Sarcoidosis

Sarcoidosis Nursing Care Plans Diagnosis and Interventions

Sarcoidosis NCLEX Review Care Plans

Nursing Study Guide on Sarcoidosis

Sarcoidosis is a rare condition characterized by the formation of inflammatory cells called granulomas. This condition is also referred to as sarcoid and Besnier-Boeck-Schaumann disease.

Sarcoidosis can occur in any organ in the human body most commonly in the lymph nodes and the lungs. Sarcoidosis can be mild to severe depending on the damage it causes. It can also have a short or long duration.

Each case of sarcoidosis can be entirely different in terms of its effects and prognosis. It is reported that about 60% of sarcoidosis cases recover within 2-5 years. Sarcoidosis can occur at any age however it is extremely rare in children. Adults between the age of 30 to 40 years are reported to be at higher risk of getting the disease.

Signs and Symptoms of Sarcoidosis

The signs and symptoms of sarcoidosis vary greatly depending on the organ affected by the disease. When present, the signs and symptoms may not be significant enough to suspect the presence of the condition. The following are the general signs and symptoms of sarcoidosis as per the affected organ:

  • General Signs and Symptoms
    • Fatigue
    • Lymph node swelling
    • Unexplained weight loss
    • Joint pain and swelling, commonly in the ankles
    • A general feeling of sickness
    • Nights sweats
    • Headache
  • Lung
    • Chronic dry cough
    • Wheezing breath sounds
    • Shortness of breath
  • Skin
    • Presence of red to purple rash or bumps on the ankles which may be warm to touch
    • Presence of lesions on the nose, cheeks, and ears
    • Patches of darker or lighter skin
    • Growth of nodules typically around scars or tattoos
  • Eyes
    • Blurring of vision
    • Eye pain
    • Burning or itching of the eyes
    • Dryness of the eyes
    • Severe eye redness
    • Sensitivity to light
  • Heart
    • Chest pain
    • Dyspnea or difficulty breathing
    • Syncope or fainting
    • Fatigue
    • Arrhythmias
    • Palpitations
    • Edema

Causes and Risk Factors of Sarcoidosis

The exact cause of sarcoidosis is unknown. Some studies suggest that this condition is an autoimmune disease, although this theory is not officially accepted yet. However, research suggests that there are risk factors that predispose an individual from developing the disease and these are as follows:

  • Age. Sarcoidosis can occur at any age with a high incidence rate in people between 20-60 years of age.
  • Sex. Sarcoidosis can also affect both males and females, with a slightly higher incidence in women.
  • Race. The condition is more often reported in people of African or North European descent.
  • Family history. Having an immediate family member with sarcoidosis can increase the prevalence of the disease.

Complications of Sarcoidosis

  1. Pulmonary fibrosis. Sarcoidosis commonly affects the lungs. In severe cases, the damage can cause pulmonary fibrosis which involves the permanent scarring of the lung tissues. This causes difficulty in breathing and pulmonary hypertension.
  2. Eye damage. When the eyes are affected by sarcoidosis, the damage to the retina can cause blindness. In some cases, glaucoma and cataracts can occur.
  3. Hypercalcemia. Having higher levels of calcium in the blood is one known complication of sarcoidosis. This is reported in 10% of cases and can cause a cascade of problems including kidney failure.
  4. Suppressed parathyroid hormone (PTH). Hypercalcemia sends signals to the brain to reduce the production of PTH. In people with thyroid conditions, this can cause serious problems hence levels must be monitored when hypercalcemia is reported.
  5. Heart involvement. Sarcoidosis can also affect the heart which can result in serious rhythm changes.
  6. Nervous system involvement. Paralysis can occur as a complication of sarcoidosis when the granulomas affect the nerves, brain, and spinal cord.

Diagnosis of Sarcoidosis

Sarcoidosis is not an easy condition to diagnose. There is no single definitive procedure to diagnose this disease. Oftentimes, physicians use the method of exclusion to come up with a diagnosis.

This refers to the process of ruling out other possible conditions that can explain the signs and symptoms. Some cases of sarcoidosis are accidentally diagnosed through radiologic imaging intended for something else.

The following are the procedures done to help diagnose sarcoidosis:

  • Radiologic imaging. Imaging studies such as chest x rays, CT scans, MRI, and PET scans can help identify problem organs.
  • Blood and urine tests. Blood and urine testing are done to cover the basic diagnostic tests and measure the individual’s general health.
  •  Lung function test. This test can help identify lung involvement and the possible degree of damage the disease has caused to the individual’s lungs.
  • Biopsy. A small tissue sample from the organ suspected to be affected by sarcoidosis may be needed to confirm the diagnosis. In the lungs, this can be done through bronchoscopy which involved the insertion of a tiny tube with a camera down the lungs. This is normally done in an outpatient setting under local anaesthesia.

