LEPROSY

A Case Report
Presented to the College of Nursing

In Partial Fulfillment
of the Requirement in
NCM 98: INTENSIVE PRACTICUM

DOROTHY PEARL L. PALABRICA, SN IV

APRIL 2017
 I. INTRODUCTION
Leprosy, also known as Hansens disease, has been feared and
misunderstood throughout its history, thought by many to be a purely hereditary
disease, a curse, or a punishment from God. Leprosy sufferers were brutally
stigmatized and shunned. Many references to leprosy and leprosy victims exist in the
Bible, the latter considered physically and spiritually unclean. During the Middle Ages
of Europe, leprosy victims had to wear special clothing, ring bells to warn others that
they were close, and walk on a particular side of the road, depending upon the
direction in which the wind was blowing (Bachelder et.al, 2008).
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an
acid-fast, rod-shaped bacillus. The disease mainly affects the skin, the peripheral
nerves, mucosa of the upper respiratory tract, and the eyes. Initially, a mycobacterial
infection causes a wide array of cellular immune responses. These immunologic
events then elicit the second part of the disease, a peripheral neuropathy with
potentially long-term consequences (Scollard et. al, 2006).
According to official reports received from 138 countries from all WHO
regions, the global registered prevalence of leprosy at the end of 2015 was 176 176
cases (0.18 cases per 10 000 people). The number of new cases reported globally in
2015 was 211 973 (0.21 new cases per 10 000 people). Leprosy was once endemic
worldwide, and no racial predilection is known. In the late 1800s, the incidence of
leprosy in northern Europe and North America dropped dramatically, and the disease
is now reported primarily in tropical areas (Reibel et.al, 2015). Generally, it is more
common in males than in females, with a male-to-female ratio of 2:1.
Two reactions can occur from the entrance of Mycobacterium leprae into the
body a milder reaction and a stronger reaction (U.S. Department of Health and
Human Services, 2017). Tuberculoid leprosy, or TT, is the milder reaction. In the
deeper layers of the skin, the immune cells of the body attempt to seal off the
infection from the rest of the body by surrounding the Mycobacterium leprae. As a
result of this immune system response, the hair follicles, sweat glands, and nerves
can be destroyed, therefore causing the skin to become dry, discolored, and
insensitive to touch. Because of the rarity of bacteria in this type of leprosy, it is
referred to as paucibacillary (PB) leprosy. Of all leprosy cases, seventy to eighty
percent are TT.
Lepromatous leprosy, or LL, is the second, stronger reaction. The immune
system of the body is unable to create a strong response to the invading organism.
Therefore, the organism multiplies freely in the skin. Because of the large numbers
of bacteria present in LL, the disease is often referred to as the multibacillary (MB)
leprosy. The characteristic feature of this disease is the appearance of lesions all
over the body and face. Occasionally, the mucous membranes of the eyes, nose,
and throat may be involved, which often produces a lion-like appearance. This type
of leprosy can cause blindness, major change in voice, or mutilation of the nose.
Leprosy has 2 classification schemas: the 5-category Ridley Jopling system
and the simpler and more commonly used WHO standard.
Ridley Jopling: Depending on the host response to the organism, leprosy can
manifest clinically along a spectrum bounded by the tuberculoid and lepromatous

2
forms of the disease. Most patients fall into the intermediate classifications, which
include borderline tuberculoid leprosy, mid-borderline leprosy, and borderline
lepromatous leprosy. The classification of the disease typically changes as it evolves
during its progression or management. The Ridley Jopling system is used globally
and forms the basis of clinical studies of leprosy (Schreuder et. al, 2015). It may also
be more useful in guiding treatment regimens and assessing risk of acute
complications.
According to the WHO in 2016, in an endemic area, an individual is
considered to have leprosy if he or she shows either of the two following signs: (1) A
skin lesion consistent with leprosy and definite sensory loss, with or without
thickened nerves; (2) Positive skin smears.
Fortunately, leprosy has been eliminated from the most countries. However,
most of the incidents of leprosy that still occur are located in the most poverty-
stricken regions on the globe. Therefore, one could argue that environmental factors
such as insanitation, overpopulation, and malnutrition could contribute to the
contraction of the disease (Britton, 2004).

