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XI. INTRODUCTION
A. Background of the Study
Leprosy has been a Public problem in the Philippines for several decades. The
disease unequally distributed throughout the country. In 1987, in the provinces of
Ilocos Norte and Ilocos Sur, Abra, Sulu, Palawan Cebu and La Union, Pangasinan and
Metro Manila, the prevalence rate changed from 0.40 to 3.01 per thousand
populations. In other provinces. The prevalence rate is lower than 0.40/1000
population. The National Prevalence Rate as of 1998 was 0.65/1000. (Community
Health Nursing Services in The Philippines. 9th Edition, page 215)
The Nationwide implementation of Multi-drug Therapy (MDT) SINCE 1988 has
resulted in the decrease In the prevalence rate of leprosy. The prevalence rate of the
disease declined from 7.2/10,000 population in 1986 to 1.2/10,000 population in
1997. Since then, the treatment of leprosy has shifted from institutional care to that
home treatment.
Leprosy (Hansen’s Disease; Hansenosis; Lepra; Leontiasis) is a chronic disease
with an insidious onset, transmitted from man to man, affecting the skin, mucous
membranes and nervous tissue and eventually producing deformities. This chronic,
mildly, infectious disease is caused by rod-shaped bacilli, Mycobacterium Leprae pr
Leprosy bacilli or Hansen’s Bacillus.
B. Rationale for Choosing the Case
Most of our patient assignments are Non-hansen patient. Meaning they are not
affected with the Mycobacterium Leprae. Since my focus is Patient care
management and we are in a Leprosarium, I choose the case of Hansen patient or

2. patient affected with the Mycobacterium Leprae because it would help us to have
focus study regarding this case- more nursing care would be given.
XII. PATIENT PROFILE
A. General Data
Name: Patient X
Age: 25 years old
Birth date: January 24, 1979
Birth Place: Cebu
Sex: Female
Nationality: Roman Catholic
Civil Status: Single
Address: Caloocan City
Ward/Accommodation/Service: Female Ward/Charity/Medicine
Patient Category: Non regular Hansen
Date Admitted: June 16, 2012
Time Admitted: 3:00pm
XIII. PHYSICAL ASSESSTMENT
BODY PARTS NORMS ACTUAL
FINDINGS
INTERPRETATION
AND ANALYSIS
Skin Varies from light to
deep brown; from
ruddy pink; from
yellow overtones
to olive (pg. 538
Fundamentals of
Nursing by Kozier,
7th Edition)
Skin lesions all
over the body.
Loss of sensation
on the skin
lesions.
Not normal. The
cardinal signs of
leprosy are the ff:
--Loss of sensation
on the skin lesions
--Enlargements of
peripheral nerves
--Presence OF
leprosy bacilli in the
skin smear. Loss of
sensation can cause
further damage to
skin.
XIV. Anatomy and Physiology

3. The skin is the body’s largest organ, covering the entire body. In addition to
serving as a protective shield against heat, light, injury and infection, the skin also:
a. Regulates body temperature
b. Stores sensory organ
c. Prevents water loss
d. Prevents entry of bacteria
Throughout the body, the skin’s characteristics (thickness, color, texture)
vary. For instance, the head contains more hair follicles than anywhere else,
while the soles of the feet contain none. In addition, the soles of the feet and the
palms of the hand are much thicker. The skin is made up of the following layers,
with each layer performing specific functions:
a. Epidermis
b. Dermis
c. Subcutaneous fat layer
Epidermis The epidermis is the thin outer layer of the skin and
consists of three parts:
a. Stratum corneum (horny layer)
-this layer consists of fully mature
keratinocytes which contain fibrous proteins
(keratins) The outermost layer is continuously
shed. The stratum corneum prevents the
entry of most foreign substances as well as
the loss fluid from the body.
b. keratinocytes (squamous cells)
-This layer just beneath the stratum corneum
contains living keratinocytes, which mature
and forms stratum corneum.
c. Basal layer
-the basal layer is the deepest layer of the
epidermis containing basal cells. Basal cells
continually divide, forming new keratinocytes
that replace the cells that are shed from the
skin’s surfaces. The epidermis also contain
melanocytes, which are cells that produces
melanin (skin pigment)

