CASE PRESENTATION: LEPROSY

I. INTRODUCTION

A. BACKGROUND OF THE STUDY

Leprosy has been a public health problem in the Philippines for
several decades. The disease is unequally distributed throughout
the country. In 1987, in the provinces of Ilocos Norte and Ilocos
Sur, Abra, Sulu, Palawan, Cebu and La Union, Pangasinan and
Metro Manila, the prevalence rate ranged from 0.40 to 3.01 per
thousand populations. In other provinces, the prevalence rate is
lower than 0.40/1000 population. The National Prevalence Rate as
of 1998 was 0.65/1000. (Community Health Nursing Services in
the Philippines, 9th edition, page 215)
The nationwide implementation of Multi-Drug Therapy (MDT)
since 1988 has resulted in the decrease in the prevalence rate of
leprosy. The prevalence rate of the disease declined from
7.2/10,000 population in 1986 to 1.2/10,000 population in 1997.
Since then, the treatment of leprosy has shifted from institutional
care to that of home treatment
Leprosy (Hansen’s disease; Hansenosis; Lepra; Leontiasis) is a
chronic disease with an insidious onset, transmitted from man to
man, affecting the skin, mucous membranes and nervous tissue,
and eventually producing deformities. This chronic, mildly,
infectious disease is caused by rod-shaped bacilli, Mycobacterium
Leprae or leprosy bacilli or Hansen’s bacillus.

B. RATIONALE FOR CHOOSING THE CASE

Most of our patient assignments are Non-Hansen patient,
meaning they are not affected with the Mycobacterium Leprae.
Since our focus is Patient Care Management and we are in a
Leprosarium, we choose the case of Hansen patient or patient
affected with the Mycobacterium Leprae because it would help us
to have a focus study regarding this case—more nursing care
would be given. Added to that, we choose the client because of
the fact that she is cooperative in the sense that she always try to
answer the questions asked in her full knowledge and try to
verbalize anything that she wants to say.
 C. LEARNING OBJECTIVES
(1) To explore patient’s past health history prior to Leprosy
(2) To review the body system involve in Leprosy (anatomy
and physiology)
(3) To review the disordered function of the body related to
Leprosy (pathophysiology)
(4) To review the laboratory results and compare it to normal
and the implication of the abnormal
(5) To make a list of nursing problems
(6) To prioritize listed nursing problems
(7) To make Nursing Care Plan for prioritized problem
(8) To make a health teaching to the client and other potential
candidates regarding about Leprosy

II. CLINICAL SUMMARY

A. GENERAL DATA
Name: V.C.
Age: 25 years old
Birth date: January 24, 1979
Birth place: Cebu
Sex: Female
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single
Address: Caloocan City
Ward/Accommodation/Service: Female Ward/Charity/Medicine
Patient Category: Non regular Hansen
Date Admitted: November 13, 2006
Time Admitted: 3:00pm
B. HISTORY OF PRESENT ILLNESS
The client stated that she is having difficulty walking to
different areas of the hospital because she experiences
shortness of breath. She verbalized, “Dito sa kama ko hanggang
diyan sa kubeta hinihingal na ako”, “Simula nung napasok na
ako dito ganyan na yung nararamdaman ko”.
The client was admitted at Dr. Jose N. Rodriguez Memorial
Hospital, Tala, Caloocan City last November 13, 2006 at around
3 o’ clock in the afternoon

C. PAST MEDICAL HISTORY

--When asked about the client’s perception on how does that
disease got into her. The client states that “Sa kuya ko, kasi mas
nauna syang nagkaroon ng ganito….” “Sa aming magkakapatid
kami yung close talaga, inaalagaan ko rin kasi yun” “That time,
may sugat ako”

1. Childhood Illnesses
--The client verbalized, “Nagka-asthma ako nung grade 1
hanggang gade 5”

2. Immunizations
--According to the client, “Wala akong bakuna”

3. Allergies
--The client stated that she doesn’t have any allergies

4. Accidents
--According to the client, "Nahulog ako sa hagdanan nung
mga 2 years old ako”

5. Hospitalization
-- The client verbalized, “Na-ospital ako nang 1-2 years, dahil
dun sa aksidente”

6. Medicines
--Her medicine are part of MDT (Multi Drug Therapy)—
Rifampicin, Dapsone and Clofazimine
 7. Foreign Travel
--According to the client she doesn’t have travels outside the
country.

8. Operation
--According to the client, she doesn’t gone any operations

D. FAMILIAL HISTORY
-- According to the client, diabetes and hypertension are
common in her family specifically from her father’s side and
kidney disease from her mother’s side.