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 II. ANATOMY AND PHYSIOLOGY

The peripheral nervous system includes the cranial nerves, the spinal nerves,
and the autonomic nervous system.

There are 12 pairs of cranial nerves that emerge from the lower surface of the
brain and pass through the foramina in the skull. Three are entirely sensory (I, II,
VIII), five are motor (III, IV, VI, XI, and XII), and four are mixed (V, VII, IX, and X) as
they have both sensory and motor functions (Downey & Leigh, 1998; Hickey, 2003).
The cranial nerves are numbered in the order in which they arise from the brain. For
example, cranial nerves I and II attach in the cerebral hemispheres, whereas cranial
nerves IX, X, XI, and XII attach at the medulla.

The spinal cord is composed of 31 pairs of spinal nerves: 8 cervical, 12

thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. Each spinal nerve has a ventral root
and a dorsal root. The dorsal roots are sensory and transmit sensory impulses from
specific areas of the body known as dermatomes to the dorsal ganglia. The sensory
fiber may be somatic, carrying information about pain, temperature, touch, and
position sense (proprioception) from the tendons, joints, and body surfaces; or
visceral, carrying information from the internal organs. The ventral roots are motor
and transmit impulses from the spinal cord to the body. These fibers are also either
somatic or visceral. The visceral fibers include autonomic fibers that control the
cardiac muscles and glandular secretions.

The autonomic nervous system regulates the activities of internal organs such
as the heart, lungs, blood vessels, digestive organs, and glands. Maintenance and
restoration of internal homeostasis is largely the responsibility of the autonomic
nervous system. There are two major divisions: the sympathetic nervous system,

4
with predominantly excitatory responses, most notably the fight or flight response,
and the parasympathetic nervous system, which controls mostly visceral functions.
The autonomic nervous system innervates most body organs. Although usually
considered part of the peripheral nervous system, it is regulated by centers in the
spinal cord, brain stem, and hypothalamus.

The hypothalamus is the major subcortical center for the regulation of visceral
and somatic activities, with an inhibitory excitatory role in the autonomic nervous
system. The hypothalamus has connections that link the autonomic system with the
thalamus, the cortex, the olfactory apparatus, and the pituitary gland. Located here
are the mechanisms for the control of visceral and somatic reactions that were
originally important for defense or attack, and are associated with emotional states
(eg, fear, anger, anxiety); for the control of metabolic processes, including fat,
carbohydrate, and water metabolism; for the regulation of body temperature, arterial
pressure, and all muscular and glandular activities of the gastrointestinal tract; for
control of genital functions; and for the sleep cycle.

5
 III. PATHOPHYSIOLOGY

Predisposing Factors: Precipitating Factors:

Ethnicity/Race (SEAN) Socioeconomic status
Males Tropical areas (Asia)
Age (peaks at 10)

M leprae

Enter through respiratory tract

Legend:

Pathway Schwann cells in cooler places

(Cutaneous nerves & peripheral nerve trunks of
Signs/Symptoms limbs and face)

Nursing Diagnosis
Bacilli multiply in the Schwann
Treatment
cells
Diagnostics
Bacterial load increases in the body

Lymphocytes and histiocytes (macrophages)

invade the infected tissue.

Demyelination of nerves may start to manifest Loss of sensation

6
Pressure on nerve Nerves become thickened and inflamed
produces pain
 Good Cell-Mediated Weak Cell-Mediated
Immune response Immune response

Hypopigmented macule No skin/nerve lesion Multi bacillary / (MB) Leprosy

that is ovoid, circular, or appear, or In addition to skin and nerve, eyes,
serpiginous. Skin/nerve lesions testes, kidney, voluntary/smooth
appear followed by muscles, reticulo-endothelial system,
spontaneous healing , or and vascular endothelium get involved
Pauci-bacillary (PB)
Leprosy
Skin biopsy

