, 2020). Psoriasis is triggered by stress, infections that include skin infections and strep throat, cold and dry weather conditions, injury to the skin, heavy consumption of alcohol, and smoking as well as exposure to secondhand smoke. Besides, psoriasis is triggered by rapid withdrawal of systemic or oral corticosteroids, and certain medications such as medications for hypertension, lithium, and antimalarial medications (Rendon & Schäkel, 2019).             The common signs, as well as symptoms of psoriasis, are swollen and stiff joints, burning, soreness or itching, and pitted, thickened, or ridged nails. Also, psoriasis signs and symptoms include small scaling spots and dry and cracked skin which can itch or bleed (Armstrong & Read, 2020). Definitions and Comparison of Breast Diseases            Fibrocystic breast disease is a noncancerous or benign condition that makes the breasts feel lumpy. The condition is dangerous or harmful, but it can be uncomfortable or bothersome for some women (Malherbe & Fatima, 2019). On the other hand, fibroadenoma is a common painless, and unilateral, and non-cancerous or benign breast tumor which is a solid and not fluid-filled lump, and made up of stromal tissue and glandular tissue. This condition occurs most frequently in women in their twenties and thirties, but it can be found among women of any age. Fibroadenoma may shrink after menopause when levels of hormone decrease (Ajmal & Van Fossen, 2018). Conversely, a malignant breast tumor is a cancerous breast tumor that can be aggressive since it invades as well as damages the surrounding tissues (Sharma et al., 2017).            Fibrocystic breast disease symptoms include tenderness, swelling, thickening tissue, pain, and lumps in one breast or both breasts (Malherbe & Fatima, 2019). In contrast, the symptoms of fibroadenoma are solid breast lumps which are easily moved, painless, firm, and round with distinct and smooth borders (Ajmal & Van Fossen, 2018). On the other hand, the symptoms of malignant breast tumor comprise a lump in the breast, and nipple discharge, discomfort, thickening or swelling of part of the breast, and irritation or dimpling of the breast skin (Sharma et al., 2017).            Fibrocystic breast disease is mainly caused by changes in breast tissue in response to hormones that are made by ovaries. Individuals with this condition have more pronounced changes in reaction to the hormones (Malherbe & Fatima, 2019). On the contrary, the main cause of fibroadenoma is unknown; nonetheless, it may be related to reproductive hormones. The condition often occurs during reproductive years and may become bigger during pregnancy or with the utilization of hormone therapy (Ajmal & Van Fossen, 2018). In contrast, a malignant breast tumor develops when there is the uncontrollable growth of cells. The condition occurs when the cells which are growing uncontrollably are abnormal as well as do not function like the normal cells of the body. The continuous growth and spread of the cells make the disease to be life-threatening (Sharma et al., 2017). References Ajmal, M., & Van Fossen, K. (2018). Breast fibroadenoma.Retrieved from https://europepmc.org/article/NBK/nbk535345 Armstrong, A. W., & Read, C. (2020). Pathophysiology, clinical presentation, and treatment of psoriasis: a review. Jama, 323(19), 1945-1960. doi:10.1001/jama.2020.4006 Malherbe, K., & Fatima, S. (2019). Fibrocystic breast disease. Retrieved from https://europepmc.org/article/nbk/nbk551609 Rendon, A., & Schäkel, K. (2019). Psoriasis pathogenesis and treatment. International journal of molecular sciences, 20(6), 1475. https://doi.org/10.3390/ijms20061475 (Links to an external site.) Sharma, M., Singh, R., & Bhattacharya, M. (2017, November). Classification of breast tumors as benign and malignant using textural feature descriptor. In 2017 IEEE International Conference on Bioinformatics and Biomedicine (BIBM) (pp. 1110-1113). IEEE. DOI: 10.1109/BIBM.2017.8217811 Part 2 Your response to your peers by extending, refuting/correcting, or adding additional nuance to their posts. Patient Interview KM is a 38-year-old white woman with a 6-year history of psoriasis. Her family history includes allergies and asthma and her mother with psoriasis. KM returns today for an increase in symptoms, and she wants to improve the appearance of her skin. Please discuss the following: What is the underlying cause of psoriasis? According to the Journal of Psoriasis and Psoriatic Arthritis (2021), Psoriasis is an autoimmune disease that causes inflammation in the body. Because of the inflammation, you may be able to see visible signs on the skin. These signs include raised plaques and scales. These appear because the immune system is overactive causing a rapid production of skin cells. Risk factors include a person’s family history, stress, and smoking. In KM’s case, she is a white female with a family history of psoriasis. One research study showed that the prevalence of psoriasis