Skip to main content

Sarcoidosis Nursing Guide

The content was created by Zeliha Ozen, MSN, RN, CCRN, CNL

Sarcoidosis Overview

This course is intended as a Quick Reference for sarcoidosis, where we address diagnosing, managing, and providing treatment to patients with sarcoidosis.

Sarcoidosis Etiology and Epidemiology

Sarcoidosis is an inflammatory disease where granulomas form in various organs (Bokhari et al., 2021). Sarcoidosis can be caused by viruses, chemicals, and/or bacteria. The immune system's reaction to viruses, chemicals, and/or bacteria triggers an inflammatory response.

Some individuals have a genetic predisposition to developing sarcoidosis when they come in contact with a foreign substance.

The incidence of sarcoidosis is higher in Black individuals than in White individuals. The current statistics for sarcoidosis is 11 cases per 100,000 in White individuals and 35 cases per 100,000 in Black individuals (Bokhari et al., 2021). Cardiac involvement has a higher prevalence rate in males than females. Females present more with eye and skin involvement than males.

Sarcoidosis Diagnosis: Laboratory Analysis

Individuals presenting with signs concerning for sarcoidosis will receive blood draws to analyze for auto-immune disorders. Currently, there are no specific blood tests to diagnose sarcoidosis (Bokhari et al., 2021). A thorough assessment with a combination of blood work is required.

Typical lab work can include:

  • C-reactive protein (CRP): CRP can be mildly elevated in about one-third of individuals.
  • Complete blood count (CBC): A CBC can screen for any hematological abnormalities such as anemia.
  • Comprehensive metabolic profile (CMP): Hypercalciuria is common.
  • Liver function tests (LFTs): Alkaline phosphatase may be elevated.
  • Serum markers can show elevated angiotensin-converting enzyme (ACE) levels and elevated adenosine deaminase (ADA) levels.

Sarcoidosis Diagnosis: Imaging

Providers will perform a thorough clinical and imaging evaluation and exclude any other possible diseases. Most patients will need a biopsy if there is a suspicion of more than one organ involvement. Images help identify organ involvement in sarcoidosis (Bokhari et al., 2021). Typically, non-invasive imaging can include:

  • Chest X-ray: Lung parenchymal findings can vary, but nodular, reticular, ground-glass opacities, and consolidation can be seen.
  • High-resolution computer tomography (HRCT): Evaluates any abnormalities that are seen on chest X-ray such as:
    • Hilar and mediastinal lymphadenopathy
    • Irregular thickening of the bronchovascular structures
    • Cysts
  • Fluorine-18-fluorodeoxyglucose-positron emission tomography (FGD-PET scan):
    • Evaluate for lesions
    • Evaluate for cardiac involvement
  • Pulmonary function test (PFT):
    • Specific for pulmonary involvement: PFTs can show reduced carbon monoxide diffusing capacity (DLCO), indicating reduced vital and lung capacity.
  • 6 minute walk test (6MWT):
    • A 6MWT is reduced in the majority of individuals and is associated with reduced forced vital capacity (FVC).

Managing Sarcoidosis

Treatment for sarcoidosis depends on the severity of the disease and organ involvement (King et al., 2021). Individuals who have significant symptoms or disease progression, such as pulmonary or cardiac involvement, may be started on medications.

  • Glucocorticoids: This class of medications can improve symptoms of sarcoidosis such as cough and dyspnea. The long-term side effects of glucocorticoids will need to be assessed and evaluated if an individual is appropriate for this therapy. Clinicians will need to monitor side effects of glucocorticoid therapy, such as:
    • Diabetes mellitus
    • Excessive weight gain
    • Myopathy
    • Osteoporosis
  • Immunosuppressants: Individuals with sarcoidosis who cannot tolerate or have difficulty responding to glucocorticoids can be treated with other immunosuppressive or immunomodulatory agents. Immunosuppressant medications that can be prescribed include:
    • Methotrexate (Xatmep®)
    • Azathioprine (Azasan®)
    • Leflunomide (Arava®)
    • Mycophenolate (CellCept®)
  • Tumor necrosis factor-alpha (TNF-alpha) inhibitors: This medication group can be used to manage inflammation that is associated with sarcoidosis.
  • Pacemaker: A cardiac pacemaker or intracardiac defibrillator (ICD) may be required in individuals who have cardiac involvement.
  • Transplant: Organ transplant may be necessary for individuals whose sarcoidosis has severely damaged organ function. Typically, organ transplantation for sarcoidosis includes the following:
    • Lung
    • Liver
    • Heart