Serologic assay-
phenolic glycolipid-1
Disabilities/Deformities

Lepromin test
Z-Plasty

1. Impaired skin Integrity related to deficit cellular immune response as
evidenced by skin patches and loss of sensation secondary to
Mycobacterium Leprae infection
2. Impaired Physical Mobility related peripheral nerve damage as
evidenced by limited range of motion, joint stiffness and ulcerations
3. Acute Pain related to rapid peripheral damage and neuritic
involvement as evidenced by verbalization of pain, foot drop,
muscle weakness secondary to Leprosy
4. Disturbed Body Image related to changes skin and
peripheral nerve damage as evidenced by deformities of
extremities, skin lesions, isolation, disparaging comments
about physical changes.
5. Risk for infection related to presence of surgical incision
and other external device as possibly evidenced by surgical
wound, redness, itchiness and fever.
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Pathophysiology of Leprosy: A narrative
Onset of leprosy is insidious. It affects nerves, skin and eyes. It may also affect
mucosa (mouth, nose, pharynx), testes, kidney, voluntary/smooth muscles, reticulo-
endothelial system, and vascular endothelium.
Bacilli enter the body usually through respiratory system. It has low
pathogencity, only a small proportion of infected people develop signs of the disease.
Though infected, majority of the population do not develop the disease.
After entering the body, bacilli migrate towards the neural tissue and enter the
Schwann cells. Bacteria can also be found in, macrophages, muscle cells and
endothelial cells of blood vessels. After entering the Schwann cells /macrophage;
fate of the bacterium depends on the resistance of the infected individual towards the
infecting organism. Bacilli start multiplying slowly (about 12-14 days for one
bacterium to divide into two) within the cells, get liberated from the destroyed cells
and enter other unaffected cells. Till this stage person remains free from signs and
symptoms of leprosy.
As the bacilli multiply, bacterial load increases in the body and infection is
recognized by the immunological system. Lymphocytes and histiocytes
(macrophages) invade the infected tissue. At this stage clinical manifestation may
appear as involvement of nerves with impairment of sensation &/ or skin patch. If it is
not diagnosed and treated in the early stages, further progress of the diseases is
determined by the strength of the patients immune response
Specific and effective cell mediated immunity (CMI) provides protection to a
person against leprosy. When specific CMI is effective in eliminating/ controlling the
infection in the body, lesions heal spontaneously or it produces pauci-bacillary (PB)
type of leprosy. If CMI is deficient; the disease spreads uncontrolled and produces
multi bacillary (MB) leprosy with multiple system involvement. Sometimes, the
immune response is abruptly altered, either following treatment (MDT) or due to
improvement of immunological status, which results in the inflammation of skin or /
and nerves and even others tissue, called as leprosy reaction.

8
IV. DIAGNOSTIC TESTS

1. Skin biopsy
- Skin biopsies are performed to detect
malignancies and are indicated when
skin lesions have suspicious
appearance or when they change in
size, color, or texture. Skin biopsies can
be performed with a biopsy punch or by
scraping or excising the lesion using a
scalpel (Cavanaugh, 2010).
-used to assess for acid-fast bacilli
using Fite stain. Biopsies should be full
dermal thickness taken from an edge of
the lesion that appears most active
(Ustianowski & Lockwood, 2003).
Preparation:
-Explain to the client:
That the test involves removing a small skin sample or portion
of a skin lesion
That the test will be performed by a physician
That it may be necessary to shave the site before the biopsy
That a local anesthetic will be either sprayed onto or injected
at the biopsy site to prevent pain
That one or two sutures may be necessary to close the biopsy
site, depending on its extent
That a dressing or Band-Aid will be applied to the site after
the procedure.
Nursing considerations:
-Ensure to frequently check the site for bleeding
-Inform client of follow-up appointment to remove sutures, if any are
present.
-Instruct client in care and assessment of the site
-Instruct the client to maintain a dry and clean site until it is healed.
-Change dressing as needed.

