Sarcoidosis is a multisystem inflammatory disorder characterized by the formation of granulomas (small clumps of inflammatory cells) in various organs, most commonly the lungs and lymph nodes.
This condition can affect people of all ages and races, but it is more prevalent in adults between 20 and 40 years old.
Causes (Related to)
Sarcoidosis can result from various factors that trigger an abnormal immune response. The following are common causes and risk factors associated with sarcoidosis:
- Genetic predisposition
- Environmental factors (exposure to certain dusts or chemicals)
- Infectious agents (bacteria or viruses)
- Autoimmune reactions
- Occupational exposures (beryllium, aluminum, zirconium)
- Ethnicity (more common in African Americans and people of Scandinavian descent)
- Age (typically occurs between 20-40 years)
- Gender (slightly more common in women)
Signs and Symptoms (As evidenced by)
Sarcoidosis can manifest with a variety of signs and symptoms, which can vary depending on the organs affected. In a physical assessment, a patient with sarcoidosis may present with one or more of the following:
Subjective: (Patient reports)
- Persistent dry cough
- Shortness of breath
- Chest pain
- Fatigue
- Night sweats
- Weight loss
- Joint pain
- Vision changes
- Skin rashes or lesions
Objective: (Nurse assesses)
- Enlarged lymph nodes
- Abnormal lung sounds (crackles or wheezing)
- Skin nodules or plaques
- Enlarged liver or spleen
- Eye inflammation
- Cardiac arrhythmias
- Neurological deficits
- Elevated serum calcium levels
- Abnormal chest X-ray or CT scan findings
- Elevated angiotensin-converting enzyme (ACE) levels
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for patients with sarcoidosis:
- The patient will report improved respiratory function and reduced dyspnea
- The patient will demonstrate normal vital signs and oxygen saturation levels
- The patient will exhibit improved energy levels and reduced fatigue
- The patient will show resolution or reduction of skin lesions
- The patient will maintain optimal weight and nutritional status
Nursing Assessment
The nursing assessment is crucial in developing an effective care plan for patients with sarcoidosis. The following section covers aspects of the nursing assessment:
Perform a thorough respiratory assessment
- Assess respiratory rate, depth, and pattern
- Auscultate lung sounds for crackles, wheezes, or decreased breath sounds
- Observe for use of accessory muscles or signs of respiratory distress
Monitor vital signs and oxygen saturation
- Note any tachycardia, tachypnea, or hypoxemia
- Use continuous pulse oximetry if indicated
Assess for extrapulmonary manifestations
- Examine skin for erythema nodosum or lupus pernio
- Check for enlarged lymph nodes, particularly in the neck and axillary regions
- Assess for joint pain or swelling
- Evaluate for neurological symptoms (e.g., facial nerve palsy, seizures)
Review laboratory results
- Check serum calcium levels (may be elevated in sarcoidosis)
- Monitor ACE levels (often elevated in active sarcoidosis)
- Review complete blood count and inflammatory markers
Evaluate psychological status
- Assess for signs of anxiety or depression
- Gauge the patient’s understanding of the disease and its impact on daily life
Assess nutritional status
- Monitor weight and appetite
- Evaluate for difficulty swallowing if there is involvement of the upper respiratory tract
Review medication regimen
- Assess compliance with prescribed medications
- Monitor for side effects of corticosteroids or other immunosuppressive drugs
Nursing Interventions
Effective nursing interventions are essential for managing sarcoidosis and improving patient outcomes. The following interventions should be tailored to each patient’s specific needs:
Provide oxygen therapy as prescribed
- Administer supplemental oxygen to maintain SpO2 > 92%
- Teach proper use of home oxygen equipment if prescribed
Implement measures to improve respiratory function
- Encourage deep breathing and coughing exercises
- Teach pursed-lip breathing technique to reduce dyspnea
- Assist with chest physiotherapy if ordered
Administer medications as prescribed
- Corticosteroids (e.g., prednisone) to reduce inflammation
- Immunosuppressants (e.g., methotrexate) for refractory cases
- Bronchodilators for symptomatic relief of wheezing
Manage skin manifestations
- Apply topical corticosteroids as prescribed for skin lesions
- Protect affected skin from further irritation or injury
Promote adequate rest and energy conservation
- Encourage regular rest periods throughout the day
- Teach energy conservation techniques for daily activities
Provide nutritional support
- Encourage a balanced diet rich in fruits, vegetables, and whole grains
- Monitor calcium intake, especially if the patient is on corticosteroids
Nursing Care Plans
The following nursing care plans address common problems associated with sarcoidosis. Each plan includes a nursing diagnosis statement, related factors/causes, nursing interventions with rationales, and desired outcomes.