GENOGRAM
Father Mother

Hx of DM & HPN Hx of Kidney Disease

Patient
(25 years old)

Brother
(24 years old)
with Leprosy

Sister
(23 years old)

Sister
(20 years old)

Brother
(16 years old)

Sister
(14 years old)
E. PHYSICAL ASSESSMENT

BODY PARTS NORMS ACTUAL FINDINGS INTERPRETATION AND

ANALYSIS

Skin Varies from light Skin lesions all Not normal.

to deep brown; over the body. The cardinal signs
from ruddy pink; Loss of of leprosy are the
from yellow sensation on ff:
overtones to the skin lesions. --Loss of sensation
olive on the skin
(pg. 538, lesions.
Fundamentals of --Enlargement of
Nursing by peripheral nerves.
Kozier, 7th --Presence of
edition) leprosy bacilli in
the skin smear.
Loss of sensation
can cause further
damage to skin.

F. PATTERNS OF FUNCTIONING

a. Psychological Health

1. Coping Pattern
According to the client, the people significant to her are her
parents, siblings and relatives. When in times that the client feel
stressed the client just tends to be quiet.

ANALYSIS: Coping maybe described as dealing with problems

and situations, or contending with them successfully. Coping
strategies varies among individuals and are often related to the
individual’s perception of stressful events. A person’s coping
strategies often change with a reappraisal of a situation.
(Fundamentals of Nursing by B. Kozier, 7th edition, p 1020)
INTERPRETATION: Effective Coping Pattern
2. Interaction Pattern
According to the client the people in her family are her father,
step-mother and siblings. She said that she usually express her
feelings and thoughts to other indirectly but most of the times
verbally. According to her she doesn’t find ways to blame others
for something she did. Then after the client verbalized, “Sa
aming magkakapatid mas kadikit ko yung sumunod sa’kin.”

ANALYSIS: Interaction patterns involve ways of expressing

affection, love, sorrow, anger and other feelings and thought in
most significant family in person and life. Openness of
communication with all family members develops the family’s
ability to function as a cooperative, growth producing unit.
(Fundamentals of Nursing by B. Kozier, 7th edition, p 671) Illness
limits an individual psychosocial world. As a result of sickness,
the ability to interact w/ others becomes limited of effects on
personl stamina, social activity and mobility. (Charlotte
Eliopoulos, Assesment of Older Adult 2nd edition p. 131)
INTERPRETATION: Effective/ Normal Interaction Pattern

3. Cognitive Pattern
The highest formal education of the client was High school
graduate.

ANALYSIS: Changes in the cognitive function of middle adults are

rare except with trauma or illness. The middle aged adults are
able to continue learning new skills and can reflect on the past
and current experience and can imagine, anticipate, plan and
hope. (Fundamentals of Nursing by Potter and Perry, 3rd edition,
Vol.1 p 821) Formal thinking is not entirely related to
chronological age, and its expression varies among individual.
(Craven, RF. FUN 4th edition p. 278)
INTERPRETATION: Proper cognitive pattern

4. Self Concept
According to the client, after the signs and symptoms are
visible, she became depress. “Pumunta ako sa albularyo tapos
ang ginawa lang sa akin ay pinausukan ako tapos napansin
parang dumami ung mga sugat” She also added that in 3
months regimen, “Tanggap ko na rin naman at nagproprogress
naman ang kalagayan ko eh.”

ANALYSIS: Self concept is an individual’s perception of self. It

includes self esteem (an individual’s perception of self worth)
and body image (perception of physical self). Self concept
influences individual’s health behaviors in that people think
highly themselves will tend to take care of themselves. On the
other hand, a person with a negative self concept will engage in
reckless or self destructive behaviors that endanger health.
Persons with a low self concept frequently ignore their own
needs because they are perceived to be less important than the
needs of other people. (Nursing Fundamentals by R. Daniels p
854) Interest in appearance it begins to wane and intensifies
when the external physical changes, it accompany advancing
age become noticeable. Middle age adults realize he/she is
growing older. Reasonable concern for one’s health and
appearance is compatible w/ sound mental health. The person
accepts physical attributes that cannot be altered and then
attends other matters. (Mattie Collins. Communication in Health
Care p. 16-17)
INTERPRETATION: Healthy Self Concept

5. Emotional Pattern
The client is a quiet type person. When in times that the
client feel stressed the client just tends to be quiet.

ANALYSIS: Cooperative or friendly, expressive feelings

appropriate to the situation, verbalizes positive things regarding
others and the future. Express positive coping mechanism.
(Nurses Handbook of Health Assessment, Janet Weber, pg. 513)
Emotional states such as depression and anger affect a client’s
perception and degree of risk taking behavior. These emotional
states alter a client’s thinking pattern and reaction time (Nursing
Fundamentals by R. Daniels p 874). The developmental crisis
according to Erickson is Generativity vs. Self Stagnation
INTERPRETATION: Effective Emotional Pattern
6. Family Coping Patterns
The client verbalized, “Sinabi ko sa kanila ung kalagayan ko
ngayon.” She also added that she was supported by her family
thru texting.