2. Serologic assay-phenolic glycolipid-1 (specific for M leprae)

- This is a specific serologic test based on the detection of antibodies to
Phenolic glycolipid-1. This test yields a sensitivity of 95% for the detection of
lepromatous leprosy but only 30% for tuberculoid leprosy (Singh et.al, 2011).
Preparation:
-Explain to the client:
The purpose of the test
The procedure, including the site from which the blood sample is
likely to be obtained
That momentary discomfort may be experienced when the skin
is pierced
That food, fluids, and drugs are to be withheld before to the test
Nursing considerations:

9
 -Ensure patient safety while performing the test.
-Maintain digital pressure directly on the puncture site for 3 to 5
minutes after the needle is withdrawn.
-Inspect the site for excessive bruising after the procedure

3. Lepromin test
-this test assesses a patient's ability to mount a granulomatous response
against a skin injection of killed M leprae. Patients with tuberculoid leprosy or
borderline lepromatous leprosy typically have a positive response (>5 mm).
Patients with lepromatous leprosy typically have no response.
Preparation:
- Explain the diagnostic test to patient
- Teach patient that when antigen is injected, there may be a slight
stinging or burning. There may also be mild itching at the site of
injection afterward.
Nursing considerations:
- The injection site is labeled and examined 3 days, and again 28 days
later to see if there is a reaction.

V. INTERVENTIONS
A. General Nursing Interventions

Explanation of the disorder and treatment plan to the

patient and family.
Provide reassurance that early and prompt treatment
commonly results in complete cure of the disease.
Emphasize the need to adhere to regimen such as the
taking of antibiotics to prevent multi drug resistance.
B. Medical Interventions
1. Pharmacological Interventions
The goals of pharmacotherapy are to eliminate the
infection, to prevent complications, to halt its further
transmission and spread, and to reduce morbidity. These
drugs include the following:
Dapsone
Rifampin
Clofazimine
Minocycline
Ofloxacin
Corticosteroids

**DRUG STUDY FOR EACH MEDICATION IS PRESENTED BELOW

10
Generic Name:
Classification: Contraindication: Side/Adverse
Dapsone

Brand Name: Hypersensitive to CNS: Dizz

Dapsone Dapsone and other fatigue, fev
Bactericidal sulfonamides headache,
Bacteriostatic components weakness
Pharmacologic class:
Bactericidal Pregnant and lactating EENT: Pha
women. GI: Anorex
Dosage, timing & route Mechanism of Action diarrhea,
100 mg PO, OD for 6 dysphagia
months Inhibits para- vomiting
aminobenzoic acid, a GU: Crysta
bacterial MS: Arthra
enzyme responsible for myalgia
synthesizing folic SKIN: Blist
acid, which susceptible erythema,
bacteria require for pallor,
growth. photosens
pruritus, ra
Other: Dru
induced fe

Generic Name:
Classification: Contraindication: Side/Adverse
Rifampin

Brand Name: Concurrent use of CNS: Chill

Rifadin non-nucleoside dizziness,
Antimycobacterial reverse drowsiness
Pharmacologic class: antitubercular transcriptase headache
Semisynthetic antibiotic inhibitors or EENT: Dis
derivative of rifamycin protease inhibitors saliva, tear
Dosage, timing & route Mechanism of Action by patients with HIV sputum; m
600 mg every 12 hr for Hypersensitivity to tongue sor
4-6 months Inhibits bacterial and rifamycins periorbital
mycobacterial RNA GI: Abdom

11
 synthesis by binding to
DNA-dependent
RNA polymerase,
thereby blocking RNA
transcription. Exhibits
dose-dependent
bactericidal
or bacteriostatic action.
cramps, an
Rifampin
diarrhea, d
is highly effective against
feces, elev
rapidly dividing
function te
bacilli in extracellular
GU: Disco
cavitary lesions, such as
urine
those found in the
MS: Arthra
nasopharynx.
myalgia

