Nursing diagnoses in patients with immune-bullous dermatosis

Abstract

Objective: identify nursing diagnoses in patients with immune-bullous dermatosis. Method: a quantitative and descriptive research, carried out in three institutions located in Rio de Janeiro and Mato Grosso do Sul, Brazil, using the Client Assessment Protocol in Dermatology during a nursing consultation. Simple descriptive statistics was used for data analysis. Results: 14 subjects participated in the study, nine with a diagnosis of pemphigus vulgaris, pemphigus two and three of bullous pemphigoid. The age ranged between 27 and 82 years, predominantly females (11). 14 nursing diagnoses were discussed and identified from a clinical rationale in all study participants, representing the most common human responses in this sample. The application of the Assessment Protocol in Dermatology facilitated the comprehensive assessment, in addition to providing the identification of diagnostics according to the North American Nursing Diagnosis Association International. Conclusion: the nursing diagnoses presented confirm the necessity of interdisciplinary work during the care for this clientele. For better description of the phenomena related to the client in question, it is suggested the inclusion of two risk factors related in three diagnoses of this taxonomy. It is worth noting the contribution of the findings for the care, education and research in nursing in dermatology.

Cuidados de enfermagem para conforto de pessoas com dermatoses imunobolhosas: avaliação pela lógica fuzzy [Nursing care to comfort people with immunobullous dermatoses: evaluation by fuzzy logic] [Cuidados de enfermería para la comodidad de personas con dermatosis inmunoampollares: evaluación por la lógica fuzzy]

“…Dos 14 participantes, oito tiveram redução da dor de T 0 para T 1 , enquanto que após uma semana, dos 13 clientes que deram continuidade à internação, três reduziram ainda mais a dor, cinco mantiveram e cinco aumentaram, como demonstrado na Tabela1. 15 .…”

Diagnósticos de enfermagem em clientes com afecções cutâneas

“…However, the authors suggest the inclusion of the related risk factor "autoimmune bullous dermatoses", justifying that such inclusion would improve the definition of the diagnostic category, helping in its identification. 11 The ND "risk for impaired skin integrity" is the "vulnerability to changes in the epidermis and/or dermis that may harm the health", 12 mentioned in two studies (1 and 2). The risk factors identified in the first one were: "Changes in turgor"; "immunological"; "altered physical mobility"; "nutritional condition"; "bone prominences"; "altered sensitivity"; "altered pigmentation"; "mechanical factors"; "hypothermia or hyperthermia"; "altered movement" and "wet skin".…”

“…Study 3 states that the lack of skin integrity in clients with autoimmune bullous dermatoses directly affects the issues related to the pattern of sleep and rest. 11 The nurse should be attentive to observe such needs so that they can be remedied, promoting physical and mental well-being of the individual, helping in his/her recovery process.…”

“…Furthermore, during the process of orientation, the Nursing must ascertain whether the individual understands the message, because, depending on the stage of the disease, in view of the degree of discomfort for the individual, he/she will not absorb the information that will be passed. 24 Study 3 cites the diagnoses "Risk for unstable glycemia", defined as the "vulnerability to varying levels of glucose/sugar in the blood, in relation to the normal variation, which may jeopardize the health" 12 , "Risk for electrolyte imbalance" and "Risk for imbalance in the volume of liquids", having in view that the subjects, clients autoimmune bullous dermatoses, were under treatment with high doses of corticosteroids or immunosuppressive drugs 11 . The use of high doses of corticosteroids, for long periods or repeatedly, leads to complications with greater frequency, including insulin resistance and glucose intolerance 25 .…”

Wound Care in Immunobullous Disease

“…Raw areas need to be cleaned by antiseptics or normal saline and then covered by a non-adhesive dressing. Excessive skin manipulation and trauma should be avoided in active pemphigus vulgaris [51]. When patients have oral mucosal lesions, it is recommended them to maintain a soft diet, use soft tooth brushes, antiseptic gargles and prophylaxis against oral candidiasis [52].…”