4. Dermis The Dermis is the middle layer of the skin. The dermis
contains the following.
d. Blood vessels
e. Lymph vessels
f. Hair follicles
g. Sweat glands
h. Collagen bundles
i. Fibroblasts
j. Nerves
The dermis is held together by a protein called
collagen, made fibroblasts. This layer also contains
pain and touch receptors.
Subcutaneous Fat
Layer
The subcutis is the deepest layer of the skin. The
subcutis, consisting of network of collagen and fat
cells, helps conserve the body’s heat and protects the
body from injury by acting as shock absorber.
XV. Patophysiology/Schematic diagram of the disease
a. A chronic intracellular infectious disease unique to man usually it is not fatal. The
manifestations of the disease depend on the resistance of the host.
Types:
1. Tuberculoid- host is highly resistant, clinical abnormalities limited yo a few
peripheral nerves and adjacent skin areas, tuberculoid granuloma
2. Lepromatous- host lacks resistance, all tissues affected from cell granuloma
3. Borderline- between tuberculoid and lepromatous
The earliest clinically detectable lesions of leprosy involve the skin and show
histologic association with sebaceous glands and hair follicles. From the
onset, small cutaneous nerve fibers are involved. With bacillary
multiplication, contiguous skin areas including autonomic nerve fibers,
dermal appendages, and blood vessels are invaded.
Lymphohemategenous dissemination of bacilli is probably an early
phenomenon. An infection spreads along sensory nerves motor fibers within

5. parent nerve trunks are damaged. Leprosy bacilli are unable to penetrate
directly into the nervous system proximal to the dorsal root ganglions:
central nervous systeminfection does not occur.
When there is dense proliferation of leprosy bacilli, as a lepromatous leprosy,
bacteremia is virtually continues, and bacilli are easily demonstrable in many
organs. Yet there is little systematic reaction, and tissue destruction occurs
mainly in cool superficial locations; the skin (except folds); peripheral nerves
in subcutaneous loci; oral and naso pharyngeal mucous membranes (not
enteric or vaginal) ; the testes (not the ovaries) and the anterior third of the
eye.
The clinical manifestations are the indeterminate (1) lesion, which may be
the initial manifestation, shows as ordinary-looking skin changes, such as
pale oval or rounded macules, papulonodules, wheals or circinate patches.
They may be found in the malar area, extremities’ or buttocks. There may be
only one or few lesions which may appear and disappear, undergo
spontaneous healing or gradually progress through the borderline (BB) form
towards the tuberculoid (BT) or lepromatous (BL) forms. The lesions are
usually anesthetic but this may be later manifestations. They maybe
depigmented or erythomatous. Sensory disturbances as paresthesias,
numbness and formication may also be found. There may also be thickening
or superficial nerve trunks. Especially the ulnar, as well as lymphadenophaty
anhindrosi, ichtyosis and limb weakness. The foregoing manifestations may
be seen in nay of the clinical forms particularly in the tuberculoid (TT) which
is also characterized by adefinite tendency towards healing. Damage in the
following nerves is associated with characteristic impairments in leprosy;
®ulnar and median- clawed hand
®posterior tibila- plantar insensitivity and clawed toes
®common peroneal- foot drop
Radial cutaneous, facial and greater auricular nerves infiltration by
bacteria may lead to destruction of nasal cartilage (lepromatous form) ocular
movement and diffuse thickening of the skin. Advanced cases involve the loss
of eyebrows and lashes but these deformities are less common.
XVI. Laboratory and Diagnostic Examination