ANALYSIS: Family coping mechanisms are the behaviors families

use to deal with stress or changes imposed from either within or
without. (Fundamentals of Nursing by B. Kozier, 7th edition, p
193) Because chronic illness lasts longer than acute illness, it
can influence the family to a greater extent. People with
chronically ill children, parents, or other family members may
express negative feelings about themselves such as guilt,
inadequacy, failure, rejection and helplessness. The family may
be in denial initially as members struggle with the shock of the
illness. (Fundamentals of Nursing by Craven and Hirnle, 4th
edition, p 1282)
INTERPRETATION: Effective Family Coping Pattern

b. Socio Cultural Health

1. Cultural pattern
According to the client, the social values she was brought up
to were respect, sense of responsibility, fear of God. The
traditions in her family are Christmas, Birthday, New Year and
Holy week.

ANALYSIS: The value placed on children and elders within a

society is culturally derived. (Fundamentals of Nursing by Craven
and Hirnle, 4th edition, p212) The family passes on patterns of
daily living and lifestyles to offspring. Cultural rules, values, and
beliefs give people a sense of being stable and able to predict
others (Fundamentals of Nursing by Kozier, 7th edition p 178). A
relief system that the member of the culture holds, consciously
and unconsciously as absolute truth. This guides the everyday
behavior and makes it routine. Cultural norms can influence a
client’s belief about what constitutes illness and personal
responsibility. (Craven and Hirule, FON p. 326 and 366)
INTERPRETATION: Proper Cultural Pattern
2. Significant relationship
According to the client, her family and her girlfriend are the
significant persons in her life. They have harmonious
relationship with her family and relatives

ANALYSIS: Family influences on health care because health is

defined uniquely by each client’s culture. Family is often major
care givers of their relatives. Lack of social support from family
or significant others results in psychological and spiritual
isolation, which negatively impacts a person’s physiological
state. Thus, it is important to help clients identify, strengthen,
and use their social support systems. Sometimes, families need
guidance to optimize health behaviors. (Nursing Fundamentals
by R. Daniels p849-851)
INTERPRETATION: Effective Significant Relationship

3. Recreational Pattern
The client verbalized, “Bago ako maospital puro barkada
talaga ako”. But because of her hospitalization, her recreational
activities are listening to radio, watching TV and sometimes
socialization with the patients in and out of the ward

ANALYSIS: Leisure time is important for normal social

development and adjustment (Nursing assessment and Health
Promotion by Murray and Zentner, 5th edition, p 386)
INTERPRETATION: Proper Recreational Pattern

4. Economic
According to the client, she was not financially supported by
her family. The hospital accommodates all the needs of the
patients regarding about her basic needs

ANALYSIS: Financial resources increase the ability to provide the

necessary commodities for health and well being. (Nursing
Fundamentals by R. Daniels p 855)
INTERPRETATION: Adequate Economic Finances

c. Spiritual Pattern
 1. Religious beliefs and practices
According to the client, praying is her religious practice since
she is at the hospital.

ANALYSIS: In middle age, people tend to be less dogmatic about

religious beliefs and religion often offers more comfort to the
middle aged person than it did previously. People in this age
group often relies on spiritual beliefs to help them deal with
illness, death and tragedy (Fundamentals of Nursing by Kozier,
7th edition p 400)
INTERPRETATION: Proper practice of religious beliefs

2. Values and valuing

According to the client God and family and her girlfriend are
the most important persons in her life.

ANALYSIS: Values can be described as the outcome of an

individual‘s effort to apply universal moral laws to his everyday
life. Values are more personal, and provide meaning and
direction. (Fundamentals of Nursing practice by Narrow and
Buschle, 2nd edition p 84)
INTERPRETATION: Proper valuing

F. PATIENT’S CONCEPT OF HEALTH, ILLNESS AND HOSPITALIZATION

The ideal health status is one in which people are successful in
achieving their full potential regardless of any limitations they
might have. The person with a chronic illness or disability may
still be able to achieve a desirable level of wellness. The key to
wellness is to function at the highest potential within the
limitations over which there is no control.
The client views her role as a sick person as a vulnerable
person who seek help and proper care. She expects support and
proper care management and calmness to those people who care
for her. She said that her illness should be treated with the help of
medicines and proper care management. She wants to know the
things that are necessary for her and health promotion.
She also added that within 3 months of regimen, she already
accepted what she is now. She verbalized that after discharge,
“Hindi na ako maglalakwatsa, wala na ring ang inom-inom.”
 ANALYSIS: The patients expect the nurse to be thoughtful,
understanding and accepting of him. Patients are critical of
behavior that is primitive or judgmental. He expects the nurse to
orient him in the health agency. Nearby everyone is afraid of the
unknown and to be left alone without orientation can be a
frightening experience. He also expects the nurse to provide an
explanation of his care. Health practitioners who ignore this
aspect of care are often referred to as cruel and unkind
(Fundamentals of Nursing, 7th edition, pp. 277-278)

