# A nurse is caring for a client with newly diagnosed sarcoidosis. Which nursing intervention should be the priority?

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## 문제

A nurse is caring for a client with newly diagnosed sarcoidosis. Which nursing intervention should be the priority?

## 보기

1. Encourage increased fluid intake to 3-4 liters per day
2. Administer oxygen therapy at 2 L/min via nasal cannula
3. Implement strict bed rest to conserve energy
4. Monitor for signs and symptoms of respiratory distress **✔ 정답**

**정답: 4**

## 해설

Monitoring for respiratory distress is the priority for sarcoidosis as it can cause progressive pulmonary involvement. Other options like high fluid intake, oxygen therapy, or strict bed rest are not standard initial interventions.

## 심화 해설

Understanding the Priority for a Newly Diagnosed Sarcoidosis Client

When caring for a client with newly diagnosed sarcoidosis, the nurse's immediate priority is to ensure physiological safety by applying the airway, breathing, and circulation (ABC) framework. Sarcoidosis is a systemic granulomatous disorder primarily classified among interstitial lung diseases (ILDs), with the lungs and intrathoracic lymph nodes being the most frequently affected sites [2]. The unpredictable nature of pulmonary involvement means a client can rapidly develop compromised gas exchange. Therefore, vigilant respiratory assessment is the cornerstone of initial nursing management.

Analysis of the Options

Option 4: Monitor for signs and symptoms of respiratory distress is the priority intervention. The pathological hallmark of sarcoidosis is the formation of non-caseating granulomas in the lung parenchyma, which can lead to decreased lung compliance and impaired diffusion capacity. A focused respiratory assessment—including monitoring respiratory rate, depth, breath sounds, oxygen saturation, and signs of increased work of breathing—allows the nurse to detect early deterioration and intervene before a crisis develops. This aligns directly with the nursing process, where assessment is the critical first step.

Option 1: Encourage increased fluid intake to 3-4 liters per day is not an evidence-based priority for pulmonary sarcoidosis. While hypercalcemia can occur in sarcoidosis due to activated macrophages producing excess vitamin D, and hydration is a component of managing hypercalcemia, this is a secondary, not primary, concern in the initial stabilization phase. The immediate threat is respiratory compromise, not fluid and electrolyte imbalance.

Option 2: Administer oxygen therapy at 2 L/min via nasal cannula is a dependent nursing intervention that requires a provider's order. More importantly, it should only be implemented based on a clinical assessment indicating hypoxemia. Administering oxygen without first assessing the client's respiratory status and oxygen saturation is premature and could delay recognition of a more serious problem, such as a pneumothorax.

Option 3: Implement strict bed rest to conserve energy addresses a common symptom but not the priority. Sarcoidosis-associated fatigue (SAF) is indeed the most reported symptom and leads to impaired quality of life . However, fatigue management is a long-term, quality-of-life concern. In the acute or newly diagnosed phase, the physiological threat of respiratory failure takes precedence over energy conservation. Strict bed rest also carries risks of deconditioning and venous thromboembolism and is not a first-line safety intervention.

The clinical heterogeneity of sarcoidosis, which arises from complex interactions between environmental exposures and immune responses in genetically susceptible individuals, means the nurse must be prepared for a wide range of presentations [2]. A systematic assessment of the respiratory system is the only intervention that provides the data needed to guide all subsequent actions, from notifying the provider to administering oxygen or other prescribed therapies.

References (research sources)

- [2]Uncovering Sex and Gender Differences in Sarcoidosis: A Systematic Review of Current Evidence.Meta-analysis/systematic reviewPianigiani T, Perea B, Dilroba A, Fanella A, Milli C, Postiferi S, Rubegni L, Bergantini L, D'Alessandro M, Cameli P, Bargagli E. (2026) · DOI: 10.3390/jpm16010024

## 임상 시나리오

Sarcoidosis: Priority Nursing AssessmentApplying the ABC Framework to Interstitial Lung Disease
For a client with newly diagnosed sarcoidosis, the immediate priority is to monitor for respiratory distress. Pulmonary involvement from non-caseating granulomas can rapidly decrease lung compliance and impair gas exchange.

Perform a focused respiratory assessment including rate, depth, breath sounds, oxygen saturation (SpO2), and signs of increased work of breathing. This aligns with the nursing process where assessment precedes intervention.

CautionDo not administer oxygen therapy routinely without first assessing the patient's oxygenation status. Interventions like managing hypercalcemia with fluids are secondary to ensuring a patent airway and effective breathing.

## 핵심 개념

- **Sarcoidosis** — A systemic granulomatous disorder of unknown etiology primarily affecting the lungs and intrathoracic lymph nodes, leading to non-caseating granuloma formation.
- **Non-caseating Granuloma** — A discrete collection of inflammatory cells without central necrosis, the pathological hallmark of sarcoidosis that can impair organ function.
- **Interstitial Lung Disease (ILD)** — A group of disorders characterized by inflammation and scarring of the lung interstitium, reducing lung compliance and gas exchange.
- **ABC Framework** — A prioritization method in nursing (Airway, Breathing, Circulation) used to identify and manage life-threatening conditions first.
- **Nursing Process** — A systematic method of providing care involving assessment, diagnosis, planning, implementation, and evaluation; assessment is the critical first step.

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