Scleroderma Nursing Diagnosis and Nursing Care Plan

Scleroderma Nursing Care Plans Diagnosis and Interventions

Scleroderma NCLEX Review and Nursing Care Plans

Scleroderma is an umbrella term for a group of autoimmune diseases that result in the hardening and tightening of the skin and connective tissues.

It occurs when a person’s immune system attacks the tissues, blood vessels, or internal organs underneath the skin. The damage results in the scarring of tissues in the said areas.

Scleroderma affects about 2.5 million people worldwide and is seen more often in women aged between 30-50 years.

There is no cure for scleroderma, however, treatments are available to manage symptoms and improve the quality of life. 

Types of Scleroderma

Scleroderma has two main types: localized and systemic.

  1. Localized scleroderma – commonly affects the skin only
  2. Systemic scleroderma – includes the involvement of internal organs such as the heart, lungs, or kidneys

Signs and Symptoms of Scleroderma

The signs and symptoms of scleroderma vary depending on the type and organs involved. The following are the most common signs and symptoms noted:

  • Hard and tight patches of skin – The patches of hard and tight skin can vary in shapes and sizes. They can be small or big enough to cover wide areas such as the trunk or limbs. They can also be small oval or linear patches. The patches may also appear shiny and may restrict movement in the affected area.
  •  Raynaud’s disease – Raynaud’s disease is a common symptom both in localized and systemic scleroderma. This is a circulatory or vascular disease that causes the toes and fingertips to turn blue (cyanosis). It is one of the earliest signs of scleroderma.
  • Digestive symptoms – The digestive tract can be affected by the damage caused by scleroderma. The digestive symptoms can vary depending on the organ affected. Heartburn and dysphagia are common when the esophagus is affected while bloating, cramps, diarrhea, or constipation are associated when the intestines are involved. Scleroderma can also cause issues with nutrients absorption.
  • Heart, lungs, kidney-related symptoms – major organs may also be involved in scleroderma. Symptoms relating to the function of the heart, lungs, and kidneys may be present depending on the degree of damage.

Causes of Scleroderma

 Scleroderma occurs when the immune system becomes hyperactive and attacks the healthy connective tissues under the skin, blood vessels, and/or other organs in the body.

The damage to the tissues causes the overproduction of collagen which is a protein that makes up connective tissues including the skin.

The exact cause of this immune-mediated disease is still unknown. It is believed that genetics and environmental factors play a role in its etiology.

Complications of Scleroderma

Scleroderma can cause the following complications on certain organs or parts in the body.

  1. Raynaud’s disease. Raynaud’s disease is highly associated with scleroderma. The damage at the fingertips and toes can cause severe blood flow restriction causing permanent damage.
  2. Lung problems. Scarring in the lungs can cause reduced lung function that can affect the ability to complete vigorous activities. Also, scleroderma can lead to pulmonary hypertension.
  3. Kidney issues. Complications in the kidneys include hypertension, accumulation of protein, and renal crisis. Renal crisis is a serious complication involving hypertension and a rapid decline in kidney function.
  4. Cardiac arrhythmias. Arrhythmias can occur due to the scarring of heart muscles.
  5. Oral problems. The complications are related to the narrowing of the mouth caused by the tightening of the skin. This further leads to difficulty in brushing the teeth leading to tooth decay and gum problems. Also, people with scleroderma produce less saliva which increases the risks for complications even more.
  6. Malabsorption and weight loss. Scleroderma can lead to malabsorption of nutrients.
  7. Sexual dysfunction. In men, erectile dysfunction is a known complication. In women, decreased lubrication and constricting of the vaginal opening are the common worries.

Diagnosis of Scleroderma

The diagnosis of scleroderma typically starts with Raynaud’s disease. When the suspicion arises, the following procedures and tests are performed:

  • Medical History and Physical Examination
  • Antinuclear antibodies (ANA) blood test – checks the presence of an overactive immune system which is commonly noted in people with autoimmune disease.
  • Biopsy – tissue sample from the affected skin is examined for abnormalities.
  • Pulmonary function tests and a scan of the lungs- to measure the functions of the lungs may be performed to rule out systemic scleroderma.
  • Other tests may be performed to identify the involvement of other organs, such as imaging of the lungs, kidneys, and the heart.

Treatment for Scleroderma

Mild forms of scleroderma may not need treatment as the symptoms may disappear between 2-5 years.

However, serious cases, especially systemic scleroderma, may need a series of treatments to manage the disease and prevent complications.

