SARCOIDOSISDefinitionCause / EtiologyClinical ManifestationsPathophysiologyDiagnostic TestsMedical ManagementNursing Management

Definition• Sarcoidosis is an inflammatory condition that affects

many body systems.• Its onset typically occurs between 20 & 40 years of age, it

can be present in children and older adults.• It is characterized by the formation of wide spread

granulomatos lesions. In addition to lung involvement which occurs in more than 90% of cases, clients may present with clinical manifestations involving the peripheral lymphatic system, eyes, skin, liver, spleen, bones, salivary glands, joints, nervous system, and heart.

Causes / Etiology• The causes of sarcoidosis remains unknown.• It is suggested that a triggering agent (which

may be genetic, infections, immunologic, or toxic) stimulates enhanced cell-mediated immune process at the site involvement.

Clinical Manifestations• There maybe no symptoms. When symptoms

occur, they can involve any body part or organ systems in the body.

• Almost all patients have lung and chest symptoms:

Chest pain (most often behind your breastbone)

Dry cough Shortness of breath

HemoptysisPneumothorax

• Symptoms of general discomfort or uneasiness often occur:

FatigueFeverArthralgiaOverall feeling of discomfort, illness, or

lack of well-beingWeightloss

• Skin symptoms:Hair lossErythema nodosumRashScars that become raised or inflamed

• Nervous System symptoms:HeadacheSeizuresWeakness on one side of the face

• Eye symptoms:Burning sensationDischarge from the eyeDry eyesIthchingPainVision loss

• Other symptoms include:Dry mouthNosebleed

• Hemoptysis

• Pneumothorax

Pathophysioloy

Race: African-American Age: 20-40 years old

Etiology: unknown Maybe caused by: Infection Immunologic response Toxins

Stimulates enhanced cell mediated immune processes at the site of involvement: (90% of cases involve the lungs)

Series of interactions between T-lymphocytes and monocytes macrophages leads to formation of non-cascading granulomas.

Lungs: Dry cough Shortness of breath Chest pain Hemoptysis Pneumothorax Fever Fatigue Wheezing

Eyes: Burning sensation Discharge from the eyes Dry eyes Itching Pain

Nervous System Headache Seizures Weakness on one side of the face

Skin: Hair loss Erythema nodosum Rash Scars that became raised or inflamed

Other sites: Lymphatic System Heart Liver Spleen Bones Salivary glands Joints

Aspergilloma Pulmonary fibrosis

Death

Glaucuma

Blindness

Systemic Corticosteroid/ Methotrexate

Hydroxychloro quine

LEGEND: Intervention

Diagnostic Tests• Physical Examination result:

Abnormal breath soundsEnlarged liverEnlarged lymph glandsEnlarged spleenRash

• Different imaging test:Chest x-rayCT scan of the chestLung gallium scanBronchoscopyBronchoalveolar lavageMediastinoscopyOpen-lung biopsy

• For definitive diagnosis tissue biopsy is performed.

• This disease may affect the laboratory result of the following:

Calcium levelsComplete Blood CountImmunoelectrophoresis-serumLiver Function TestQuantitative immunoglobulinSerum phosphorus

Medical Management• Medical management is primarily determined

by the extent to which the client’s life is disturbed by the manifestations experienced.

• If the client with sarcoidosis is asymptomatic, management involves ongoing assessment for further disease progression, such as obtaining a chest radiograph every 6 months.

• When manifestations are present, medical treatment usually consist of systemic corticosteroids to suppress the immune process and often leads to improvement.

Nursing Management• Nursing intervention in clients with sarcoidosis

is the same as that in clients with other restrictive lung diseases and hypoxemia.

• Access for drug side effects, especially adverse responses to corticosteroids (such as weight gain, change in mood, and development of diabetes mellitus).

• Also assess for manifestations of improvement, such as increased exercise tolerance, disappearance of initial assessment findings, improvement of pulmonary function studies, and better oxygenation.

• If assessment findings worsen, document them and notify the physician.

References:• Drake W, Newman LS. Sarcoidosis. In: Mason RJ, Broaddus

VC, Martin Tr, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 59.

• Iannuzzi MC, Rybicki Ba, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357:2153-2165.

• Weinberger SE. Sarcoidosis. Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa:Saunders Elsevier; 2007:chap 95.

• Sharon L. Lewis, et al., Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 7th ed. Mosby Inc., p. 597