Treatment of Sarcoidosis

The treatment of sarcoidosis involves management of symptoms, prevention of complications and improvement of patient outcomes. Some cases of sarcoidosis are mild and may not need treatment at all; however, in serious cases, the following may be needed:

  1.  Medications. Several drugs are used to treat sarcoidosis, which include:
    • Corticosteroids – corticosteroids are anti-inflammatory drugs. Depending on the organ system affected, this medication can be given orally, topically, or as drops, if the eyes are affected.
    • Immunosuppressant medications – medications that can suppress the immune system are sometimes used to manage the signs and symptoms of sarcoidosis. This form of treatment can suppress inflammation which helps manage the disease.
    • TNF-alpha inhibitors – these medications are also used to treat rheumatoid arthritis. They are believed to be helpful in managing sarcoidosis that is not responding to other treatments.
  2. Regular Monitoring. After the diagnosis of sarcoidosis, regular monitoring on the progress of the disease is strictly needed. Routine tests may also be required to prevent complications and monitor organs that may become affected.
  3. Other treatments. Treatment may be required depending on the damage the condition has on the organs affected. An example is the surgical treatment of the lungs, liver, or heart in cases of serious damage.

Nursing Care Plans for Sarcoidosis

Nursing Care Plan 1

Nursing Diagnosis: Acute Pain related to granulomas in the ankles and joints secondary to sarcoidosis, as evidenced by  pain score of 10 out of 10, verbalization of pressure-like chest pain, guarding sign on the chest, heart rate of 120 bpm, respiratory rate of 29 bpm, and restlessness

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

InterventionsRationale
Administer prescribed medications that alleviate the symptoms of pain.To provide pain relief to the patient.  
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is within the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Place the patient in complete bed rest when in severe pain. Educate patient on stress management, deep breathing exercises, and relaxation techniques.Stress may further increase pain levels.

Nursing Care Plan 2

Nursing Diagnosis: Activity intolerance related to persistent fatigue as evidenced by verbalization of unrelieved fatigue, overwhelming lack of energy, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To allow the patient to pace activity versus rest.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Nursing Care Plan 3

Nursing Diagnosis: Risk for Imbalanced Nutrition: Less than Body Requirements related to sarcoidosis

Desired Outcome: The patient will be able to achieve or maintain a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

InterventionRationale
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight gain.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.  
Help the patient to select appropriate dietary choices to follow a high caloric diet.Patients tend to expend a significant amount of energy by overusing respiratory muscles to breathe. High caloric diet may help provide the energy he/she needs and combat fatigue and weight loss.  
Instruct the patient to avoid carbonated beverages and gas-producing food.To reduce abdominal distention which can hinder the optimal expansion of the diaphragm.
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet as appropriate.  

Nursing Care Plan 4

Nursing Diagnosis: Disturbed Visual Sensory Perception related to altered status of the eyes and vision secondary to sarcoidosis, as evidenced by blurry vision, eye pain, eye redness, photosensitivity, and eye dryness

Desired Outcome: The patient will maintain current visual acuity without further vision loss.

InterventionRationale
Assess the patient’s current visual acuity and visual field.To establish current visual acuity and visual field and to customize interventions based on this initial assessment.
Discuss the possibility of loss of vision and allow the patient to express his/her feelings towards it.Early intervention and treatment of glaucoma or cataract as a complication of sarcoidosis can help prevent further vision loss. However, the patient is still at risk for partial or complete vision loss. Discussing feelings and thoughts about this can help the patient appropriately grieve, while establishing rapport with the healthcare team and becoming encouraged to follow the agreed treatment plan.
Administer the eye drops as prescribed.Eye drops for glaucoma are prescribed to constrict pupillary constriction and reduce the intraocular pressure, thereby reducing further vision loss.
Teach the patient on how to properly administer the eye drops and educate him/her the right schedule to administer the drops daily as prescribed. Allow the patient to demonstrate the procedure.Educating the patient and allowing him/her to demonstrate the procedure encourages the patient to take ownership of his/her healthcare, as well as enables the nurse to determine good eye drop administration technique or correct any mistake in doing the procedure.
Prepare for surgical intervention intended for sarcoidosis-related glaucoma or cataract.To prevent further loss of vision.

Other possible nursing diagnoses:

  • Fatigue
  • Risk for Impaired Skin Integrity
  • Risk for Injury
  • Anxiety/Fear

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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