Helping a Man with Leprosy: A Case Study

International Journal of Nursing Terminologies and Classifications, Jul-Sep 2009 by Guimar�es, Helo�sa C Q C P, Barros, Alba L B L, Bassoli, Sidin�ia R B, Salotti, Selma R A, Oda, Roseli M

PURPOSE. This case study illustrates nursing diagnoses and interventions for a man with leprosy.

DATA SOURCES. Data sources were published literature on the disease of leprosy, and the experience and expertise of the authors in working with people with leprosy.

DATA SYNTHESIS. Data were synthesized using the standardized nursing languages of North American Nursing Diagnosis Association International and the Nursing Interventions Classification. The accuracy of the diagnoses and the appropriateness of the nursing interventions were supported by the positive health outcomes of the patient.

CONCLUSIONS. Although leprosy has been eradicated in some countries, the risk of new cases is present anywhere that Mycobacterium leprae still exists. The recommended treatment of multibacilar polychemotherapy has lowered the rate of new cases in Brazil.

IMPLICATIONS FOR NURSING PRACTICE. Nurses need to incorporate evidence-based practice interventions for leprosy-based wound care, and nurses should encourage persons with leprosy to maintain regular medical care with multibacilar polychemotherapy.

Search terms: Case studies, impaired skin integrity, leprosy, nursing diagnoses, nursing interventions, self-care deficit, wound care

Mr. C is a 57-year-old male who was a bricklayer prior to being diagnosed with virchovian leprosy in 2004. His religion is Catholic and he is still close to his family, although he is separated from his wife. He does not regularly come to the leprosy clinic for treatment, as needed, with multibacilar polychemotherapy, a therapy that consists of dapsone, clofazimine, and rifampicin.

Today, Mr. C was brought to the hospital by his son with whom he lives. His leprosy symptoms had worsened to the point that he could not deal with them without help. On physical examination, it was shown that he had face and ear infiltration, Hansen's bastones, nose collapse, septal perforation, and corneal opacity of the right eye, indicating the possible need for a corneal transplant. There were signs of bone resorption, and his index and middle fingers were like claws. He had an ulcerative wound on his right hand, resulting from a burn. On his right leg, there was a chronic ulcer located on the lower lateral external aspect that was irregularly shaped, 16.0-cm high ? 7.0-cm wide. The wound had devitalized tissue, including necrosis and debris along its length, with extensive serous exudate, bad odor, and elevated margins. He said that pain restricted his movements of the upper and lower limbs and he had difficulty in handling utensils and opening containers. Neurological testing showed that he had postural instability, limited capacity to perform gross and fine motor activities, and an altered gait. A baciloscopy test confirmed that Mr. C had a disease relapse, so Mr. C was admitted to the male medical department of Instituto Lauro de Souza Lima so that multibacilar polychemotherapy treatment could be restarted.

Which Nursing Diagnoses, Patient Outcomes, and Nursing Interventions Would You Select?

Submitter's Analysis and Use of North American Nursing Diagnosis Association International, NOC Nursing Outcomes Classification, and Nursing Interventions Classification

Leprosy is a millennial chronic granulomatous disease, with slow progression, caused by Mycobacterium leprae, which is an intracellular parasite (Opromola, 2000). The bacterium has an affinity for skin cells and peripheral nerves, and it remains viable up to 36 hr in the environment. Its incubation time is from 2 years to 7 years, although cases were reported with up to 10 years of incubation. Transmission is still possible while there are people with viable bacilli or bacilliferous (Opromola).

The profiles of people who are at risk for leprosy are those living in low socioeconomic conditions and with poor immune status (Kawamoto, 1995). Leprosy is not related to race, age, or gender. The possibility of infection is high in endemic areas, although pathogenicity is low except for people whose constitutional factors render them susceptible to M. leprae (Kawamoto).

Currently, Brazil has the second largest number of people with leprosy in the world, after India (Pereira, Helene, Pedrazini, Martins, & Vieira, 2008). About 94% of the reported cases in the United States and 94% of the new cases have been reported by Brazilians. In 2005, the prevalence rate of leprosy decreased to 1.5 cases in 10,000 inhabitants (Pereira et al.). Recently, the rate of new cases was 2.09 in 10,000 inhabitants. In the State of S�o Paulo, the rate was 1.04 in 10,000 inhabitants, and in the city of Bauru, it was 0.62 in 10,000 inhabitants. The proposition to combat leprosy is based on the number of cities that still keep the disease transmission chain (Pereira et al). When prevalence rates decline, it is thought to be a result of the Polychemotherapie treatment of dapsone, clofazimine, and rifampicin. But detection rates of new cases are still too high for eradication of the disease (Pereira et al.).