6. Diagnostic Exam Norms Actual Results Interpretation and
Analysis
Urinalysis Reference Values
Color: light straw to
dark amber
Appearance: clear
Odor: aromatic
Ph: 4.5-8.0
Specific gravity:
1.005-1.030
Protein: 2-8
Mg/dl: Negative
reagent strip test
Trace Glucose:
negative
Ketones: negative
(Handbook of
Laborator and
Diagnostic Test)
Actual findings Color:
Yellow
Appearance: Clear
Odor: aromatic
pH: Acidic
Specific gravity:1.030
Protein: Negative
Glucose: negative
Microscopic
Examination:
RBC: 0-1/hpf
Pus: 0-3/hpf
Epithelial Cells:
positive
Urates: postive
Interpretation: The
urine color, Ph,
specific gravity and
microscopic
examination
(epithelial cells and
urates) are not normal
while the appearance
protein, glucose are
normal.
Analysis: Color of the
urine changes can
results from diet.
Drugs and much
disease. (pg. 395,
Diagnostic Test) When
water loose from the
body exceeds water
intake, the kidneys
need to consume
water making the
urination more
concentrated with
waste products and
subsequently dark in
color. Yellow colored
urine is possible of
pyuria, and infection.
(Medical Surgical
Nursing by Bare and
Smeltzer pg. 1263) A
normal pH is 7. A pH <
7 indicates alkaline
urine. Acid urine pH is
associate with renal
tubercolosis, pyrexia,
phenylketonuria,
alkaptonuria and
acidosis. (Diagnostic
Tests. A prescriber’s
Guide to Selection and

7. Interpretation by
Lippincott Williams
and Wilkins, p. 395)
due to carbohydrate
malabsorption, fat
malabsorption and
disaccharides
deficiency. (A manual
of Laboratory and
Diagnostic Tests, 7th
Edition by Lippincott
Williamand Wilkins,
p.279) Normally,
freshly voided urine
has a faint odor owing
to the presence of
volatile acids. It is not
generally offensive.
Fresh urine from most
persons has a
characteristics
aromatic odor (pg. 396
Diagnostic Test)
Specific gravity is an
indication of the
relative proportions of
dissolved solid
components to the
total volume of the
specimen and reflects
the relative degree of
concentration or
dilution of the
specimen.
(www.intensive
caring.com) In a
healthy renal and
urinary tract system,
urine contains no
protein or only trace
amount (pg. 191, A
Manual Laboratory
and Diagnostic Test)
Sugar, usually absent

8. from the urine may
appear under normal
conditions (pg.329
Handbook of
Diagnostic Test 3rd
Edition) A high
number of white
blood cells in the urine
is usually a symptom
of urinary tract
infection. A large
number of cells from
tissue lining (epithelial
cells) indicate damage
to the small tubes that
carry material into out
of the kidneys.
(www.healthatoz.com)
Hematology Reference Values:
WBC: 5-10x 10’ g/dl
Neutrophils:0.40-0.60
Lymphocytes: 0.20-
0.40 (Diagnostic
Testing and Nursing
Implications, 4th
edition)
Actual findings:
WBC: 12.6
Neutrophils: 0.71
Interpretation: Not
normal.
Analysis: increased
Leukocytosis, an
increase in circulating
leukocytosis in all
types occur, if it is
usually a result of hem
concentration (A
Manual of Laboratory
and Diagnostic Tests,
7th Edition By
Lippincott Williamand
Wilkins p.49)
Increase in
neutrophils: severe
bacterila disease,
diabetic acidosis,
infarctions, increase in
acute, severe
inflammation
malignancies
(Diagnostic Testing
and Implications 4th
edition)

