Chronic and Complex Nursing Care in Systemic Sclerosis - Case Study Example

? Chronic and Complex Nursing Care Systemic Sclerosis Systemic sclerosis (SSc) is defined as a multisystemic disease that is autoimmune affecting microvessels, small arteries and fibroblasts resulting in collagen accumulation, vascular obliteration and scaring of the skin and internal organs. This normally leads to hidebound skin as well as the damage of lungs, heart, gastrointestinal tract and kidneys (Vlachoyiannopoulos, 2009). Symptoms In gastrointestinal manifestations, the symptoms include bloating, abdominal cramps and distension due to aggravation of reflux. The musculoskeletal symptoms include pain, tendonitis, joint contractures, muscle weakness and arthritis. Urogenital symptoms include an increase in bladder wall, deposition of connective tissues and proliferative vascular lesions. In women, vaginal symptoms include tightness, dyspareunia and dryness. In men, there is a reduced penile blood flow leading to erectile dysfunction (Vlachoyiannopoulos, 2009). Prevalence The distribution of SSc is worldwide affecting all races. The prevalence of scleroderma has been estimated to be between 4 and 253 cases per million persons. Its susceptibility is influenced by factors such as sex, age, environmental exposure and genetic background. Family members may be affected by other connective tissue diseases meaning that a genetic factor might be an important factor in expression of the disease. The peak incidence is normally within the third and fifth decade of life. The ratio of male to female is approximately 5:1 while annual incidence being 14.1 cases per million. The highest prevalence for SSc has been found to be in Choctaw Native Americans in Oklahoma (Vlachoyiannopoulos, 2009). Treatment Therapy is normally individualized to each patient’s needs and clinical presentation due to the heterogeneity of SSc. The treatment is done for organ specific complications including: Raynaud Phenomenon This is done using long-acting channel blockers and angiotensin II receptor blockers. Phosphodiesterase-5 inhibitors are mostly used in the treatment of secondary Reynaud phenomenon. An oral endothelin-1 receptor inhibitor can be useful to the patients having recurrent ischemic ulcers (Eisenberg M.E. et al. (2008)). Scleroderma Renal Crisis Patients with systemic sclerosis are advised to regularly check their blood pressure at home. ACE inhibitors are used to control hypertension since they are essential in preserving and restoring of the renal function (Eisenberg M.E. et al. (2008)). Gastrointestinal Complications Therapies are essential in the control of gastrointestinal symptoms while preventing GERD complications. Patients with SSc and gastrical antral vascular ectasia normally require coagulation of the endoscopic laser to reduce the bleeding risks. Intestinal pseudo-obstruction is normally diagnosed during the laparotomy time while bacterial overgrowth is treated by antibiotics. The mainstays of therapy for the intestinal overgrowth are the antibiotics and correction of nutritional deficiencies (Eisenberg M.E. et al. (2008)). Pulmonary complications patients having an early and progressive interstitial lung disease may benefit from oral or intravenous cyclophosphamide. Symptomatic pulmonary arterial hypertension is treated by oral bosentan, parenteral epoprostenol, sidenafil, inhaled iloprost and treprostinil. Continuous oxygen is also necessary for patients with hypoxemia (Eisenberg et al, 2008) Lung cancer Lung cancer refers to cancer that forms in the tissues of the lungs, mostly in the cells that are lining air passages. The main types of lung cancer are: small cell lung cancer and non-small cell lung cancer. These types are normally diagnosed on the basis of how the cells look under the microscope (Wender R. et al, 2013). Symptoms Lung cancer may either present with symptoms or found incidentally on the chest imaging. Symptoms of lung cancer may result from the local invasion or the compression of adjacent thoracic structure like the compression involving esophagus which cause dysphagia, involving laryngeal nerves thereby causing hoarseness or involving superior venacava which causes the facial edema and the distension of the superficial veins of both the head and the neck. At presentation, the most common symptoms include the worsening cough or chest pain. Symptoms from distant metastases include personality change from brain metastases, neurological defect and pain from bone metastases. Physical examination may also identify enlarged supraclavicular lymphadenophathy, unresolved pneumonia and lobar collapse or pleural effusion (Lung cancer in the republic of Ireland, 2011). Prevalence Anyone may develop lung cancer but the risks of cancer diagnosis increases with age. Therefore, it mostly occurs in adults that are middle aged or older. The larger percentage (77%) of those diagnosed with lung cancer are 55 years of age or older. The prevalence rate is expressed in terms of lifetime risk. This refers to the probability that one will develop and die of cancer in the course of the lifetime. Relative risk is a measure of strength of the relationship that exists between cancer and a risk factor. These risks include factors causing lung cancer including smoking and hereditary factors (American Cancer Society, 2013). Treatment The right treatment depends on the type of cancer and its stage though one may receive different types of treatment. At a given stage of lung cancer, care