Guest guest Posted May 6, 2004 Report Share Posted May 6, 2004 http://www.medscape.com/viewarticle/473349_1 From Topics in Advanced Practice Nursing eJournal Scleroderma: A Fascinating, Troubling Disease Posted 05/03/2004 Elaine A. Furst, RN, MA Abstract and Case Study Abstract Scleroderma is classified as a rare, autoimmune, collagen-vascular disease of unknown etiology that can be difficult to diagnose and treat. Its onset can be insidious or rapid; the symptoms range from challenging and painful to life threatening. Individuals may experience a range of symptoms different from the classic description of the disease, resulting in confused health professionals and frightened patients. The toll on lives, careers, and disrupted family and social roles can be overwhelming as well as destructive both to the patient and to loved ones. Because it is rare (the incidence rate for the systemic form is estimated to be 19 new cases per year per 1 million adults), many nurses and physicians have only read about scleroderma.[1] This article seeks to familiarize advanced practice nurses (APNs) and other clinicians with the major manifestations of scleroderma and to provide the information necessary for its recognition and symptom management. A list of resources is provided to assist with care planning. Case Study: Sara Has Unusual Symptoms but No Clear Diagnosis Sara is a 40-year-old woman who is ordinarily very active and busy with her family and her community, but her busy life is at a standstill. She has severe fatigue, arthralgias, and tight, itchy skin on her face, arms, hands, and trunk. She spends most of her days sitting up in the lounger in the living room because she is both fatigued and has constant heartburn. She has had frequent dental problems because of excessive dryness of her mouth. She describes a dwindling appetite and thus has had very poor nutritional intake for months. Sara is always cold, and her fingertips and nails are often numb, even in the summertime. There are 2 small, painful, digital ulcers on the knuckles of her right hand and 1 under the thumbnail on her left. Her fingers exhibit the beginnings of sclerodactyly, making it difficult for her to perform daily activities and household duties. Her internist has prescribed an antihistamine for the itching and a protein pump inhibitor for dyspepsia and told her to rest and " reduce the stress in your life. " She has been to see quite a few specialists about her complaints, including a psychologist, and none of them were definitive about the diagnosis. Sara is finally referred to a rheumatologist at a nearby university medical department who diagnoses systemic sclerosis. She and her husband are frightened, especially when she is prescribed methotrexate, which they know is a drug used in cancer. She types scleroderma into her computer search engine and discovers advertisements for herbal remedies for scleroderma, the site for the Scleroderma Foundation, and articles about scleroderma in women's magazines. This only adds to her confusion and worry. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2004 Report Share Posted May 8, 2004 Thanks for sending this article, Kathi. It's quite good. And here's some rheumatology trivia - Elaine Furst is married to rheumatologist E. Furst - world-class expert on systemic sclerosis. What a team! I'll tell you where to go! Mayo Clinic in Rochester http://www.mayoclinic.org/rochester s Hopkins Medicine http://www.hopkinsmedicine.org [ ] RE:Lets try this again... > http://www.medscape.com/viewarticle/473349_1 > > > > > From Topics in Advanced Practice Nursing eJournal > > Scleroderma: A Fascinating, Troubling Disease > Posted 05/03/2004 > > Elaine A. Furst, RN, MA > > Abstract and Case Study > Abstract > Scleroderma is classified as a rare, autoimmune, collagen-vascular > disease of unknown etiology that can be difficult to diagnose and > treat. Its onset can be insidious or rapid; the symptoms range from > challenging and painful to life threatening. Individuals may > experience a range of symptoms different from the classic > description of the disease, resulting in confused health > professionals and frightened patients. The toll on lives, careers, > and disrupted family and social roles can be overwhelming as well as > destructive both to the patient and to loved ones. Because it is > rare (the incidence rate for the systemic form is estimated to be 19 > new cases per year per 1 million adults), many nurses and physicians > have only read about scleroderma.[1] This article seeks to > familiarize advanced practice nurses (APNs) and other clinicians > with the major manifestations of scleroderma and to provide the > information necessary for its recognition and symptom management. A > list of resources is provided to assist with care planning. > > Case Study: Sara Has Unusual Symptoms but No Clear Diagnosis > Sara is a 40-year-old woman who is ordinarily very active and busy > with her family and her community, but her busy life is at a > standstill. She has severe fatigue, arthralgias, and tight, itchy > skin on her face, arms, hands, and trunk. She spends most of her > days sitting up in the lounger in the living room because she is > both fatigued and has constant heartburn. She has had frequent > dental problems because of excessive dryness of her mouth. She > describes a dwindling appetite and thus has had very poor > nutritional intake for months. > > Sara is always cold, and her fingertips and nails are often numb, > even in the summertime. There are 2 small, painful, digital ulcers > on the knuckles of her right hand and 1 under the thumbnail on her > left. Her fingers exhibit the beginnings of sclerodactyly, making it > difficult for her to perform daily activities and household duties. > > Her internist has prescribed an antihistamine for the itching and a > protein pump inhibitor for dyspepsia and told her to rest > and " reduce the stress in your life. " She has been to see quite a > few specialists about her complaints, including a psychologist, and > none of them were definitive about the diagnosis. > > Sara is finally referred to a rheumatologist at a nearby university > medical department who diagnoses systemic sclerosis. She and her > husband are frightened, especially when she is prescribed > methotrexate, which they know is a drug used in cancer. She types > scleroderma into her computer search engine and discovers > advertisements for herbal remedies for scleroderma, the site for the > Scleroderma Foundation, and articles about scleroderma in women's > magazines. This only adds to her confusion and worry. Quote Link to comment Share on other sites More sharing options...
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