9. XVII. DRUG STUDY
Generic/Trade
Name/Drug
Class
Mode of
Action
Dosage/Route
Frequency
Indications Contraindications Side Effects Nursing
Consideration
Rifampin
Rifadin,
Rimactane,
Rofact (CAN)
Antibiotic
Antituberculotic
(First line)
Inhibits
DNA-
dependent
RNA
polymerase
activity in
susceptible
bacterial
cells.
Adults:
10mg/kg/day;
no to exceed
600mg in a
single daily
dose PO or IV
Treatment of
Pulmonary TB in
conjunction with
atleast one other
effective
antituberculotic.
Neisseria
Meningitidis
carriers, for
asymptomatic
carriers to
eliminate
meningococcemia
from naso
pharynx; not for
treatment of
meningitis
Contraindicated
with allergy to
any rifamycin,
acute hepatic
disease,
lactation.
Use cautiously
with pregnancy
Headache,
Drowsiness,
Fatigue,dizzy-
ness, Rash,
urticuria,
flushing,
epigastric
distress,
nausea,
vomiting gas,
cramps,
diarrhea,
Administer to
an empty
stomach, 1hr
before or 2 hr
after meals.
Administer in
a single dose
only
Consult
pharmacist
for rifampin
supension.
Report fevers,
chills, muscle
and bone
pain.
Generic/Trade
Name/Drug Class
Mode of
Action
Dosage/Route
Frequency
Indications Contraindications Side
Effects
Nursing
Considerations
Dapsone
Aczone Gel
Lerostatic
Treatment of
Hansen’s disease
Treatment of
herpetiformis
Topical
drugs
Contraindicated
with allergy to
these drugs, open
wounds or
abrasions.
Local
irritation,
stinging,
burning,
dermatitis,
toxic effects if
absorbed
systematically.
Apply
sparingly to
the affected
area as
directed. Do
not use with
open wounds
or broken skin.
Avoid contact
with eyes.
Report any
local irritation,
allergic
reaction,
worsening of
condition

10. XVIII. NURSING CARE PLAN PRIORITIZATION
A.
RATE Nursing Problems
Identified
Justification
1 Ineffective airway
breathing pattern related
to excessive mucus
secretion
According to Abraham
Maslow of Hierarchy of
needs, physiologic needs
come in priority. This is an
actual problem that
requires immediate
attention. It is the chief
complaint of the patient
and the other nursing
problems occur in relation
to the presence of this
problem
2 Impaired skin integrity
related to presence of skin
lesion.
Fur2ther damage to skin
may cause other
infections. This is an actual
problem which is an effect
of the prioritized problem
above interventions are
available and possible for
this problem.
3 Anxiety (Mild) related to
changes in health status
Sudden in her way of
living
B. NURSING CARE PLAN.
ASSESSTME
NT DIAGNOS
IS
PLANNING
INTERVENTIO
N
RATIONALE EVALUATIO
N
Subjective
: “Hindi
naman na
Impaire
d skin
integrit
Independent: After
nursing intervention
with collaborative
Goal
met.
being treated.

11. masakit
itong mga
sugat ko,
matagal
na rin
naman na
itong mga
sugat ko”
Objective:
-presence
of skin
lesion all
over the
body
-black
color
lesions
y
realted
to
presenc
e of
skin
lesions
all over
the
body
nursing intervention,
the client will be able
to have improved
skin integrity as
evidenced by:
a. Exhibited no
further skin
breakdown
b. Healed skin
lesions
Objectives: After 8
hours shift the client
will be able to:
1. Exhibit
evidence of
skin
breakdown
a. Inspect
patient’s
skin every
shift,
describe
and
document
skin
condition
and report
changes.
b.Perform
and teach
patient
prescribed
treatment
regimen
for skin
condition
involved
and
monitor
progress.
Report
response
a. This
provides
evidence of
effectivene
ss of skin
regimen.
(Nursing
Diagnosis
CARD 9TH
Edition by
Taylor and
Sparks card
158)
b. to
maintain or
modify
current
therapy.
(Nursing
Diagnosis
card 9th
edition by
Taylor and
Sparks,
Card 158)

12. 2. Communicate
understanding
, verbalizes
intent to use
skin
protection
measures,
demonstrates
skin
inspection
technique and
performs skin
care continue
to
treatment
regimen.
c.warm the
patient
against
tampering
with
wound.
d.explain
therapy to
patient.
a.instruct
patient in
skin care
regimen
b.supervise
patient in
skin care
c.to avoid
spread of
infection
and
decreased
chance of
further skin
damage
(Nursing
Diagnosis
card 9th
edition by
Taylor and
Sparks,
Card 158)
d. to aid
compliance
(Nursing
Diagnosis
card 9th
edition by
Taylor and
Sparks,
Card 158)
a.to
encourage
compliance
(Nursing
Diagnosis
card 9th
edition by
Taylor and
Sparks,
Card 158)
b.to
improve
skill of the
patient
(Nursing
Diagnosis