Generic Name:
Classification: Contraindication: Side/Adverse
Minocycline

Brand Name: Hypersensitivity to CNS: Dizzin

Minocin minocycline, other fever, head
Antibiotic tetracyclines, or lightheaded
Antiprotozoal their components unsteadine
Pharmacologic class:
Tetracycline vertigo
CV: Pericar
Dosage, timing & route Mechanism of Action EENT: Blur
vision, dark
Initial: 200 mg. Inhibits bacterial protein discolored t
Maintenance: 100 mg synthesis by tooth discol
every 12 hr. Or 100 to competitively binding to vision chan
200 mg initially followed the 30S ribosomal GI: Abdomi
by 50 mg every subunit of the mRNA- cramps or p
6 hr. ribosome complex of anorexia, d
certain organisms. dysphagia,
GU: Genita
candidiasis
nephrotoxic
HEME: Eos
hemolytic a
neutropenia
thrombocyt
MS: Arthral

12
 myopathy (
RESP: Pulm
infiltrates (w
Generic Name: eosinophilia
Classification: Contraindication: Side/Adverse
Ofloxacin

Brand Name: Hypersensitivity to CNS:

Floxin ofloxacin, other Aggressive
Antimycobacterial fluoroquinolones, or agitation, a
Pharmacologic class: antitubercular their components dizziness,
Fluoroquinolone drowsiness
emotional
Dosage, timing & route Mechanism of Action CV: Arrhyt
300 mg every 12 prolonged
hours for 6 weeks to 4 Inhibits synthesis of the interval, se
months bacterial enzyme hypotensio
DNA gyrase by EENT: Blu
counteracting excessive vision; dipl
supercoiling of DNA disturbanc
during replication or taste, sme
transcription. Inhibition of hearing, an
DNA gyrase equilibrium
causes rapid- and slow- ENDO:
growing bacterial cells to Hyperglyce
die. hypoglycem
GI: Abdom
cramps or
acute diarr
hepatitis, ja
nausea
GU: Acute
insufficienc
failure, cal

Generic Name:
Classification: Contraindication: Side/Adverse
Clofazimine
Brand Name: Bactericidal Hypersensitive to Red brown
Lamprene Antimicrobial Clofazimine and its discoloratio

13
 components. especially
Pharmacologic class: Pregnant and lactating exposed to
Antimicrobial
women hair, sweat
Dosage, timing & route Mechanism of Action urine feces
100 mg PO, OD for 6 Rash, prur
months Inhibits mycobacterial Photosens
growth, binds Diarrhea, n
preferentially to Abdominal
mycobacterial DNA. Has Decreased
antimicrobial properties, sweat prod
but mechanism of action
is unknown. Part of 3
drug regimen for
treatment of
multibacillary leprosy.

Generic Name:
Classification: Contraindication: Side/Adverse
Prednisone

Brand Name: Hypersensitivity to CNS: Euph

Deltasone prednisone or its headache,
Anti-inflammatory components, systemic nervousnes
Pharmacologic class: fungal infection restlessnes
Glucocorticoid seizures
CV: Edema
Dosage, timing & route Mechanism of Action failure, hype
5 to 60 mg daily as a EENT: Cata
single dose or in divided Binds to intracellular exophthalm
doses. glucocorticoid receptors glaucoma,
and suppresses ocular pres
inflammatory and ENDO: Adr
immune responses by: insufficienc
inhibiting neutrophil and Cushings s
monocyte accumulation GI: Anorexi
at inflammation site and bleeding an

14
 suppressing
their phagocytic and
bactericidal
activity

ulceration, i
appetite, ind
intestinal
GU: Menstr
irregularitie
MS: Avascu

15
2. Surgical and Special Procedures

a) Z plasty.
A versatile plastic surgery
technique that is used to improve the
functional and cosmetic appearance
of scars. It can elongate a contracted
scar or rotate the scar tension line.
With this technique, it is possible to
redirect a scar into better alignment
with a natural skin foldor the lines of
least skin tension. It involves the
creation of two triangular flaps of
equal dimension that are then
transposed. Basic z-plasty flaps are created using an angle of 60 degrees on
each side, which can lengthen a scar by 50 to 70 percent and reorient the
direction of the central wound by 90 degrees.

