Primary Nursing Diagnosis

Impaired skin integrity related to diminished or absent glandular secretions

OUTCOMES. Tissue integrity: Skin and mucous membranes; Wound healing: Primary intention; Knowledge: Treatment regime; Self-care: Hygiene; Treatment behavior: Illness

INTERVENTIONS. Skin and membrane surveillance; Skin care; Medication administration; Fluid balance; Surveillance

H PLANNING AND IMPLEMENTATION Collaborative

Care of the patient with SS is designed to treat symptoms. Instill artificial tears as often as every 30 minutes to prevent corneal ulcerations or opacifications that may be caused by insufficient lacrimal secretions.

Patients who also have RA may benefit from a combined program of medical, rehabilitative, and surgical treatments. The primary goals are suppression of further joint and tissue inflammation, maintenance ofjoint and tissue function, repair ofjoint damage, and relief of pain.

Pharmacologic Highlights

Medication or Drug Class Dosage Description

Cyclosporine

Apply 1% or 2% solution

Rationale

Suppresses T-cell formation and has been used to increase lacrimal gland function in SS

Other Therapy: Corticosteroids; eye lubricants; twice-a-day, sustained-release cellulose capsules (hydroxypropyl cellulose) may be used. If eye infection develops, the patient receives antibiotics; topical steroids are avoided.

Independent

Suggest the use of sunglasses to protect the patient's eyes from strong light, wind, and dust. To reduce the risk of infection caused by dry eyes, advise the patient to keep his or her face clean and to avoid rubbing the eyes. Mouth dryness can be relieved by using a swab or spray and by drinking plenty of fluids, especially at mealtime. Sugarless throat lozenges can also relieve mouth dryness without promoting tooth decay. Meticulous oral hygiene should include regular

848 Skin Cancer brushing, flossing, and fluoride treatment at home, along with frequent dental checkups. Teach the patient to avoid medications that decrease saliva production, such as atropine derivatives, antihistamines, anticholinergics, and antidepressants. Suggest high-protein, high-calorie liquid supplements to patients with painful mouth lesions. Soft foods may be easier for patients to swallow. Parotid gland enlargement can be treated with local heat and analgesia.

Respiratory dryness can be reduced by using a humidifier at home and at work. Nasal dry-ness can be relieved by the use of normal saline solution drops. Moisturizing lotions can ease skin dryness, as can avoiding lengthy hot showers or baths. Patients should avoid sunburn and any lengthy exposure to the sun; recommend using a sunscreen when outdoors. Water-soluble lubricating jelly is an effective lubricant during sexual intercourse.

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