5 Appendices
5.5 Mid Term Quiz
DISEASES; SARCOIDOSIS
CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content
3.1 Occupational Lung Diseases: Pneumoconioses 3.2 Sarcoidosis
4.0 Conclusion 5.0 Summary
6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
Laws require work areas to be safe in terms of dust control, ventilation, protective masks, hoods, industrial respirators, and other protection.
Workers are encouraged to practice healthy behaviors, such as quitting smoking. Dyspnea and cough are the most common symptoms of occupational lung diseases. Those exposed to coal dust may expectorate black-streaked sputum.
2.0 OBJECTIVES
At the end of this unit you will be able to:
• describe preventive measures appropriate for controlling and eliminating the problem of occupational lung disease
• describe the pathophysiology, medical and nursing managements of sarcoidosis.
3.0 MAIN CONTENT
3.1 Occupational Lung Diseases: Pneumoconioses
Exposure to organic and inorganic dusts and noxious gases over a long period can cause chronic lung disorders. Pneumoconiosis refers to a fibrous inflammation or chronic induration of the lungs after prolonged exposure to dust or gases. It specifically refers to diseases caused by the inhalation of
73 silica (silicosis), coal dust (black-lung disease, miners’ disease), or asbestos (asbestosis). The resulting effect is referred to as restrictive lung disease, which means that the lungs have decreased volume and inability to expand completely. Although these conditions are not malignant, they may increase the client’s risk for development of malignancies.
The primary focus is prevention, with frequent examination of those who work in areas of highly concentrated dust or gases.
Diagnosis
The diagnosis is based on the history of exposure to dust or gases in the workplace. A chest radiograph may reveal fibrotic changes in the lungs.
The results of pulmonary function studies usually are abnormal.
Treatment
Treatment typically is conservative because the disease is widespread rather than localized. Surgery seldom is of value. Infections, when they occur, are treated with antibiotics. Other treatment modalities include oxygen therapy if severe dyspnea is present, improved nutrition, and adequate rest. Many people with advanced disease are permanently disabled.
Nursing management
Nursing management of clients with occupational lung diseases is basically the same as for clients with emphysema. Many clients require a great deal of emotional support because these diseases may result in permanent disability at a relatively young age.
3.2 Sarcoidosis
Sarcoidosis is a multisystem, granulomatous disease of unknown etiology.
It may involve almost any organ or tissue but most commonly involves the lungs, lymph nodes, liver, spleen, central nervous system, skin, eyes, fingers, and parotid glands. The disease is not gender-specific, but some manifestations are more common in women.
Pathophysiology
Sarcoidosis is thought to be a hypersensitivity response to one or more agents (bacteria, fungi, virus, chemicals) in people with an inherited or acquired predisposition to the disorder. The hypersensitivity response results in granuloma formation due to the release of cytokines and other substances that promote replication of fibroblasts. In the lung, granuloma infiltration and fibrosis may occur, resulting in low lung compliance, impaired diffusing capacity and reduced lung volumes.
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Signs and symptoms
A hallmark of this disease is its insidious onset and lack of prominent clinical signs or symptoms. The clinical picture depends on the systems involved. With pulmonary involvement, signs and symptoms may include dyspnea, cough, hemoptysis, and congestion.
Generalized symptoms include anorexia, fatigue, and weight loss. Other signs include uveitis, joint pain, fever, and granulomatous lesions of the skin, liver, spleen, kidney, and central nervous system. The granulomas may disappear or gradually convert to fibrous tissue. With multisystem involvement, the patient has fatigue, fever, anorexia, weight loss, and joint pain.
Assessment and Diagnostic Findings
Chest x-rays and CT scans are used to assess pulmonary adenopathy. The chest x-ray may show hilaradenopathy and disseminated miliary and nodular lesions in the lungs. A mediastinoscopy or transbronchialbiopsy (in which a tissue specimen is obtained through the bronchial wall) may be used to confirm the diagnosis. In rare cases, an open lung biopsy is performed. Pulmonary function test results are abnormal if there is restriction of lung function (reduction in total lung capacity). Arterial blood gas measurements may be normal or may show reduced oxygen levels (hypoxemia) and increased carbon dioxide levels (hypercapnia).
Medical Management
Many patients undergo remission without specific treatment. Corticosteroid therapy may benefit some patients because of its anti-inflammatory effect, which relieves symptoms and improves organ function. It is useful for patients with ocular and myocardial involvement, skin involvement, extensive pulmonary disease that compromises pulmonary function, hepatic involvement, and hypercalcemia. Other cytotoxic and immunosuppressive agents have been used, but without the benefit of controlled clinical trials.
There is no single test that monitors the progression or recurrence of sarcoidosis. Multiple tests are used to monitor the involved systems.
4.0 CONCLUSION
Occupational lung diseases or pneumoconiosis refers to a fibrous inflammation or chronic induration of the lungs after prolonged exposure to dust or gases.
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5.0 SUMMARY
In this unit, you have learnt that:
• Dyspnea and cough are the most common symptoms of occupational lung diseases.
• Sarcoidosis is a multisystem, granulomatous disease of unknown etiology.
• Pneumoconiosis includes silicosis and asbestosis.
6.0 TUTOR-MARKED ASSIGNMENT
1. Describe preventive measures appropriate for controlling and eliminating the problem of occupational lung disease.
2. Describe the pathophysiology, medical and nursing managements of Sarcoidosis.
7.0 REFERENCES/FURTHER READING
Bullock, B.A., & Henze, R.L. (2000). Focus on pathophysiology.
Philadelphia: Lippincott Williams & Wilkins.
Burke, K.M; Mohn-Brown, E.L & Eby, L (2011). Medical-Surgical Nursing Care. (3rd ed.). Boston: Pearson Education, Inc.
Nettina, S.M (2010). Lippincott Manual of Nursing Practice (9thed). China:
Wolters Kluwer Health Lippincott Williams & Wilkins.
Rueling, S., & Adams, C. (2003). Close to the vest: a novel way to keep airways clear. Nursing 2003, 33(12), 56–57.
Smeltzer, S. C., Bare, B. G., Hinkle, J. L. & Cheever, K. H. (2008).
Brunner & Suddarth’s Textbook of Medical–Surgical Nursing(11th ed.). Philadelphia: Lippincott Williams &Wilkins.
Timby, B.K & Smith, N.E (2010). Introductory Medical-Surgical Nursing (10th ed.).Philadelphia: Wolters Kluwer Health Lippincott Williams & Wilkins.
Williams, L.S & Hopper, P.D (2003). Understanding Medical-Surgical Nursing. Philadelphia: F. A. Davis Company.
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