Hospital care plan endorsed

The New Zealand Rheumatology Association has endorsed a hospital care plan prepared by Dianne, Gordon and Maureen.

The leaflet aims to help nurses and other health professionals manage patients in hospital with scleroderma.

It is a check-list of some of the main problems a person with scleroderma may experience and how to manage these problems.

 

Common SymptomManagement
Raynaud’s phenomenon, including internal Raynaud's
Provide extra blankets. Keep core warm. Avoid drafts. Maintain warmth particularly pre & post-op.
Ulceration, Impaired healing
Assess for signs of infection. Provide appropriate dressings. Assist with activities of daily living as necessary. Refer to occupational therapist as necessary.
Tight skin
Provide protection during surgery and/or procedures. Assess for signs of skin breakdown. Extra care required with venipuncture and blood pressure measurement.
Dry skin
Assist with moisturising as required. Regular moisturising if important.
Painful hands and feet
Avoid injury, e.g. during transfer and ambulation.
Painful joints
Assist with repositioning. Provide extra pillows. Use massage and the application of heat. Assess pain and anti-inflammatory medications. Physiotherapy assessment. Encourage ambulation as tolerated. If available the extra thick mattresses.
Impaired movement and mobility
Assistance may be required with feeding, oral hygiene and other daily care. Possible difficulties with intubation. Important to sit upwards for meals to aid digestion. Assistance with walking, watch for balance issues.
Dry mouth, dry eyes (Sicca symptoms, Sjögren's Syndrome)
Ensure drinking water is readily accessible. Maintain good oral hygiene especially when patient unable to drink. Assist with application of eye drops or ointment if patient unable to self-administer, particularly pre and post-op and prior to sleeping. Provide sugar free gum if tolerated by patient.
Oesophageal involvement including difficulty swallowing
Elevate head of bed. Provide extra pillows. Position the patient in an upright position when eating and after meals. Administer antacids as required. Discuss food preferences while ensuring adequate and appropriate dietary intake. Consult with dietician as necessary. Monitor if using a feeding tube. Easy to eat food, soft, small meals often. Straws for drinking. Watch for choking.
Bowel involvement; diarrhoea and/or constipation; faecal incontinence
Assess for dietary requirements and medication regime. Consult with dietician as necessary.
Shortness of breath on exertion
Allow patient to set the pace during physical activity. Assess O2 saturation and need for oxygen. Refer to respiratory therapist as needed.
Reduced capacity to cope
Create calm, supportive environment. Encourage stress reduction and relaxation techniques. Refer for social work assessment. Limit visitors, group cares together
Increased skin sensitivity
Take extra care as patient has a low pain threshold. Ask nurses to remove watches or jewellery so skin tears don’t occur.
Blood pressure irregularities, pulmonary arterial hypertension and pre-operative guide
It may signal kidney impairment requiring immediate intervention. If patient has pulmonary arterial hypertension, the anaesthetist needs to be alerted well in advance as anaesthesia carries increased risks. Extra care required with intubation. Maintain warmth to allow for optimal venous access.
Preparation for sleep. Insufficient clearance of mucus/saliva from airway can create breathing difficulties. Weakness of neck muscles – hard to find comfortable sleeping position.
Administer nebuliser just before bed-time, elevate head of bed. NB – For tall patients: if backrest is tilted, the foot of the bed may need to be extended. Arrange pillows – ‘armchair’ position may help. A rolled-up small towel may give support to the neck.