Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)

Understanding Systemic Lupus Erythematosus (SLE):
- Define Systemic Lupus Erythematosus and its autoimmune nature.
- Explore the various organs and systems affected by SLE and the role of the immune system in the disease.
Etiology and Risk Factors:
- Identify the potential causes and triggers of SLE, including genetic predisposition and environmental factors.
- Understand the demographic and gender-related aspects of SLE risk.
Clinical Manifestations and Organ Involvement:
- Recognize the diverse clinical manifestations of SLE, including joint pain, skin rashes, and involvement of organs such as the kidneys, heart, and lungs.
- Understand the variability in symptom presentation among individuals with SLE.
Diagnostic Criteria and Laboratory Tests:
- Familiarize with the diagnostic criteria for SLE, including criteria established by organizations such as the American College of Rheumatology.
- Explore the common laboratory tests used to confirm and monitor SLE, such as antinuclear antibodies (ANA) and complement levels.
Management and Treatment Approaches:
- Discuss the principles of managing SLE, including pharmacological interventions, lifestyle modifications, and the importance of patient education.
- Explore the interdisciplinary approach to care involving rheumatologists, nurses, and other healthcare professionals.

Pathophysiology of Systemic Lupus Erythematosus (SLE)

Autoimmune Dysfunction:
- SLE is characterized by an autoimmune response where the body’s immune system mistakenly targets its own tissues and organs.
- Autoantibodies, particularly antinuclear antibodies (ANA), are produced, contributing to immune complex formation.
Immune Complex Deposition:
- Immune complexes formed by the interaction of antibodies and self-antigens deposit in various tissues, triggering inflammation and tissue damage.
- These deposits can occur in the skin, joints, kidneys, and other organs.
Multi-Organ Involvement:
- SLE can affect multiple organs, leading to a wide range of clinical manifestations.
- Commonly affected organs include the skin, joints, kidneys, heart, lungs, blood vessels, and the central nervous system.
Inflammatory Cascade Activation:
- The immune complexes and inflammatory mediators activate a cascade of inflammatory responses, leading to tissue injury and damage.
- Chronic inflammation contributes to the development of characteristic symptoms such as joint pain, rashes, and organ dysfunction.
Episodic Flares and Remissions:
- SLE often follows a pattern of episodic flares and remissions, with periods of increased disease activity and symptom exacerbation followed by periods of relative stability.
- The unpredictable nature of flares makes long-term management and monitoring crucial.

Etiology of Systemic Lupus Erythematosus (SLE)

Genetic Factors:
- Genetic predisposition plays a role in the development of SLE, with certain gene variations associated with increased susceptibility.
- Family history may contribute to the risk of SLE development.
Hormonal Influence:
- Hormonal factors, particularly estrogen, may contribute to the higher prevalence of SLE in women.
- Hormonal changes, such as those occurring during puberty, pregnancy, and menopause, can impact disease activity.
Environmental Triggers
- Exposure to certain environmental factors, including sunlight, infections, and medications, can act as triggers for SLE development or exacerbation.
- Ultraviolet (UV) light exposure is known to influence skin manifestations in SLE.
Immune System Dysregulation:
- Dysregulation of the immune system, including abnormalities in T and B lymphocyte function, contributes to the autoimmune response seen in SLE.
- Aberrant activation of the complement system is also implicated in the pathogenesis.
Epigenetic Modifications:
- Epigenetic changes, such as alterations in DNA methylation and histone modification patterns, have been associated with SLE.
- These modifications can influence gene expression and contribute to the autoimmune response.

Desired Outcome for Systemic Lupus Erythematosus (SLE)

Disease Management and Symptom Control:
- Achieve effective management of SLE symptoms, including joint pain, skin rashes, and other manifestations, to enhance the patient’s quality of life.
Prevention of Flares and Complications:
- Minimize the frequency and severity of disease flares to prevent complications and organ damage associated with SLE.
Maintenance of Functional Independence:
- Support the patient in maintaining or improving their functional independence and ability to perform activities of daily living (ADLs).
Psychosocial Well-being:
- Address and improve psychosocial well-being, including emotional health, coping mechanisms, and adaptation to the challenges posed by SLE.
Patient Education and Empowerment:
- Provide comprehensive education to the patient on SLE, its management, and the importance of medication adherence, lifestyle modifications, and regular follow-up.

