MICA · CARE LEARNING NOTES
Observe, keep care safe and communicate
Systemic sclerosis affects skin, hands, eating and sometimes several internal organs. Daily support combines comfort, appropriate rehabilitation and vigilance for unusual changes.
Skin and hand function
Observe pain, colour, wounds and finger limitations. Protect against cold and trauma, support smoking cessation and deliver prescribed skin care. A persistently painful, cold or markedly discoloured finger, or a worsening ulcer, requires prompt assessment. Support hand and mouth exercises taught by qualified professionals, without forceful stretching or aggressive care of an ischaemic area.
[1][2][3]Look beyond the skin
Measure blood pressure according to the individual plan and compare with usual values. An unusual rise with headache, visual symptoms, breathlessness or reduced urine output requires urgent assessment, including for kidney involvement. Absence of marked hypertension does not exclude renal crisis. Also report increasing breathlessness, presyncope, palpitations or syncope; distress or syncope warrants emergency care.
[1]Eating, mobility and independence
Ask about reflux, difficulty swallowing, early fullness, bowel changes and weight loss. Adapt mealtime assistance and positioning to the care plan; new dysphagia or persistent vomiting requires advice. Establish what the person can still do independently and what assistance helps. Arrange home adaptations, rehabilitation and nutritional advice with the team, respecting the person’s priorities.
[1][2]Unusual blood pressure elevation, new headache or reduced urine output warrants prompt advice in this context. Record swallowing difficulty, reflux and weight loss to adapt support. Protect fingers from cold and trauma without applying aggressive heat to an area with reduced sensation.
- Compare blood pressure and daily function with baseline.
Medication safety and handover
Check the actual prescription and scheduled cardiopulmonary and kidney assessments. Report any new medication, particularly a corticosteroid, to the physician managing systemic sclerosis so that its indication and monitoring can be assessed. Do not independently stop prescribed treatment. Document dated measurements, symptoms, wounds and functional changes, together with the response to escalation. Check that the person understands contact instructions.
[1][3]A learning situation
FICTIONAL SITUATION · REFLECTION WITHOUT A SCORE
Fictional situation: a patient with systemic sclerosis reports new headaches and less urine. Her blood pressure is markedly above her usual readings.
Can assessment wait to see whether the headache resolves?
Read the reasoning
No. This combination requires urgent medical assessment, including for a kidney complication. Repeat the measurement correctly without delaying escalation, and provide usual and current readings plus the medication list. Do not administer extra antihypertensive medication without a prescription. Monitoring and handover must be explicit and documented.
References and scope
- French recommendations for the management of systemic sclerosis (2021) ↗
- EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis (2024) ↗
- Scleroderma — fiche patient, mise à jour février 2025 ↗
Original documentary teaching summary for adult care. Procedures and medicines depend on professional competence, prescription and institutional procedures. International references do not establish an Algerian protocol. Independent human scientific review remains to be confirmed.