NCLEX Review Guide: Sarcoidosis

Disease Overview

• Sarcoidosis is a multisystem inflammatory disease characterized by formation of noncaseating granulomas in affected organs, most commonly the lungs and lymph nodes.
• The exact cause is unknown, but it involves an abnormal immune response to environmental triggers in genetically susceptible individuals.
• Peak incidence occurs in adults aged 20-40 years, with higher prevalence in African Americans and Northern Europeans.

Primary Clinical Manifestations

• Pulmonary symptoms: Dry cough, dyspnea on exertion, chest pain, and fatigue are most common presenting symptoms.
• Systemic symptoms: Fever, weight loss, malaise, and night sweats may occur during active disease phases.
• Extrapulmonary manifestations: Skin lesions (erythema nodosum), eye involvement (uveitis), cardiac arrhythmias, and neurological symptoms.

Essential Diagnostic Tests

• Chest X-ray shows bilateral hilar lymphadenopathy in 95% of cases, often the first abnormal finding detected.
• High-resolution CT scan provides detailed imaging of lung parenchyma and can detect early disease not visible on chest X-ray.
• Tissue biopsy showing noncaseating granulomas confirms diagnosis, commonly obtained via bronchoscopy or lymph node biopsy.

Pharmacological Management

• Corticosteroids (prednisone) are first-line treatment for symptomatic disease, typically started at 20-40mg daily with gradual taper.
• Monitor for steroid side effects: hyperglycemia, hypertension, osteoporosis, and increased infection risk during long-term therapy.
• Immunosuppressive agents (methotrexate, azathioprine) may be used for steroid-sparing effects in chronic cases.

Nursing Assessment Priorities

1. Monitor respiratory status: rate, depth, oxygen saturation, and adventitious breath sounds
2. Assess activity tolerance and degree of fatigue with daily activities
3. Evaluate skin integrity and document any lesions or changes
4. Monitor for medication side effects, especially with corticosteroid therapy
5. Assess psychological adaptation to chronic disease diagnosis

Essential Patient Teaching

• Educate about disease unpredictability and importance of regular follow-up appointments for monitoring disease progression.
• Teach recognition of worsening symptoms: increased dyspnea, persistent cough, chest pain, or visual changes requiring immediate medical attention.
• Discuss medication adherence and importance of gradual steroid tapering to prevent adrenal insufficiency.

Potential Complications

• Pulmonary fibrosis leading to restrictive lung disease and respiratory failure in 5-10% of patients.
• Cardiac involvement can cause arrhythmias, heart block, or sudden cardiac death in 5% of cases.
• Hypercalcemia due to increased vitamin D production by granulomas, leading to kidney stones or renal dysfunction.

Commonly Confused Points

Self-Assessment Checklist

• ☐ Can I identify the classic chest X-ray findings?
• ☐ Do I understand when treatment is indicated?
• ☐ Can I differentiate from tuberculosis?
• ☐ Do I know the nursing priorities for assessment?
• ☐ Can I identify serious complications?