G.LABORATORY AND DIAGNOSTIC EXAMINATION

DIAGNOSTIC NORMS ACTUAL RESULTS INTERPRETATION AND

EXAM ANALYSIS

Urinalysis Reference Actual Findings Interpretation: The

Values Color: Yellow urine color, pH, specific
Color: light Appearance: gravity and microscopic
straw to dark clear examination (epithelial
amber Odor: aromatic cells and urates) are
Appearance: pH: acidic not normal while the
clear Specific appearance, protein,
Odor: aromatic Gravity: 1.030 glucose are normal.
pH: 4.5-8.0 Protein: Analysis:
Specific negative Color of the urine
Gravity: 1.005- Glucose: changes can results
1.030 negative from diet, drugs and
Protein: 2-8 Microscopic many diseases (pg.
mg/dl; negative Examination: 395, Diagnostic Test).
reagent strip RBC: 0-1/hpf When water loose from
test; trace Pus: 0-3/hpf the body exceeds water
Glucose: Epithelial cells: intake, the kidneys
negative positive need to consume water
Ketones: Urates: positive making the urination
negative more concentrated with
(Handbook of waste products and
Laboratory and subsequently dark in
Diagnostic Test color. Yellow colored
DIAGNOSTIC NORMS ACTUAL RESULTS INTERPRETATION AND
EXAM ANALYSIS
with Nursing urine is possible of
Inplication, 5th pyuria, and infection.
edition, pg. (Medical Surgical
343) Nursing by Bare and
Smeltzer pg.1263). A
Microscopic normal pH is 7. A pH <
Examination: 7 indicates acid urine
RBC: 0-2/high and > 7 indicates
power field alkaline urine. Acid
WBC: 0-5/high urine ph is associated
power field with renal tuberculosis,
Epithelial cells: pyrexia,
0-5/high power phenylketonuria,
field alkaptonuria and
(Handbook of acidosis. (Diagnostic
Diagnostic Tests, A Prescriber’s
Test, 3rd Guide to Selection and
edition, pg. Interpretation by
329) Lippincott Williams and
Wilkins, p.395) Due to
carbohydrate
malabsorption, fat
malabsorption and
disaccharides
deficiency. (A Manual of
Laboratory and
Diagnostic Tests, 7th
edition by Lippincott
William and Wilkins,
p.279)Normally, freshly
voided urine has a faint
odor owing to the
presence of volatile
acids. It is not generally
offensive. Fresh urine
from most persons has
a characteristic
DIAGNOSTIC NORMS ACTUAL RESULTS INTERPRETATION AND
EXAM ANALYSIS
aromatic odor (pg. 396,
Diagnostic Test).
Specific gravity is an
indication of the
relative proportions of
dissolved solid
components to the total
volume of the
specimen and reflects
the relative degree of
concentration or
dilution of the
specimen.
(www.intensivecaring.c
om) In a healthy renal
and urinary tract
system, urine contains
no protein or only trace
amount (pg. 191, A
Manual of Laboratory
and Diagnostic Test).
Sugar, usually absent
from the urine, may
appear under normal
conditions (pg. 329,
Handbook of Diagnostic
Test, 3rd edition)
A high number of
white blood cells in the
urine is usually a
symptom of urinary
tract infection. A large
number of cells from
tissue lining (epithelial
cells) can indicate
damage to the small
tubes that carry
DIAGNOSTIC NORMS ACTUAL RESULTS INTERPRETATION AND
EXAM ANALYSIS
material into and out of
the kidneys.
(www.healthatoz.com)

Hematolog Reference Actual Interpretation: Not

y Values: Findings: normal
WBC: 5 – 10 x WBC: 12.6 Analysis:
109 g/L Neutrophils: Increased.
Neutrophils: 0.71 Leukocytosis, an
0.40-0.60 increase in circulating
Lymphocytes: leukocytes in all types.
0.20-0.40 When this does occur,
(Diagnostic it is usually, it is
Testing and usually a result of
Nursing hemoconcentration.
Implications, 4th (A Manual of
edition) Laboratory and
Diagnostic Tests, 7th
edition by Lippincott
William and Wilkins,
p.49)
Increase in
Neutrophils: severe
bacterial disease,
diabetic acidosis,
infarctions, increase in
acute, severe
inflammation,
malignancies
(Diagnostic Testing and
Nursing Implications,
4th edition)

I. IMPRESSION/DIAGNOSIS
The admitting diagnosis is Hansen’s disease
J. ANATOMY AND PHYSIOLOGY
The skin is the body’s largest organ, covering the entire body. In
addition to serving as a protective shield against heat, light,
injury, and infection, the skin also:
a. regulates body temperature
b. stores water and fats
c. is a sensory organ
d. prevents water loss
e. prevents entry of bacteria
Throughout the body, the skin’s characteristics (thickness, color,
texture) vary. For instance, the head contains more hair follicles
than anywhere else, while the soles of the feet contain none. In
addition, the soles of the feet and the palms of the hand are much
thicker. The skin is made up of the following layers, with each
layer performing specific functions:
a. epidermis
b. dermis
c. subcutaneous fat layer