in Caucasian patients was 2.5% and nearly 1.3% in African American patients (Gelfand et al., 2017) What are the common signs and symptoms of this disease? According to Mayo Clinic, Psoriasis is a chronic, common disease with no cure. Usually, it will go through cycles where it can flare for a few weeks or months then goes into remission. Although signs and symptoms can vary from person to person the most common include red patches of skin covered with thick, silvery scales, dry, cracked skin that may itch and bleed, swollen and stiff joints, and thickened pitted or ridged nails. Define, Compare and Contrast the following conditions: Fibrocystic breast disease Fibrocystic breast disease also called fibrocystic breasts or fibrocystic change is a benign condition where the breast feels lumpy. All though it may be bothersome for some women, it is not harmful or dangerous (Cafasso, 2019). According to Mayo Clinic, more than half of women will develop fibrocystic breast disease at some point. Having fibrocystic breasts can make it more challenging to detect breast cancer. Some signs and symptoms of fibrocystic breast include swelling, pain, lumps, and tenderness. Fibrocystic breast disease is caused by hormonal changes and one’s symptoms can present before or during your menstrual cycle. Diagnosis consists of a doctor performing a breast exam or it can also be diagnosed from an ultrasound, Mammogram, or MRI. Fibroadenoma According to the American Cancer Society (2021), Fibroadenoma are common and are benign. Fibroadenomas are breast tumors made up of glandular tissue and connective tissue. There are commonly found in women in their 20s and 30s. Fibroadenomas are round in nature with clear-cut borders, can often feel like a marble within the breast. When a fibroadenoma is present, a biopsy is ordered to make sure the tumor is indeed benign. Physicians recommend removing fibroadenomas. Malignant breast tumor A malignant breast tumor is also known as breast cancer, according to the American Cancer Society (2020). Breast cancer usually evolves from a lump. Although it is more prevalent in women, men may also get breast cancer. Most breast cancers start in the ducts that carry milk to the nipple. According to the Cleveland Clinic, Non-Hispanic Black women in the US have a 39% higher risk of dying from breast cancer. At the current time, there is no specific cause of breast cancer only certain risk factors can put you at higher risk of developing it. Some of these risk factors include body weight, Implants, using hormone-based prescriptions, and alcohol consumption. Breast cancer is diagnosed by either a breast examination, Mammography, or Ultrasonography, and biopsy. Treatment is different depending on the size and location of the tumor. References Breast cancer: Causes, stage, diagnosis & treatment. Cleveland Clinic. (n.d.). https://my.clevelandclinic.org/health/diseases/3986-breast-cancer.  Cafasso, J. (2019, March 7). Fibrocystic breast disease: Causes, symptoms, and diagnosis. Healthline. https://www.healthline.com/health/fibrocystic-breast-disease.  Fibroadenomas of the breast. American Cancer Society. (2021). https://www.cancer.org/cancer/breast-cancer/non-cancerous-breast-conditions/fibroadenomas-of-the-breast.html.  Gelfand, J. M., Stern, R. S., Nijsten, T., Feldman, S. R., Thomas, J., Kist, J., Rolstad, T., & Margolis, D. (2017, January). The prevalence of psoriasis in African Americans: Results from a population-based study. Journal of the American Academy of Dermatology. https://pubmed.ncbi.nlm.nih.gov/15627076/.  Journal of Psoriasis and Psoriatic Arthritis. (2021). Psoriasis: Causes, triggers and treatments. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/. 

1. Describe the blood-brain barrier2. Describe the pathophysiology of Parkinson’s disease.3. Describe the mechanism of action of the dopaminergic medications to treat Parkinson’s. How do these medications reduce symptoms? Is there a cure for Parkinson’s.4. Describe the pathophysiology of Alzheimer's Disease.5. Describe the mechanism of action of the drugs for cognitive impairment (page 193). How do these medications achieve a therapeutic effect in Alzheimer's disease. 6. Describe the pathophysiology of multiple sclerosis.7. Describe the mechanism of action of the disease-modifying drugs used to treat MS.8. Discuss 3 major nursing implications to medication used to treat MS and how these would be attended to.9. Describe the 5 ways in which antiepileptic drugs (AEDs) work to reduce seizures.10. Discuss two teaching points for a patient that is starting phenytoin.11. How do centrally acting muscle relaxants work to relieve spasticity?

The Institute of Medicine has stated a goal that 90% of practice be evidence-based by 2020. According to HealthyPeople.gov, the United States is currently at approximately 15%. Discuss two barriers that might hold nursing practice from achieving this goal and suggest ways in which identified barriers may be addressed.