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Learning Scope #308
1.5 contact hours
Expires June 8, 2011

Right Click Here to download the mp3 file, Definition & Development

1. Define and discuss scleroderma in terms of its diagnosis, treatment, acuity and progression.
2. Discuss the pathogenesis of scleroderma.
3. Plan the nursing care for a patient with scleroderma according to the patient's symptoms.

Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 008-0-07), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Merion Publications Inc. is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).

There are an estimated 300,000 people with various forms of scleroderma in the U.S., 75 percent of whom are females and in the 40-55 age range. Scleroderma is rare in children (less than 1 percent of cases) and usually manifests itself as morphea. People with diffuse forms of scleroderma can have moderate-to-severe symptoms that affect every aspect of their lives.

Scleroderma is a multisystem disease of unknown etiology that can affect the GI tract, muscles, joints, skin and underlying structures and tissues, kidneys, lungs, nerves and heart. Fatigue, disfigurement and depression are common along with psychosocial consequences such as loss of job, dysfunctional coping, financial difficulties and fear of death and disfigurement.

This article will familiarize you with the principal manifestations of systemic sclerosis so you will know when and where to refer these complicated patients.

Case Study

Sara is a 40-year-old woman whose busy life is at a standstill. She has severe fatigue 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 to help with the fatigue and gastroesophageal reflux disease (GERD). She describes a dwindling appetite with worsening of her nutritional status.

Sara is always cold and her fingertips and nails often are severely hyperemic. There are two small, painful digital ulcers on her right hand. Her fingers are beginning to curl, making it difficult for her to perform her ADLs and household duties.

She has seen quite a few specialists about her complaints, including a psychologist, and none of them could be definitive about the diagnosis. (Patients often report a period of 1-3 years from first signs and symptoms to actual diagnosis.)

Sara finally is 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 to treat cancer. She types scleroderma into her computer search engine and discovers ads for herbal remedies, the Scleroderma Foundation site and scary articles in women's magazines.