Epidermis The epidermis is the thin outer layer of the skin and
consists of three parts:
a. stratum corneum (horny layer)
--this layer consists of fully mature keratinocytes
which contain fibrous proteins (keratins). The
outermost layer is continuously shed. The stratum
corneum prevents the entry of most foreign
substances as well as the loss of fluid from the
body.
b. keratinocytes (squamous cells)
--this layer just beneath the stratum corneum,
contains living keratinocytes, which mature and
forms stratum corneum
c. basal layer
--the basal layer is the deepest layer of the
epidermis, containing basal cells. Basal cells
continually divide, forming new keratinocytes that
replace the cells that are shed from the skin’s
surfaces
 The epidermis also contain melanocytes, which are
cells that produces melanin (skin pigment)
Dermis The dermis is the middle layer of the skin. The
dermis contains the following
d. blood vessels
e. lymph vessels
f. hair follicles
g. sweat glands
h. collagen bundles
i.fibroblasts
j.nerves
The dermis is held together by a protein called
collagen, made by fibroblasts. This layer also
contains pain and touch receptors
Subcutaneous The subcutis is the deepest layer of skin. The
Fat Layer subcutis, consisting of network of collagen and fat
cells, helps conserve the body’s heat and protects
the body from injury by acting as shock absorber

K. PATHOPHYSIOLOGY/SCHEMATIC DIAGRAM OF THE DISEASE

A chronic intracellular infectious disease unique to man,
usually it is not fatal. The manifestations of the disease depend on
the resistance of the host. Types:
1. Tuberculoid—host is highly resistant, clinical abnormalities
limited to a few peripheral nerves and adjacent skin areas,
tuberculoid granuloma
2. Lepromatous—host lacks resistance, all tissues affected, form
cell granuloma
3. Borderline—between tuberculoid and lepromatous
The earliest clinically detectable lesions of Leprosy involve the
skin and show histologic association with sebaceous glands and
hair follicles. From the onset, small cutaneous nerve fibers are
involved. With bacillary multiplication, contigous skin areas,
including autonomic nerve fibers, dermal appendages, and blood
vessels, are invaded.
Lymphohematogenous dissemination of bacilli is probably an
early phenomenon. As infection spreads along sensory nerves,
motor fibers within parent nerve trunks are damaged. Leprosy
bacilli are unable to penetrate directly into the nervous system
proximal to the dorsal root ganglions; central nervous system
infection does not occur.
When there is dense proliferation of leprosy bacilli, as in
lepromatous leprosy, bacteremia is virtually continuous, and
bacilli are easily demonstrable in many organs. Yet there is little
systematic reaction, and tissue destruction occurs mainly in cool,
superficial locations; the skin (except in folds); peripheral nerves
in subcutaneous loci, oral and nasopharyngeal mucous
membranes (not enteric or vaginal); the testes (not the ovaries);
and the anterior third of the eye.
The clinical manifestations are the indeterminate (1) lesion,
which may be the initial manifestation, shows as ordinary-looking
skin changes, such as pale oval or rounded macules,
papulonodules, wheals or circinate patches. They may be found in
the malar area, extremities or buttocks. There may be only one or
a few lesions which may appear and disappear, undergo
spontaneous healing, or gradually progress through the
borderline (BB) form towards the tuberculoid (BT) or lepromatous
(BL) forms. The lesions are usually anesthetic but this may be
later manifestations. They may be depigmented or erythomatous.
Sensory disturbances as paresthesias, numbness and formication
may also be found. There may also be thickening or superficial
nerve trunks, especially the ulnar, as well as lymphadenopathy,
anhindrosis, ichthyosis and limb weakness. The foregoing
manifestations may be seen in any of the clinical forms,
particularly in the tuberculoid (TT) which is also characterized by
a definite tendency towards healing. Damage in the following
nerves is associated with characteristic impairments in leprosy:
o Ulnar and median - Clawed hand
o Posterior tibial - Plantar insensitivity and clawed toes
o Common peroneal - Foot drop
Radial cutaneous, facial, and greater auricular nerves Infiltration
by bacteria may lead to destruction of nasal cartilage
(lepromatous form), ocular involvement, and diffuse thickening of
the skin. Advanced cases involve the loss of eyebrows and lashes,
but these deformities are less common.
L. DRUG STUDY

GENERIC NAME BRAND ACTION CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS/ NURSING
NAME ADVERSE RESPONSIBILITY
REACTIONS