Nursing Interventions:

The patient should be discharged to the ward with comprehensive monitoring

of the following: vital signs, pain control, aate and type of intravenous fluid,
urine and gastrointestinal fluid output, other medications, laboratory
investigations
The patients progress should be monitored and should include at least: A
comment on medical and nursing observations, specific comment on the
wound or operation site, any complications, any changes made in treatment
Encourage early mobilization: Deep breathing and coughing; Active daily
exercise; Joint range of motion; Muscular strengthening
Ensure adequate nutrition
Prevent skin breakdown and pressure sores
Provide adequate pain control as ordered

16
 VI. NURSING CARE PLANS
Impaired skin Integrity related to deficit cellular immune response as evidenced by skin patches and loss of sensation secondary to
Mycobacterium Leprae infection
ASSESSMENT
May exhibit:
Destruction of skin layers
Skin patches
Ulcerations on hands and
feet
Skin redness and lesions
OBJECTIVES
Short term:
At the end of 1 hour, the client
will be able to:
Communicate
understanding of skin
protection measures.
Communicate feelings
about change in body
image.
Long term:
At the end of 1 week to 3
months, the client will be able
to:
Demonstrate skill in care
of wound and skin
inspection technique
Perform skin care routine
Show no evidence of
skin breakdown
Show normal skin turgor
Regain skin integrity
INTERVENTION
INDEPENDENT
1. Inspect skin every shift.
Describe and document
skin condition, and report
changes.
2. Allow patient to express his
or her feelings about skin
problem.
3. Assist with general hygiene
and comfort measures.
4. Maintain proper
environmental conditions.
5. Use a foam mattress and
other bed articles.
6. Maintain infection control
standards such as frequent
hand washing and
performing skin care.
7. Instruct patient and family
members in a skin care
regimen. Supervise patient
and family members in skin
care management.
COLLABORATIVE:
RATIONALE
1. These measures provide
evidence of the
effectiveness of the skin
care regimen.
2. Verbalization of feelings
helps allay anxiety and
develops coping skills.
3. To promote comfort and
sense of well-being.
4. To promote patients sense
of well-being.
5. To minimize skin
breakdown.
6. To reduce the risk of
spreading disease.
7. To encourage compliance.
To improve skill in
managing skin care.
COLLABORATIVE:
8. To maintain skin integrity
and prevent further spread
of infection to other body
system
17
 ASSESSMENT OBJECTIVES
8. Provide prescribed
Impaired Physical Mobility related peripheral nerve damage as evidenced by limited range of motion, joint stiffness and ulcerations
ASSESSMENT OBJECTIVES
Possibly evidenced by: Short term:
Limited ROM; decreased At the end of 30 minutes to 1
muscle strength/control hour, the client will be able to:
Ulcerations on hands and Verbalize feelings of 2. Turn and reposition patient
feet physical limitations
Joint stiffness Express understanding of
Muscle Weakness the teachings rendered.
Paresthesias
Foot drop Long term:
Clawed hands At the end of 1 week to 3
months, the client will be able to:
Maintain muscle strength
and joint ROM
Be free from
complications such as
contractures and further
skin breakdown
Achieve the highest level
of mobility
Use resources to help
maintain level of
INTERVENTION
antibiotics such as
Dapsone
INTERVENTION
INDEPENDENT
1. Perform ROM exercises to