Care Plan 1: Ineffective Breathing Pattern
Nursing Diagnosis Statement:
Ineffective Breathing Pattern related to inflammation and granuloma formation in the lungs secondary to sarcoidosis, as evidenced by dyspnea, tachypnea, and use of accessory muscles.
Related factors/causes:
- Inflammation of lung tissue
- Formation of granulomas in the lungs
- Decreased lung compliance
- Airway obstruction
Nursing Interventions and Rationales:
- Assess respiratory rate, depth, and pattern every 2-4 hours.
Rationale: Regular assessment helps identify changes in respiratory status and the need for intervention. - Auscultate lung sounds every shift.
Rationale: Allows for early detection of adventitious breath sounds indicating worsening condition. - Position the patient in a semi-Fowler’s or high Fowler’s position.
Rationale: Promotes optimal lung expansion and reduces the work of breathing. - Teach and encourage pursed-lip breathing and diaphragmatic breathing techniques.
Rationale: These techniques help control breathing rate and depth, reducing dyspnea and improving oxygenation. - Administer oxygen therapy as prescribed.
Rationale: Supplemental oxygen improves tissue oxygenation and reduces the work of breathing. - Encourage the use of an incentive spirometer every 2 hours while awake.
Rationale: Promotes deep breathing, improves lung expansion, and prevents atelectasis.
Desired Outcomes:
- Within 24 hours, the patient will demonstrate improved respiratory rate and depth within normal limits (12-20 breaths/minute).
- The patient will report decreased dyspnea and use of accessory muscles within 48 hours.
- The patient will maintain oxygen saturation > 92% on room air or prescribed oxygen therapy within 24 hours.
Care Plan 2: Fatigue
Nursing Diagnosis Statement:
Fatigue related to chronic inflammatory process and increased metabolic demand secondary to sarcoidosis, as evidenced by verbalized exhaustion, decreased performance in activities of daily living, and increased need for rest.
Related factors/causes:
- Chronic inflammatory disease process
- Increased metabolic demand
- Sleep disturbances due to respiratory symptoms
- Side effects of medications (e.g., corticosteroids)
Nursing Interventions and Rationales:
- Assess the patient’s fatigue level using a standardized scale (e.g., Fatigue Severity Scale) daily.
Rationale: Provides objective measurement of fatigue and helps evaluate the effectiveness of interventions. - Collaborate with the patient to develop a balanced schedule of activity and rest.
Rationale: Helps manage energy levels and prevents overexertion. - Teach energy conservation techniques (e.g., sitting while performing tasks, using assistive devices).
Rationale: Reduces energy expenditure during daily activities. - Encourage adequate sleep hygiene practices (e.g., consistent sleep schedule, relaxation techniques before bedtime).
Rationale: Promotes restorative sleep and helps manage fatigue. - Consult with a dietitian to ensure adequate nutritional intake.
Rationale: Proper nutrition supports energy production and overall health. - Encourage light to moderate exercise as tolerated, such as short walks.
Rationale: Regular physical activity can improve energy levels and overall well-being.
Desired Outcomes:
- The patient will report decreased fatigue levels on the Fatigue Severity Scale within 1 week.
- The patient will demonstrate increased participation in activities of daily living within 2 weeks.
- The patient will verbalize understanding of energy conservation techniques and implement them in daily routines within three days.
Care Plan 3: Impaired Skin Integrity
Nursing Diagnosis Statement:
Impaired Skin Integrity related to cutaneous manifestations of sarcoidosis, as evidenced by presence of erythema nodosum, lupus pernio, or other skin lesions.
Related factors/causes:
- Formation of granulomas in the skin
- Inflammatory process associated with sarcoidosis
- Side effects of medications (e.g., long-term corticosteroid use)
Nursing Interventions and Rationales:
- Assess skin integrity daily, documenting any lesions’ location, size, and characteristics.
Rationale: Regular assessment allows for the early detection of new lesions or changes in existing ones. - Gently cleanse affected skin areas with mild, non-irritating soap and warm water.
Rationale: Maintains skin hygiene while minimizing irritation to affected areas. - Apply topical medications (e.g., corticosteroids) as prescribed.
Rationale: Helps reduce inflammation and promote healing of skin lesions. - Educate the patient on proper skin care, including moisturizing and protecting the skin from sun exposure.
Rationale: Proper skin care can prevent further irritation and protect vulnerable skin. - Encourage the patient to wear loose, comfortable clothing to minimize skin irritation.
Rationale: Reduces friction and pressure on affected skin areas. - Monitor for signs of infection in skin lesions (e.g., increased redness, warmth, purulent discharge).
Rationale: Early detection of infection allows for prompt treatment.
Desired Outcomes:
- The patient will demonstrate improvement in skin lesions (reduced size, inflammation) within two weeks.
- The patient will verbalize understanding of proper skin care techniques within two days.