RIFAMPIN Rifadin, antiinfective; Semisynthetic Primarily as Hypersensitivity CNS: Fatigue, Assessment &
Rimactane antibiotic; derivative of adjuvant to rifampin; drowsiness, Drug Effects
, Rofact antituberculos rifamycin B, an with other obstructive biliary headache, • Lab tests:
is agent antibiotic antitubercul disease; ataxia, Periodic
derived from osis agents meningococcal confusion, liver
Streptococcus in initial disease; dizziness, function
mediterranei, treatment intermittent inability to tests are
with and rifampin therapy; concentrate, advised.
bacteriostatic retreatment lactation. Safe generalized Closely
and bactericidal of clinical use during numbness, monitor
actions. Inhibits tuberculosis pregnancy pain in patients
DNA-dependent ; as short- (category C) or in extremities, with
RNA polymerase term children <5 y is muscular hepatic
activity in therapy to not established. weakness. disease.
susceptible eliminate Special • Check
bacterial cells, meningococ Senses: GI: prothrombi
thereby ci from Heartburn, n time
suppressing RNA nasopharyn epigastric daily or as
synthesis. x of distress, necessary
asymptomat nausea, to establish
ic carriers of vomiting, and
N. anorexia, maintain
meningitidis flatulence, required
when risk of cramps, anticoagula
meningococ diarrhea, nt activity
cal Body as a when
meningitis is Whole: patient is
high. Hypersensitiv also
ity (fever, receiving
pruritus, an
urticaria, skin anticoagula
eruptions, nt.
soreness of Patient &
mouth and Family
GENERIC NAME BRAND ACTION CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS/ NURSING
NAME ADVERSE RESPONSIBILITY
REACTIONS
tongue, Education
eosinophilia, • Do not
hemolysis), interrupt
flu-like prescribed
syndrome. dosage
Urogenital: regimen.
Hemoglobinu Hepatoren
ria, al reaction
hematuria, with flu-like
acute renal syndrome
failure, light- has
chain occurred
proteinuria, when
menstrual therapy
disorders, has been
hepatorenal resumed
syndrome, following
(with interruptio
intermittent n.
therapy). • Be aware
Respiratory: that drug
Hemoptysis. may impart
Other: a harmless
Increasing red-orange
lethargy, color to
liver urine,
enlargement feces,
and sputum,
tenderness, sweat, and
jaundice, tears.
brownish-red • Report
or orange onset of
discoloration jaundice,
of skin, hypersensit
sweat, saliva, ivity
tears, and reactions,
feces; and
GENERIC NAME BRAND ACTION CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS/ NURSING
NAME ADVERSE RESPONSIBILITY
REACTIONS
persistence
of GI
adverse
effects to
physician.
• Use or add
barrier
contracepti
ve if using
hormonal
contracepti
on.
Concomita
nt use of
rifampin
and oral
contracepti
ves leads
to
decreased
effectivene
ss of the
contracepti
ve and to
menstrual
disturbanc
es
(spotting,
breakthrou
gh
bleeding).
• Keep drug
out of
reach of
children.

DAPSONE Avlosulfon antiinfective; Sulfone Drug of Hypersensitivity Body as a Assessment &

GENERIC NAME BRAND ACTION CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS/ NURSING
NAME ADVERSE RESPONSIBILITY
REACTIONS
, DDS antileprosy derivative choice for to sulfones or its Whole: Drug Effects
(sulfone) chemically treatment of derivatives; Hypersensitiv • Monitor for
agent related to all forms of advanced renal ity therapeutic
sulfonamides, leprosy amyloidosis, (cutaneous effectiveness that
with (unless anemia, reactions); may not appear
bacteriostatic organism is methemoglobin erythema for leprosy until
and bactericidal shown to be reductase multiforme, after 3–6 mo of
activity similar to dapsone deficiency. Safe exfoliative therapy. Skin
that group. resistant). use during dermatitis, lesions respond
Interferes with Used in pregnancy allergic well; recovery
bacterial cell dapsone- (category C) or rhinitis, from nerve
growth by sensitive lactation is not urticaria, involvement is
competitive multibacillar established. fever, usually limited.
inhibition of folic y leprosy infectous • Lab tests:
acid synthesis by (with mononucleos Perform baseline
susceptible clofazimine is-like then weekly CBC
organisms. and syndrome. during the first
rifampin) CNS: month of therapy,
and in Headache, at monthly
dapsone- nervousness, intervals for at
sensitive insomnia, least 6 mo, and
paucibacillar vertigo; semiannually
y leprosy paresthesia, thereafter.
(with muscle • Determine
rifampin, weakness. periodic dapsone
clofazimine, CV: blood levels.
or Tachycardia. • Perform liver
ethionamide GI: Anorexia, function tests in
). Also used nausea, patients who
prophylactic vomiting, complain of
ally in abdominal malaise, fever,
contacts of pain; toxic chills, anorexia,
patients hepatitis, nausea, vomiting,
with all cholestatic and have
forms of jaundice jaundice.
leprosy Hematologic: Dapsone therapy
except In patient is usually
GENERIC NAME BRAND ACTION CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS/ NURSING
NAME ADVERSE RESPONSIBILITY
REACTIONS
tuberculoid with or suspended until
and without G6PD etiology is
indetermina deficiency; identified.
te leprosy. dose-related • Monitor severity
Used for hemolysis, of anemia. Nearly
treatment of Heinz body all patients
dermatitis formation, demonstrate
herpetiformi Skin: Drug- hemolysis.
s. induced Manufacturer
lupus states that Hgb
erythematos level is generally
us, decreased by 1–2
phototoxicity. g/dL;
Special reticulocytes
Senses: increase by 2%–
Blurred 12%; RBC life
vision, span is
tinnitus. shortened; and
methemoglobine
mia occurs in
most patients
receiving
dapsone.
• Monitor
temperature
during first few
weeks of therapy.
If fever is
frequent or
severe, leprosy
reactional state
should be ruled
out.
• Report cyanotic
appearance or
mucous
membranes with
GENERIC NAME BRAND ACTION CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS/ NURSING
NAME ADVERSE RESPONSIBILITY
REACTIONS
brownish hue to
physician as
possible
methemoglobine
mia.
Patient &
Family
Education
• Report
symptoms of
leprosy that do
not improve
within 3 mos or
get worse to
physician.
• Report the
appearance of a
rash with bullous
lesions around
elbows and other
joints promptly.
Report symptoms
of peripheral
neuropathy with
motor loss
(muscle
weakness)
promptly.