joints, unless ontraindicated,
at least once every shift.
every 2 hr., establish a
turning schedule and post at
bedside.
3. Use trochanter roll along the
thigh, abduct thighs, and
pull a small pillow under
patients head.
4. Place items within reach of
the unaffected extremity.
And provide progressive
mobilization to the limits of
patients condition
5. Instruct patient and family
members in ROM exercises,
transfers, skin inspection,
and mobility regimen.
Request return
RATIONALE
RATIONALE
1. To prevent joint contractures
and muscular atrophy.
2. To prevent skin breakdown
by relieving pressure and to
place joints in functional
position.
3. To maintain joints in a
functional position and
prevent musculoskeletal
deformities.
4. To promote patients
independence.
5. To maintain muscle tone and
prevent complications of
immobility.
6. To help prepare for discharge
and promote continuity of
care. Return demonstration
will ensure use of proper
technique.
7. To increase muscle tone.
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 ASSESSMENT
Acute Pain related to rapid peripheral damage and neuritic involvement as evidenced by verbalization of pain, foot drop, muscle
weakness secondary to Leprosy
ASSESSMENT
Possibly evidenced by:
Verbalization of pain
Foot drop
Guarding behavior
Muscle weakness
Narrowed focus
OBJECTIVES
functionings
OBJECTIVES
Short term:
At the end of 30 minutes, the
client will be able to:
Rate pain on a scale of 110.
Articulate factors that
intensify pain and will modify
accordingly.
Show and express feeling of
comfort and relief from pain
Rest comfortably
Long term:
At the end of 12 hours to 2
days, the client will be able to:
Demonstrate use of
relaxation skills and
diversional activities as
INTERVENTION
demonstration
6. Instruct him/her to perform
self-care activities.
COLLABORATIVE:
7. Carry out full course of
antibiotic to manage or
prevent complications.
INTERVENTION
INDEPENDENT:
1. Make changes in the
environment at the patients
suggestion that will promote
sleep
2. Reposition patient and use
pillows to splint or support
painful areas, as
appropriate.
3. Provide patient with sleep
aids, such as pillows, bath
before sleep, and reading
materials. Milk and some
high-protein snacks, such
as cheese and nuts, contain
L-tryptophan and are also
sleep promoters.
RATIONALE
8. This promotes patients
health and well-being.
RATIONALE
INDEPENDENT:
1. This allows patient to have
an active role in treatment.
2. To minimize or relieve pain.
3. To reduce muscle spasm
and to redistribute pressure
on body parts.
4. Personal hygiene and
prebedtime rituals promote
sleep in some patients.
Comfort measures act as
distracters from pain,
reduce muscle tension or
spasm, and redistribute
pressure on body parts.
5. Listening attentively gives
the patient a feeling that the
nurse is interested. It also
19
 ASSESSMENT OBJECTIVES INTERVENTION RATIONALE
indicated for painful situation.
4. Teach relaxation techniques helps determine progress in
such as guided imagery, alleviating the pain.
deep breathing, and
progressive muscle
relaxation.
5. Listen to description of pain.
Allow time for the patient to
talk about his/her frustration.
COLLABORATIVE:
1. Administer analgesic
medications to alleviate pain
Disturbed Body Image related to changes skin and peripheral nerve damage as evidenced by deformities of extremities, skin
lesions, isolation, disparaging comments about physical changes.