Systemic Lupus Erythematosus (SLE) Nursing Care Plan

Subjective Data:

Joint pain
Chest pain with deep breathing
Extreme fatigue
Sensitivity to sun

Objective Data:

Butterfly or malar rash on face
Swollen joints
Unexplained fever
Hair loss
Swelling in legs or around eyes
Mouth ulcers
Swollen lymph glands
Raynaud’s phenomenon (pale or purple fingers or toes)

Nursing Assessment for Systemic Lupus Erythematosus (SLE)

Physical Assessment:
- Conduct a thorough physical assessment, including joint examination for signs of arthritis, skin inspection for rashes or lesions, and evaluation of vital signs.
Musculoskeletal Assessment:
- Assess musculoskeletal symptoms, including joint pain, stiffness, and swelling.
- Evaluate the impact of musculoskeletal symptoms on mobility and activities of daily living.
Skin Examination:
- Perform a detailed examination of the skin for characteristic lupus rashes, such as the butterfly rash on the face and other skin manifestations.
- Monitor for changes in skin condition and document any lesions.
Renal Function Assessment:
- Monitor renal function through regular assessments, including urine analysis, serum creatinine levels, and blood pressure measurements.
- Identify early signs of renal involvement and collaborate with the healthcare team for timely interventions.
Cardiopulmonary Assessment:
- Assess cardiopulmonary symptoms, including chest pain, shortness of breath, and signs of pericarditis or pleuritis.
- Monitor for any cardiovascular or pulmonary complications associated with SLE.
Neurological Evaluation:
- Conduct neurological assessments to detect any signs of central nervous system involvement, such as cognitive impairment, seizures, or headaches.
Psychosocial and Emotional Assessment:
- Evaluate the patient’s psychosocial well-being, addressing emotional health, coping mechanisms, and any signs of anxiety or depression related to the chronic nature of SLE.
Medication Adherence and Side Effects:
- Assess the patient’s adherence to prescribed medications and inquire about any medication-related side effects or concerns.
- Provide education on the importance of medication compliance.

Implementation for Systemic Lupus Erythematosus (SLE)

Pharmacological Management:
- Administer medications as prescribed, including disease-modifying antirheumatic drugs (DMARDs), corticosteroids, and immunosuppressants, to control inflammation and manage symptoms.
Pain and Symptom Management:
- Implement pain management strategies, including the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics, to alleviate joint pain and other symptoms.
Patient Education:
- Provide comprehensive education to the patient about SLE, including the nature of the disease, treatment plans, medication adherence, and the importance of regular follow-up with healthcare providers.
Lifestyle Modifications:
- Collaborate with the patient to implement lifestyle modifications, including stress reduction techniques, regular exercise, and dietary adjustments, to promote overall well-being and manage the impact of SLE.
Multidisciplinary Collaboration:
- Facilitate collaboration with a multidisciplinary healthcare team, including rheumatologists, nurses, physical therapists, and psychologists, to address various aspects of SLE and provide holistic care.

Nursing Interventions and Rationales

Assess and monitor skin for rash

The hallmark sign of SLE is a malar butterfly rash across the cheeks and bridge of the nose; rash may develop on the face, neck, chest or extremities

Assess mucous membranes; encourage oral hygiene; rinse mouth with half-strength peroxide three times per day

Oral lesions and ulcers are common symptoms; peroxide helps to keep oral lesions clean and promote healing

Assess and manage pain
- Analgesics
- AROM/PROM
- Positioning for comfort and to prevent contractures
- Apply warm/cool compresses to painful joints
- Recommend non-pharmacological alternatives

Inflammation and SLE related arthritis can cause significant pain and stiffness of joints; Medication may be necessary, but encourage other alternatives as well.