Sarcoidosis Nursing Care Plan

Nursing Considerations

Assessment

Symptoms can vary depending on the severity of the disease and organ involvement (Bokhari et al., 2021). Because sarcoidosis is a multisystem inflammatory process of all organs, individuals can present with an array of symptoms. Typical symptoms of sarcoidosis can include the following:

  • Fatigue
  • Shortness of breath (SOB)
  • Dry cough
  • Blurry vision
  • Palpable lymph nodes
  • Hearing loss
  • Depression
  • Anxiety

Cutaneous Symptoms

Recognition of cutaneous sarcoidosis is vital as it allows the provider easy access to perform a biopsy for diagnoses. Cutaneous symptoms can include the following:

  • Rash
  • Lesions
  • Parts of the skin that might have discoloration (i.e., lighter or darker)
  • Nodules

Nursing Diagnosis/Risk For

  • Impaired skin integrity related to rash and lesions
  • Pain related to the inflammatory response
  • Activity intolerance secondary to dyspnea
  • Emotional distress and anxiety
  • Impaired hearing
  • Impaired vision
  • Arrhythmias

Interventions & Treatment for Sarcoidosis

Hemodynamic stability:

  • Monitor for arrhythmias
  • Monitor dyspnea with rest and with ambulation
  • Monitor oxygen levels

Medication administration:

  • Administration of corticosteroids, pain medicine, and immunosuppressants as ordered
  • Monitor for any medication-related side effects

Skin integrity:

  • Monitor for any skin lesions and rash

Transplant considerations:

  • Referral to a transplant program
  • Testing for transplant candidacy
  • Strongly encouraging physical activity and strength exercises
  • Education on transplant medications, complications, and side effects

Expected Outcomes

Asymptomatic individuals may not require any invasive treatment (Bokhari et al., 2021). Most individuals are stable with sarcoidosis with no severe long-term effects. The decline of symptoms in specific individuals is related to advanced disease, especially with pulmonary and cardiac involvement. The overall mortality rate for untreated individuals is around 5% (Bokhari et al., 2021). Intended outcomes include:

  • Pain management
  • Stability of respiratory symptoms
  • Decrease inflammation
  • Knowledge specific to medication purpose and adherence

Individual/Caregiver Education

Individuals will require education on:

  • The outpatient treatment plan and expected follow-up course
  • Medication use and compliance
  • Promoting physical activity
  • Referral to pulmonary rehab
  • Monitoring for any skin changes
  • Routine eye exams

Nursing Continuing Education Courses

Earn CEUs with Nurse.com's extensive course catalog.

Learn More

Additional Information

Content Release Date 

6/11/2024

Content Expiration

12/31/2025

Course Contributor

The content for this course was created by Zeliha Ozen, MSN, RN, CCRN, CNL. Zeliha has extensive experience in critical care nursing in acute care hospitals, including cardiac intensive care and medical intensive care units. She has served in various roles, such as lung transplant coordinator, educator, preceptor, charge nurse, and code nurse. Additionally, Zeliha has worked on many quality initiatives for the ICU, such as infection control, cardiac education, and nursing onboarding. She earned a Bachelor of Science in nursing from Saint John University in Rochester, NY. She has a Master of Science in nursing and a master’s in clinical nurse leadership (CNL) from Queens University in Charlotte, NC. She is also a certified critical care nurse (CCRN).

References

View All Clinical Guides