ASSESSMENT OBJECTIVES INTERVENTION RATIONALE

Possibly evidenced by: Short term:
At the end of 30 minutes to 3
Deformities of hands and hours, the client will be able to: 1. Perform ADL measures that
feet Express concerns and
anxieties regarding hi/her
Presence of skin lesions
condition.
Social isolation
Understand the health
Limited movements and
teachings and importance
activity
of regimen
Identify ways to consider
lifestyle changes
INDEPENDENT
the patient is unable to
perform for self.
2. Provide patient with
information on appropriate
self-care activities (e.g.,
maintaining proper diet;
bathing as needed; using
alcohol-free skin lotions to
combat dryness; exercising
1. This can be done while
promoting as much
independence as possible.
2. To ensure that the patient
will be able to perform self-
care measures.
3. To maintain or increase
muscle tone and joint
mobility.
4. This enables caregivers to
participate in patients care
while supporting patients

20
 ASSESSMENT OBJECTIVES
Long term:
At the end of 4 weeks to 3
months, the client will be able to:
Identify physical changes
without making
disparaging comments.
Demonstrate increased
flexibility and willingness
to address problem of
ones physical self
Perform self-care
activities to tolerance
level.
Risk for infection related to presence of surgical incision and other external device as possibly evidenced by surgical wound,
redness, itchiness and fever.
ASSESSMENT OBJECTIVES
Possibly evidenced by: Short term:
At the end of 2 hours, the client
Surgical wound will be able to:
Achieve improvement in
Redness
wound healing, be free of
Itchiness
purulent drainage or
Fever
erythema, and be
INTERVENTION
appropriately to maintain
muscle mass).
3. Teach patient about
isometric exercises.
4. Teach significant others to
assist patient with self-care
activities in a way that
maximizes patients
potential.
5. Provide emotional support
and encouragement
6. Involve patient in planning
and decision making.
7. Encourage to engage in
social activities among
INTERVENTION
1. Inspect the skin for
preexisting irritation or
breaks in continuity.
2. Assess surgical sites/skin
areas, noting reports of
increased pain/burning
RATIONALE
independence.
5. To improve patients self-
concept and promote
motivation to perform
ADLs.
6. Having the ability to
participate will encourage
greater compliance with the
plan for activity.
RATIONALE
1. To allow further intervention
and decrease the risk of
infection
2. Pins or wires should not be
inserted through skin
infections, rashes, or
abrasions (may lead to bone
21
 ASSESSMENT OBJECTIVES INTERVENTION
Bleeding afebrile.
Foul odor sensation or presence of
Long term: edema, erythema, foul odor,
At the end of 12 hours, the client or drainage.
and parents will be able to: 3. Provide wound care, and
Identify interventions to exercise as per agency
prevent or reduce risk of policy.
infection 4. Monitor vital signs. Note
Demonstrate appropriate presence of chills, fever,
care of infection-prone malaise, changes in
site. mentation.
5. Investigate abrupt onset of
Remain free from
pain/limitation of movement
symptoms of infection
with localized edema and
pallor in injured extremity.
6. Perform hand hygiene before
and after providing care, and
direct patients parents to do
this before and after meals
and after using the bathroom
or changing the childs
diapers.
7. Help patient turn every 2 hr.
Provide skin care,
particularly over bony
prominences
8. Assist childs parents when
RATIONALE
infection).
3. May prevent cross-
contamination and
possibility of infection
4. These symptoms may
reflect development of
infection
5. May indicate lack of blood
supply on the site. Ensure to
check neurovascular status
regularly.
6. To avoid spread of
pathogens
7. This helps prevent venous
stasis and skin breakdown.
8. Cleaning perineal area by
wiping from the area of least
contamination (urinary
meatus) to the area of most
contamination (anus) helps
prevent genitourinary
infections.
22
ASSESSMENT OBJECTIVES INTERVENTION RATIONALE

necessary to ensure that

perianal area is clean after
elimination.

23
 REFERENCES

A. Books

Boyer, M. (2010). Brunner and Suddarth's Textbook of Medical-Surgical

Nursing. Philadelphia: Lippincott Williams & Wilkins.

Cavanaugh, BM. Nurses Manual of Laboratory and Diagnostics. F.A. Davis

Company; Philadelphia

Deglin, J., Vallerand, A. (2010). Davis Drug Guide for Nurses. F.A. Davis
Company; Philadelphia

Pillitteri, A. (2010). Maternal and Child Health Nursing. Philadelphia: Lippincott

Williams & Wilkins.

Sparks, S., Taylor, C. (2011). Nursing Diagnosis Pocket Guide. Wolters

Kluwer, Lippincott Williams and Wilkins; Philadelphia

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Reibel F, Cambau E, Aubry A (2015). Update on the epidemiology, diagnosis,

and treatment of leprosy. Mdecine et Maladies Infectieuses. Volume
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Scollard DM, Adams LB, Gillis TP, Krahenbuhl JL, Truman RW, Williams DL.
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Schreuder PAM, Noto S, Richardus JH (2015). Epidemiologic trends of

leprosy for the 21st century. Clinics in Dermatology. Volume 34, Issue
1:24-31

The World Health Organization. Diagnosis of Leprosy. Leprosy Elimination.

Available at http://www.who.int/lep/diagnosis/en/. Accessed: April 12,
2017

Ustianowski AP, Lockwood DN (2003). Leprosy: current diagnostic and

treatment approaches. 16(5):421-7

Anderson H, Stryjewska B, Boyanton BL, et al. (2007). Hansen disease in the

United States in the 21st century: a review of the literature

Singh P, Busso P, Paniz-Mondolfi A, et al. (2011). Molecular Drug

Susceptibility Testing and Genotyping of Mycobacterium leprae Strains
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Bachelder, E., Blake, R., et.al (2008). Hansens Disease (Leprosy)

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