CLOFAZIMINE Lamprene antiinfective; Exerts a slow Chiefly in Pregnancy GI: Assessment &
antileprosy bactericidal multiinfectiv (category C), Abdominal Drug Effects
agent effect on e therapy of lactation, children nausea, • Assess for
Mycobacterium multibacillar <12 y. vomiting, serious
leprae (Hansen's y leprosy diarrhea, adverse
bacillus). Binds (with Drowsiness, effects
preferentially to dapsone, fatigue, (e.g., pain
DNA of all rifampin, headache, in bones
GENERIC NAME BRAND ACTION CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS/ NURSING
NAME ADVERSE RESPONSIBILITY
REACTIONS
mycobacteria ethionamide giddiness, and joints,
and inhibits their ) to prevent dizziness, GI
growth. Its developmen Skin: Pink- bleeding,
antiinflammatory t of drug brown skin diminished
action (precise resistance. discoloration, vision).
mechanism ichthyosis, Reactions
unknown) dryness, are usually
controls rash, reversible
erythema pruritus, but may
nodosum phototoxicity, require
leprosum erythema months or
reactions. nodosum years to
Bacterial killing leprosum diminish.
is not detectable (lepra) • Lab tests:
in biopsy tissue reaction. Periodic
from leprosy WBC with
patient until 50 d differential,
after start of serum
therapy. electrolytes
, serum
albumin,
and liver
function
tests.
• Drug-
induced
reddish-
brown
discoloratio
n of skin,
cornea,
conjunctiva
, and body
fluids
(including
tears,
sweat,
GENERIC NAME BRAND ACTION CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS/ NURSING
NAME ADVERSE RESPONSIBILITY
REACTIONS
sputum,
urine, and
feces)
occurs in
75–90% of
patients
within a
few weeks
of
treatment.
Skin
discoloratio
n may take
months or
years to
disappear
after drug
is
discontinue
d.
• Monitor for
the onset
of tender,
erythemato
us nodules
with
lymphaden
opathy,
joint
swelling,
epistaxis,
iritis which
suggests a
type 2
leprosy
reactional
state.
GENERIC NAME BRAND ACTION CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS/ NURSING
NAME ADVERSE RESPONSIBILITY
REACTIONS
Dosage
may be
increased
to 200
mg/d. After
reactive
episode is
controlled,
dosage is
tapered to
100 mg/d
as soon as
possible.
Patient
should
remain
under
medical
surveillanc
e during
the
episode.
Patient &
Family
Education
• Adhere
strictly to
established
drug
regimen.
No drug
dosage
should be
omitted,
increased,
or
decreased
GENERIC NAME BRAND ACTION CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS/ NURSING
NAME ADVERSE RESPONSIBILITY
REACTIONS
without
advice of
physician.
• Report
promptly
bone and
joint pain;
GI
bleeding,
colicky
abdominal
pain,
nausea,
vomiting,
diarrhea;
diminished
vision.
• Minimize
use of
soap, avoid
applying it
directly to
dry skin,
and
thoroughly
rinse it off.
V. NURSING PROCESS

A. PROBLEM LIST

RATE NURSING PROBLEMS JUSTIFICATION

IDENTIFIED

1 Ineffective Breathing According to Abraham

pattern related to Maslow Hierarchy of
excessive mucus needs, physiologic needs
secretion. come in priority.
This is an actual problem
that requires immediate
attention. It is the chief
complaint of the patient
and the other nursing
problems occur in relation
to the presence of this
problem.

2 Impaired skin integrity Further damage to skin

related to presence of may cause other
skin lesion. infections.
This is an actual problem
which is an effect of the
prioritized problem above.
Interventions are
available and possible for
this problem