13. 3. Communicate
feelings about
change in the
body image
manageme
nt
a.allow
patient to
express
feelings
regarding
skin
problem
b.refer
patient to
psychiatric
liaison
nurse,
social
services or
other
support
groups.
card 9th
edition by
Taylor and
Sparks,
Card 158)
a.this helps
allay
anxiety and
develop
coping
skills
(Nursing
Diagnosis
card 9th
edition by
Taylor and
Sparks,
Card 158)
b.this
provide
additional
support for
patient
(Nursing
Diagnosis
card 9th
edition by
Taylor and
Sparks,
Card 158)
XIX. DISCHARGE PLANNING
MEDICATION
● Multi-drug Therapy (Dapsone, Rifampicin and Clofazimine)

14. EXERCISE
●The client should have a daily routine exercises
●Encourage client to have regular exercise such as performing range of motions
exercises
●Encourage the client to follow an exercise to follow a appropriate exercise
program. Exercise is also a useful way to lose weight, ease stress and maintain a
feeling of well-being. It is also good for wound healing.
TREATMENT
●Medications as prescribed by the physician
●Educating both patient and family
●Provides and arranges for provisions of nursing care of patients at home
HEALTH TEACHINGS
●Control measures such as immunizations
●Practice personal hygiene
●Health education of patients, families, and the community on the nature of the
disease, symptomatology and its transmission
●Advocates healthful living through proper nutrition, adequate rest, sleep, exercise
and good environment.
●Health teaching to prevents secondary injury
●Teach the client that she/he should not fail to complete treatment within the
prescribed duration.
●The Nurse should give health teachings like information about how to prevent and
protect his skin from wounds and lesions. If there’s such, teach how will be the
proper way of addressing the wound and taking good care of it.
OUT PATIENT FOLLOW UP
●Refers patient to other health and allied workers
●refers patient to other persons/agencies who can help inhis/her physical, mental
and social rehabilitation.

15. ●Monthly outpatient follow up is recommended during treatment, although weekly
visits may be necessary if the patient experience leprosy reaction.
DIET
●Diet as tolerated
SPIRITUAL TEACHINGS
●Mental and emotional support by encouraging self-confidence and self reliance.
●Providing counseling and guidance
References:
Fundamentals of Nursing by Kozier, 7th Edition
Handbook of Laboratory and Diagnostic Test)
www.intensive caring.com
Nursing Diagnosis card 9th edition by Taylor and Sparks
Diagnostic Testing and Nursing Implications, 4th edition)
Diagnostic Tests. A prescriber’s Guide to Selection and Interpretation by Lippincott Williams and
Wilkins
Medical Surgical Nursing by Bare and Smeltzer
Handbook of Diagnostic Test 3rd Editon
www.healthoz.com

16. TABLE OF CONTENTS
I. INTRODUCTION
A. Back ground of the Study
B. Rationale for Choosing the Case
II. PATIENTPROFILE
A. General Data
III. PHYSICAL ASSESSTMENT
IV. ANATOMY AND PHYSIOLOGY
V. PATHOPHYSIOLOGY/SCHEMATIC DIAGRAM OF THEDISEASE
VI. LABORATORYAND DIAGNOSTIC EXAMINATION
VII. DRUG STUDY
VIII. NURSING CAREPLA PRIORITIZATION
A. NURSING CAREPLAN
IX. DISCHARGEPLAN

17. X. REFERRENCE
CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY
College of Nursing
A CASE STUDY ON
LEPROSY
In Partial Fulfillment for
Related Learning Experience
Presented by:
Adelina Pinero
BSNIII

18. Presented to:
Mrs. Ma. Rowena Dimapilis RN, Man
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