is essential to control pain and also manage the breathing problems, ease emotional concerns and get treatment for the side effects. The healthcare team includes specialists including: chest surgeon who specializes on lungs surgery and organs that are inside the chest, thoracic surgical oncologist who specializes on lung tumors and those other tumors found in the chest, medical oncologist who specializes on treatment of cancer with drugs like targeted therapy and chemotherapy and radiation oncologist who treats cancer with the radiation therapy. The healthcare team also includes a social worker, oncology nurse and a registered dietitian. A respiratory therapist or pulmonologist may also be referred if the patient has problems with breathing (American Cancer Society, 2013). Impact of co-morbidity The diagnosis of cancer does not imply an automatic diagnosis in scleroderma nor does it mean that one having scleroderma will acquire cancer inevitably. Scleroderma affects people differently and there are no any predictable courses of illness, either in its progression, illness or outcome. However it has been found that the risks of cancer are high for those having systemic scleroderma. The pathogenic link existing between lung cancer and SSc is said to be the fibrotic and inflammatory environment combined with the abnormalities of immunology that is noted in these patients, which in some cases predispose to the development of cancer. Cancer can also develop due to the extended use the immunosuppressive agents (Archontogeorgis K, 2012). Role of Nurses 1. Empowerment Being empowered refers to the state of acting with integrity so as to create a suitable environment that people can develop, competence, character and synergy. Nurses advocate for their patients and themselves. They work together with each other and the patients in and thereby embracing teamwork and interdependence. Public health nursing has three functions in relation to empowerment: health promotion, curative engagement and political advocacy (Cawley T., 2012). 2. Education Nurses have a role of educating the patients based on their health status and their way of living. This will help them live a healthy life and stay away from diseases (Jones & Bartlet). 3. Advocacy This implies speaking for something that is important. Nurses need to be advocates for patients, families, themselves and for the profession. To do this, nurses must feel empowered and also be assertive. Their goal is to have a positive, accurate and informative response (Jones & Bartlet). Conclusion In conclusion, there are risks associated with our health. Some are unavoidable while it is possible to reduce others. Public awareness can be used to reduce the mortality rates due to health issues. These include campaigns against smoking and insisting on regular check-ups. Patients suffering from Scleroderma should be checked regularly for early detection of cancer as they are more vulnerable. References Archontogeorgis K et al(2012). Lung cancer and interstitial lung diseases: a systematic review. Vol 2012. Retrieved from: http://www.google.co.ke/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&sqi=2&ved=0CD8QFjAB&url=http%3A%2F%2Fdownloads.hindawi.com%2Fjournals%2Fpm%2F2012%2F315918.pdf&ei=j6hQUe7wO8qN7QbJr4DIBg&usg=AFQjCNExlrb8I48F1iRBmoKvfbSmnBTXXA&bvm=bv.44158598,d.ZGU Aberle DR, Adams AM, Berg CD, et al. (2011): Reduced lung-cancer mortality with low-dose Computed tomography screening. N Engl J Med 365 (5): 395-409,. American Cancer Society (2013). Cancer Facts and Figures 2013. Atlanta, Ga: American Cancer Society. Retieved March 23, 2013 from Cawley T. (2012). How can the Empowerment role of public health Nurses be fostered? A Review of an Exploratory Research Study Conducted in Ireland and Current Evidence, Public Health – Social and Behavioral Health, Prof. Jay Maddock (Ed.), ISBN: 978-953-51-0620-3.. Retrieved from: http://www.intechopen.com/books/public-health-social-and-behavioral-health/how-can-the-empowerment-roleof-public-health-nurses-phns-be-fostered-a-review-of-an-exploratory-res Eisenberg M.E, Nguyen B. Y & Karnath B. M. (2008). Clinical features of Systemic Sclerosis: Systemic Sclerosis. Retrieved on 23rd March 2013 from: http://www.turner-white.com/memberfile.php?PubCode=hp_jan08_sclerosis.pdF Jones & Bartlet. Image of nursing: what it is and how it needs to change. Retrieved from Lung cancer in the republic of Ireland (2011). Lung cancer incidence, mortality, treatment and survival in the Republic of Ireland: 1994-2008: National cancer Registry, Cork, Ireland. Michael C. (2012). Breathless: The New England Journal. Messachusetts medical society. Retrieved from: http://www.nejm.org/doi/pdf/10.1056/NEJMcps1011918 Ries L, Eisner M, Kosary C, et al. (2005). : Cancer Statistics Review, 1975-2002. Bethesda, Md: National Cancer Institute. Varga J & Hinchcliff M. (2009). Systemic Sclerosis/Scleroderma: A treatable multisystemdisease. Northwestern university, Feinberg School of Medicine, Chicago, Illinois. Vlachoyiannopoulos PG. (2009). Systemic Sclerosis (Scleroderma): Orphanet encyclopedia. Wender R, Fontham E, Barrera E, et al. (2013). American cancer society lung cancer screeing guidelines: CA Cancer journal for clinicians. Retrieved from: http://www.cancer.org/acs/groups/cid/documents/webcontent/003116-pdf.pdf What you need to know about cancer (2012). National Cancer Institute: NIH publication No. 12- 1553. Retrieved from: http://www.cancer.gov/cancertopics/wyntk/lung/wyntk_lung.pdf Read More