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Leprosy Nursing Guide

Content created by: Emily R. van den Berg, MSN, APRN, ACNPC-AG, CCRN

Overview: Leprosy

This content is intended as a Quick Reference for Leprosy and will provide an overview and nursing considerations utilizing the nursing process.

Etiology and Epidemiology

Leprosy has historically been a condition that caused fear and isolation of those with the disease. However, we now know that it can be cured with early interventions and routine screening at the presence of symptoms. It is considered a chronic disease and, while interventions are available, a lack of awareness about it can lead to devastating effects and disability for long-term patients. According to Donohue (2019), leprosy is endemic in many subtropical and tropical countries, but has few cases in the U.S., with only 150 to 250 new cases per year.

The disease, also known as Hansen’s disease, is bacterial and caused by Mycobacterium leprae. An infection with these bacteria leads to nerve and tissue damage in the extremities, skin, and lining of the airways, including the nose and upper respiratory tract. While historical accounts of “leper colonies” and the need to isolate those suffering from leprosy cause fear of the condition, it is not significantly contagious.

Mycobacterium leprae is found in the mucosal secretions of those infected and is transferred from breathing in air contaminated during coughing or sneezing. People in close and repeated contact with individuals with leprosy are at an increased risk of infection, as are those with compromised immune systems (such as those with cancer, HIV/AIDS, or other chronic diseases). Additionally, in the U.S. and Mexico, the disease is present in a native armadillo species (Donohue, 2019).

Leprosy Diagnosis

If leprosy is being considered as a potential diagnosis, it is important to pay attention to the following (Donohue, 2019):

  • Number and size of lesions
  • Location(s) of lesions
  • Presence of sensation in lesions

Testing for the presence of leprosy includes (Donohue, 2019):

  • Biopsy of lesion to detect presence of Mycobacterium leprae
  • Lepromin skin test with positive result, which indicates borderline or true tuberculoid leprosy

Management

Through medical advancements, the ability to cure leprosy has advanced as well. However, there are still many cases throughout the world annually. This is due to lack of knowledge of treatments, as well as lack of routine medical care in more isolated parts of the world. The World Health Organization (WHO) developed a treatment for leprosy which relies on multiple medications used together and is referred to as multidrug therapy (MDT). Antibiotics are also now available that can kill M. leprae bacteria once a diagnosis has been made (Donohue, 2019).

To detect and successfully manage leprosy prior to disfigurement or disability, it is important to routinely assess for the following (Donohue, 2019):

  • Non-healing skin lesions
  • Skin lesions appearing lighter than surrounding skin tone
  • Decreased sensation in lesions or extremities
  • Weakness in extremities
  • Extended contact with individuals infected with leprosy
  • Contact with carriers of leprosy, such as armadillos

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with leprosy are listed below.

Assessment

  • Signs and Symptoms
    • Lesions with decreased sensation
    • Numbness or decreased sensation in extremities
    • Muscle weakness
  • Past Medical History
    • Chronic disease
    • Impaired immune functioning (Cancer, HIV/AIDS, immunotherapy)
    • History of contact with individuals or animals infected with leprosy
  • Family History
    • Contact with close relatives infected with leprosy
    • Living in area with high number of annual leprosy infections

Leprosy Nursing Diagnosis/Risk For

  • Impaired skin integrity related to:
    • Presence of lesions that do not heal
    • Nerve damage
    • Tissue injury in eyes, leading to blindness, as evidenced by decreased sensation in affected extremities, lesions, and vision loss
  • Infection related to:
    • Lesions that do not heal
    • Contact with persons infected with leprosy, as evidenced by presence of M. leprae bacteria upon biopsy of lesions
  • Impaired physical mobility related to:
    • Muscle weakness
    • Physical disability due to disfigurement
    • Inadequate self-care due to vision loss and disability, as evidenced by decreased self-care activities and malnutrition

Interventions

  • Physical assessment to determine presence and extent of the following:
    • Lesions
    • Numbness or decreased sensation of affected areas
    • Vision issues
    • Mobility issues
    • Risk of infection from M. leprae bacteria
    • Presence of disfigurement or disability
  • Once infection with leprosy has been established, monitor the following:
    • Presence of lesions
    • Changes in nature and number of lesions
    • Changes in ability and disfigurement
    • Reaction to MDT or antibiotics
    • Nutrition status
    • Presence of support system

Expected Outcomes

  • Employ proactive detection and prevention methods to decrease infection risk.
  • Begin medical therapy as soon as infection is identified.
  • Prevention of disfigurement and disability through early detection and treatment
  • Advanced education and testing initiatives in areas of high infection rates

Individual/Caregiver Education

  • Necessity of reporting lesions and extremity involvement early
  • Symptoms associated with leprosy infection
  • Ability of leprosy to be treated with MDT and antibiotics
  • When to discuss symptoms with provider

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2025

Content Contributor

The content for was created by Emily R. van den Berg, MSN, APRN, ACNPC-AG, CCRN. She has been a nurse for 5 years and was educated and trained in both Florida and Alabama. She earned her Bachelor’s of Science degree in Nursing and began critical care training after completion, earning her CCRN and then continuing to complete her Master’s of Science in Nursing with a concentration in Adult-Gerontology Acute Care Nurse Practitioner Studies. Her clinical expertise is in surgical patients, and she most recently worked as a Registered Nurse in a Surgical Intensive Care Unit prior to starting her career as a Nurse Practitioner.

Resources

References

 

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