A nurse is caring for a client who was diagnosed with scleroderma 5 days ago. The nurse plans to assess the client to document the disease's progression. In addition to skin changes, which of the following findings should the nurse expect?

Choice A rationale Scleroderma typically causes a thickening and hardening of the skin, known as sclerodactyly, rather than thinning. The pathophysiology involves the excessive deposition of collagen in the dermis and subcutaneous tissues. This overproduction leads to skin that feels tight, bound down, and loses its natural elasticity. Thinning of the skin is more commonly associated with chronic corticosteroid use or natural aging rather than the fibrotic process that defines the progression of systemic or localized scleroderma. Choice B rationale Clients with scleroderma often suffer from xerostomia, which is extreme dryness of the mouth, rather than excessive salivation. This occurs because the fibrotic process can affect the salivary glands, reducing their ability to produce adequate moisture. Furthermore, many scleroderma patients also have secondary Sjogren syndrome, which further decreases glandular secretions. Excessive salivation would be an unusual finding and is not a clinical marker for the progression of the connective tissue fibrosis seen in this disease. Choice C rationale While some facial changes occur in scleroderma, such as a mask like appearance or restricted mouth opening, periorbital edema is not a standard expectation. Periorbital edema is more frequently associated with renal failure, nephrotic syndrome, or inflammatory conditions like dermatomyositis. In scleroderma, the skin around the eyes is more likely to become tight and taut due to collagen accumulation. The fibrotic nature of the disease usually results in tissue contraction and firmness rather than fluid accumulation. Choice D rationale Decreased range of motion is a common finding in scleroderma due to the hardening of the skin and fibrosis of the underlying connective tissues and tendons. As the skin becomes increasingly tight and rigid, it restricts the movement of the joints beneath it. This contracture development significantly impacts the functional mobility of the hands and limbs. Assessing for joint flexibility is essential to document disease progression as the fibrosis moves from the skin into deeper musculoskeletal structures.