249 Nursing Assessment, Management and Treatment of Autoimmune Diseases
● Lungs : If lung tissue is scarred, respiratory function can be impaired, leading to respiratory distress and possible pulmonary hypertension. ● Kidneys : If kidneys are impacted by scleroderma, hypertension may occur as well as increased protein levels in the urine. Kidney damage may also cause renal crisis that involves rapid kidney failure. ● Cardiac : If the tissue of the heart is scarred, arrhythmias, congestive heart failure, and pericarditis may occur. ● Teeth : If scleroderma causes severe facial skin tightening, the mouth may become smaller and narrower. If this occurs, it may be difficult for patients to brush their teeth or have dental work. Frequently, patients do not produce adequate amounts of saliva, which increases the risk of tooth decay. ● Gastrointestinal system : Digestive issues may cause heartburn and dysphagia. Cramps, bloating, constipation, or diarrhea may also occur. ● Sexual dysfunction : Men may experience erectile dysfunction. In women, sexual lubrication may decrease and the vaginal opening may narrow. Assessment and diagnosis A complete history and physical is con- ducted. Assessment of patients for vari- ous signs and symptoms are a critical part of the assessment and diagnostic process Signs and symptoms may include the fol- lowing (Mayo, 2019): ● Skin changes : Almost all patients with scleroderma have a hardening and tightening of patches of skin. Patches present as ovals, straight lines, or wide areas that may cover the trunk
and limbs. Skin may also appear shiny because it is so tight. There may be restriction of movement of affected areas. ● Fingers or toes : Raynaud’s disease is one of the earliest signs of systemic scleroderma. The small blood vessels of the fingers and toes contract when exposed to cold temperatures or when patients experience emotional distress. Fingers and toes may turn blue or become painful or numb. ● Gastrointestinal system : Symptoms depend on what part of the gastrointestinal system is affected. For example, an affected esophagus may lead to heartburn or dysphagia. If intestines are affected, cramping, bloating, diarrhea, and/or constipation may occur. There may be problems with absorption of nutrients if intestinal muscles fail to move food through the intestines in an efficient manner. ● Body systems : Scleroderma can affect any body organ or tissue. There may be heart, lungs, or kidney problems. If not treated, life-threatening complications may develop. Diagnostic tests Some diagnostic tests may be ordered to aid in diagnosis. These may include the following (American College of Rheuma- tology, 2019): ● X-rays and computerized tomography (CT) scans : These tests are ordered to look for abnormalities in the body. ● Thermography : Thermography can detect differences in skin temperature between affected and non-affected tissue.
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