3 Anxiety (Mild) related Sudden change in her way

to changes in health of living.
status.
 B. NURSING CARE PLAN

CUES NURSING ANALYSIS GOAL AND NURSING RATIONALE EVALUATION

DIAGNOSIS OBJECTIVES INTERVENTION

Interactio Impaired Immediate Goal

n skin cause After
“Hindi integrity presence of independent
naman related skin lesions nursing
masakit to all over the intervention with
itong mga presence body collaborative
sugat ko” of skin nursing
“Matagal lesions Intermedia intervention, the
tagal na rin all over te cause client will be able
itong mga the body Tissue to have improved
sugat ko” damage skin integrity as Effectiveness
evidenced by:
Root cause a. Exhibited no 1. Will the
Observati Invasion of further skin patient
on Mycobacteri breakdown exhibit no
=Presence um Leprae b. Healed skin evidence of
of skin lesions skin
lesion all Health breakdown?
over the Implication Objectives Yes____ No___
body Further skin After 8hour shift If no, why?
=Black damage will the client will be
color result able to: a. Inspect a. This 2. Will the
lesions increased patient’s provides patient able
risk of 1. Exhibit no skin evidence to
spread of evidence of skin every of communicate
infection and breakdown. shift, effectivene understandin
risk for other describe ss of skin g, verbalizes
CUES NURSING ANALYSIS GOAL AND NURSING RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTION
infection. and regimen. intent to use
(Nursing documen (Nursing skin
Diagnosis t skin Diagnosis protection
Card 9th condition, Card 9th measures,
Edition by and Edition by demonstrates
Taylor And report Taylor And skin
Sparks, Card changes. Sparks, inspection
158) Card 158) technique
and performs
b. To skin care
maintain routine?
or modify Yes___ No___
b. Perform current If no, Why?
and teach therapy.
patient (Nursing
prescribe Diagnosis
d Card 9th 3. Will the
treatmen Edition by patient able
t regimen Taylor And to
for skin Sparks, communicate
condition Card 158) feelings
involved about change
and in body
monitor image?
progress. c. To avoid Yes ___ No___
Report spread of If no, why?
response infection
s to and Efficiency
treatmen decreased Was the
t chance of interventions
CUES NURSING ANALYSIS GOAL AND NURSING RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTION
regimen. further done within the
skin time frame?
c. Warn damage. Yes ___ No___
patient (Nursing If no, why?
against Diagnosis
tamperin Card 9th Appropriatene
g with Edition by ss
wound. Taylor And Were the
Sparks, interventions
Card 158) suitable to the
client?
d. To aid Yes ___ No___
complianc If no, why?
e.
(Nursing Accessibility
Diagnosis Were the
Card 9th interventions
Edition by acceptable to
d. Explain Taylor And the client?
therapy Sparks, Yes ___ No___
to Card 158) If no, why?
2. Communicat patient.
e understanding, Adequacy
verbalizes intent a. To Were the
to use skin encourage interventions
protection complianc adequate to
measures, e. meet the
demonstrates (Nursing client’s needs?
skin inspection Diagnosis Yes ___ No___
technique and Card 9th If no, why?
CUES NURSING ANALYSIS GOAL AND NURSING RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTION
performs skin a. Instruct Edition by
care routine. patient in Taylor And
skin care Sparks,
regimen. Card 158)

b. To
improve
skill of the
patient.
(Nursing
Diagnosis
Card 9th
b. Supervise Edition by
patient in Taylor And
skin care Sparks,
manage Card 158)
3. Communicat ment.
es feelings about
change in body a. This
image. helps allay
anxiety
and
develops
coping
skills.
(Nursing
a. Allow Diagnosis
patient to Card 9th
express Edition by
feelings Taylor And
CUES NURSING ANALYSIS GOAL AND NURSING RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTION
regarding Sparks,
skin Card 158)
problem.
b. These
provide
additional
support for
patient.
(Nursing
Diagnosis
b. Refer Card 9th
patient to Edition by
psychiatri Taylor And
c liaison Sparks,
nurse, Card 158)
social
services,
or other
support
groups.
 C. DISCHARGE PLANNING

MEDICATION
Θ Multi-drug Therapy (Dapsone, Rifampicin and
Clofazimine)

EXERCISE
Θ The client should have a daily routine exercises
Θ Encourage client to have regular exercise such as
performing range of motions exercises.
Θ Encourage the client to follow an appropriate
exercise program. Exercise is also a useful way to lose weight,
ease stress and maintain a feeling of well- being. It is also
good for wound healing.

TREATMENT
Θ Medications as prescribed by the physician
Θ Educating both patient and family
Θ Provides and arranges for provisions of nursing care of
patients at home

HEALTH TEACHINGS
Θ Control measures such as immunizations
Θ Practice personal hygiene
Θ Health education of patients, families, and the community
on the nature of the disease, symptomatology and its
transmission
Θ Advocates healthful living through proper nutrition,
adequate rest, sleep, exercise and good environment
Θ Health teaching to prevents secondary injury
Θ Teach the client that he/she should not fail to complete
treatment within the prescribed duration
Θ The nurse should give health teachings like
information about how to prevent and protect his skin form
wounds and lesions. If there’s such, teach how will be the
proper way of dressing the wound and taking good care of it.

OUT PATIENT FOLLOW-UP

 Θ Refers patient to other health and allied workers
Θ Refers patient to other persons/agencies who can help in
his/her physical, mental and social rehabilitation
Θ Monthly outpatient follow-up is recommended during
treatment, although weekly visits may be necessary if the
patient experiences a leprosy reaction.

DIET
Θ Diet as Tolerated

SPIRITUAL TEACHINGS
Θ Mental and emotional support by encouraging self-
confidence and self-reliance
Θ Providing counseling and guidance