- The patient will report reduced discomfort associated with skin lesions within one week.
Care Plan 4: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to unfamiliarity with sarcoidosis disease process and management, as evidenced by verbalized misconceptions about the condition and frequent questions about treatment and prognosis.
Related factors/causes:
- Lack of exposure to information about sarcoidosis
- Complexity of the disease process
- Misunderstandings about chronic illness management
Nursing Interventions and Rationales:
- Assess the patient’s current understanding of sarcoidosis and its management.
Rationale: Identifies knowledge gaps and misconceptions to guide education. - Provide concise information about sarcoidosis, its potential effects on various organs, and treatment options.
Rationale: Increases patient’s understanding of their condition and promotes informed decision-making. - Use visual aids (e.g., diagrams, videos) to explain the disease process and treatment.
Rationale: Visual aids can enhance understanding and retention of information. - Teach the patient about medication regimens, including proper administration and potential side effects.
Rationale: Promotes medication adherence and helps the patient recognize and report side effects. - Discuss lifestyle modifications that can help manage symptoms (e.g., smoking cessation, stress reduction techniques).
Rationale: Helps the patient to take an active role in their health management. - Provide written materials about sarcoidosis for the patient to review at home.
Rationale: Reinforces verbal education and serves as a reference for the patient.
Desired Outcomes:
- The patient will verbalize an accurate understanding of sarcoidosis and its management within three days.
- The patient will demonstrate proper medication administration technique within 2 days.
- The patient will identify at least three lifestyle modifications to help manage symptoms within one week.
Care Plan 5: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to immunosuppression from sarcoidosis and its treatment, as evidenced by elevated inflammatory markers and use of corticosteroids or other immunosuppressive medications.
Related factors/causes:
- Compromised immune system due to sarcoidosis
- Use of immunosuppressive medications (e.g., corticosteroids, methotrexate)
- Potential for respiratory tract infections due to lung involvement
Nursing Interventions and Rationales:
- Assess for signs and symptoms of infection (e.g., fever, increased white blood cell count, localized pain or swelling) regularly.
Rationale: Early detection of infection allows for prompt treatment. - Implement and teach proper hand hygiene techniques to the patient and visitors.
Rationale: Hand hygiene is crucial in preventing the spread of infections. - Encourage the patient to receive recommended vaccinations (e.g., influenza, pneumococcal) unless contraindicated.
Rationale: Vaccinations can help prevent infections in immunocompromised individuals. - Educate the patient about avoiding crowds and individuals with known infections.
Rationale: Reduces exposure to potential pathogens. - Teach the patient to recognize early signs of infection and when to seek medical attention.
Rationale: Promotes early intervention and prevents complications. - Ensure proper care of any invasive lines or devices.
Rationale: Reduces the risk of device-associated infections.
Desired Outcomes:
- The patient will remain free from signs and symptoms of infection throughout the hospital stay.
- The patient will demonstrate proper hand hygiene techniques within one day.
- The patient will verbalize understanding of infection prevention strategies and when to seek medical attention within two days.
Conclusion
Sarcoidosis is a complex multisystem disorder that requires comprehensive nursing care. Nurses can significantly improve patient outcomes and quality of life by implementing these nursing care plans and interventions.
Regular assessment, patient education, and a multidisciplinary approach are crucial to managing sarcoidosis effectively. As research in this field continues to evolve, nurses should stay updated on the latest evidence-based practices to provide optimal care for patients with sarcoidosis.
References
- Baughman, R. P., & Culver, D. A. (2019). Sarcoidosis. In Harrison’s Principles of Internal Medicine, 20e. McGraw-Hill Education.
- Crouser, E. D., Maier, L. A., Wilson, K. C., Bonham, C. A., Morgenthau, A. S., Patterson, K. C., … & Bernstein, E. J. (2020). Diagnosis and detection of sarcoidosis. An official American Thoracic Society clinical practice guideline. American Journal of Respiratory and Critical Care Medicine, 201(8), e26-e51.
- Drent, M., Strookappe, B., Hoitsma, E., & De Vries, J. (2015). Consequences of sarcoidosis. Clinics in Chest Medicine, 36(4), 727-737.
- Judson, M. A. (2020). The clinical features of sarcoidosis: A comprehensive review. Clinical Reviews in Allergy & Immunology, 59(3), 313-329.
- Saketkoo, L. A., & Baughman, R. P. (2016). Biologic therapies in the treatment of sarcoidosis. Expert Review of Clinical Immunology, 12(8), 817-825.
- Spagnolo, P., Rossi, G., Trisolini, R., Sverzellati, N., Baughman, R. P., & Wells, A. U. (2018). Pulmonary sarcoidosis. The Lancet Respiratory Medicine, 6(5), 389-402.