  1. Medications. The medications used in scleroderma will not cure the disease, but they can help manage symptoms:
    • Steroid creams or tablets to treat the hard and tight skin patches
    • Medications to dilate blood vessels
    • Medications to suppress the immune system
    • Drugs to address digestive symptoms
    • Antibiotics to treat infection
    • Painkillers may also be given to relieve any pain if present
  2. Therapies. Physiotherapy and occupational therapy can help cope with the pain and mobility changes.
  3. Surgery. Surgical treatments are the last option in the treatment of scleroderma.
    • Amputation – amputation of fingertips toes may be necessary for Raynaud’s disease
    • Lung transplant – scarring in the lungs can cause a severe decline in lung function

Nursing Diagnosis Scleroderma

Scleroderma Nursing Care Plan 1

Nursing Diagnosis: Ineffective Tissue Perfusion (Peripheral) related to decreased peripheral blood flow (Raynaud’s disease) secondary to Scleroderma, as evidenced by pale, reddish, or bluish hands or feet, pain on the affected area, Raynaud’s phenomenon (fingers and toes turn pale when exposed to cold), digital numbness and weakness

 Desired Outcome: The patient will be able to achieve optimal tissue perfusion in the affected areas as evidenced by having strong and palpable pulses, regained leg strength, and reduced pain.

Scleroderma Nursing InterventionsRationales
Assess the patient’s vital signs at least every 4 hours, or more frequently if there is a change in them.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment for scleroderma.
Encourage the patient to cooperate in the smoking cessation program. Administer nicotine patch as prescribed. Manage tobacco withdrawal symptoms as they appear.Although the relationship between tobacco use and Raynaud’s disease is unknown, smoking cessation still proves to be the main intervention to manage the disease.  
Prepare the patient for the surgical procedure as indicated. Preparation involves educating the patient, gaining their consent, and accomplishing a pre-operative checklist.Regional sympathetic block or ganglionectomy can be done surgically to promote vasodilation and improve blood flow. In cases of gangrene and/or ulceration, conservative debridement of necrotic tissue is highly recommended. Amputation may be required to save the rest of the fingers/limb.
Administer vasodilators as prescribed.To help dilate the blood vessels and improve the blood flow to the affected area/s.
Administer analgesics as prescribed.To provide pain relief especially in the affected area.
Ensure adequate hydrationIncreased blood viscosity is a contributory factor to clotting. Adequate hydration helps reduce blood viscosity.

Scleroderma Nursing Care Plan 2

Nursing Diagnosis: Impaired physical mobility related to hardening and tightening of the skin secondary to scleroderma, as evidenced by presence of hard and tight patches in the affected skin, inability to do activities of daily living (ADLs) as normal, and verbalization of overwhelming tiredness/ fatigue

Desired Outcome: The patient will be able to perform activities of daily living within the limits of the present condition.

Scleroderma Nursing InterventionsRationales
Assess the patient’s level of functional mobility and ability to perform ADLs.To assist in creating an accurate diagnosis and monitor effectiveness of treatment and therapy.
Assist the patient during exercises and when performing activities of daily living.To encourage the patient to perform muscle-strengthening exercises and promote dignity by allowing the patient to perform their ADLs while maintaining safety.
Ensure the safety of the environment. Check that the call bell is within reach, the bed rails are up when the patient is on the bed, the bed is in the lowest level, the room is well-lit, the floor is not slippery, and that important things like phone and eyeglasses are easy to reach.To maintain patient safety and reduce the risk of falls.      
Encourage the patient to perform range of motion (ROM) exercises in all extremities.To improve venous return, muscle strength, and stamina while preventing stiffness and contracture deformation.
Administer steroid creams or tablets as prescribed.To treat the hard and tight skin patches and help the worsening of these symptoms.
Refer to the physiotherapy and occupational therapy team.To provide a specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing.

Scleroderma Nursing Care Plan 3

Nursing Diagnosis: Diarrhea related to damage of the digestive tract secondary to scleroderma as evidenced by loose, watery stools, abdominal cramping and pain, increased urgency to defecate, tenesmus, and increased bowel sounds

Desired Outcome: The patient will be able to return to a more normal stool consistency and frequency.

Scleroderma Nursing InterventionsRationales
Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool chart.To monitor the patient’s bowel pattern.
Administer medications as prescribed.To help decrease the frequency of stools and alleviate diarrhea, the doctor may prescribe anti-diarrheals and antispasmodics.  
Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Avoid cold drinks. Check if the patient is in any fluid restriction before doing so.To help ensure that the patient will not have dehydration due to severe diarrhea. Cold drinks can increase intestinal motility.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and avoid high fiber, high fat foods.To relieve abdominal pain and cramping, alleviate diarrhea, and to promote healthy food habits. High fiber and high fat foods can cause irritation in the intestines.
Start the patient on a nothing by mouth status, and gradually progress to clear liquids, followed by bland diet, and the low residue diet. The patient can then have a low fat/residue, low fiber diet on a long-term basis, as recommended by the dietitian.Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to a low fat and low fiber diet can help manage the symptoms of diarrhea.  

More Scleroderma Nursing Diagnosis

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

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