Encourage deep breathing exercises to promote adequate gas exchange and prevent lung diseases
- Splinting
- Incentive spirometer
- Relaxation

Patients may report chest pain with deep breathing. Encourage breathing exercises to open airways, reduce pain and relieve anxiety. Incentive spirometers and splinting with pillows may be beneficial.

Cluster care and schedule activity

Fatigue is a common complaint for patients with lupus. Encourage activity as tolerated but discourage patients from overexertion. Cluster care to reduce fatigue and conserve energy.

Monitor lab / diagnostic tests
- ANA (antinuclear antibody)
- ESR (erythrocyte sedimentation rate)
- RF (rheumatoid factor)
- CMP / liver function tests

Lab tests can help determine the extent, if any, of organ failure or dysfunction and therefore determine progression of disease and response to treatments.

Administer medications appropriately
- Antimalarials (chloroquine)
- Corticosteroids (prednisone)
- NSAIDs
- Immunosuppressants (cyclophosphamide)
- Opioids

Medications are often given to suppress immune system, treat existing inflammation and manage symptoms such as pain. Monitor for GI discomfort or irritation when giving medications; prevent constipation if opioids are given.

Nutrition and lifestyle education
- Healthy diet (fruits, grains, vegetables)
- Regular exercise
- Avoid sun exposure
- Adequate rest

Maintaining a healthy lifestyle and staying active can help improve immunity and reduce the number and frequency of flares. Sun exposure often triggers rash and flare, try to avoid; Rest helps promote healing and reduces inflammation.

Evaluation for Systemic Lupus Erythematosus (SLE)

Symptom Control and Disease Activity:
- Regularly assess and evaluate the control of symptoms, including joint pain, skin manifestations, and other disease-specific symptoms.
- Monitor disease activity through laboratory tests and clinical assessments.
Medication Adherence:
- Evaluate the patient’s adherence to prescribed medications, addressing any barriers or concerns related to compliance.
- Assess the effectiveness of the current medication regimen in managing SLE.
Functional Independence:
- Assess the patient’s ability to perform activities of daily living (ADLs) and maintain functional independence.
- Identify areas of improvement or support needed to enhance daily functioning.
Psychosocial Well-being:
- Evaluate the patient’s psychosocial well-being, including emotional health and coping mechanisms.
- Address any signs of anxiety, depression, or stress related to living with a chronic autoimmune condition.
Quality of Life:
- Assess and discuss the patient’s overall quality of life, considering physical, emotional, and social aspects.
- Collaborate with the patient to identify areas for improvement and develop strategies to enhance their quality of life.

References

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Transcript

Hey guys, today, we’re going to take a look at the care plan for lupus. So in this lesson, we’ll briefly take a look at the pathophysiology and etiology of lupus. We’ll also take a look at subjective and objective data included in the care plan, as well as nursing interventions and rationales.

Lupus is a chronic auto-immune disease in which the immune system attacks different parts of the body causing inflammation and damage to various body tissues. Lupus can affect the skin, the joints, heart, lungs, kidneys, blood vessels, and the brain. Patients with lupus may have phases of worsening symptoms called flares, and also periods of milder symptoms. The symptoms of lupus may mimic other disorders and may go undetected for several years. Patients with lupus should be managed by a rheumatologist. The exact cause of SLE or systemic lupus erythematosus is not known, but scientists believe it to be, in part, related to genetics. The desired outcome is to reduce inflammation, regaine optimal mobility, reduce organ dysfunction and reduce the frequency of those flares.

So let’s take a look at some of the subjective and objective data that your patient with lupus may present with. Remember, subjective data are going to be things that are based on your patient’s opinions or feelings. These things could include joint pain, chest pain with deep breathing, extreme fatigue, and sensitivity to the sun.

Objective data that your patient with lupus may present with includes a butterfly or malar rash on the cheeks and across the nose, swollen joints, unexplained fever, hair loss, swelling in the legs or around the eyes and mouth, ulcers, swollen lymph glands, and Raynaud’s phenomenon with pale or purple fingers or toes.

Nursing interventions are a critical part of a care plan, so let’s take a look at these. Assess and monitor your patient’s skin for a rash. The hallmark sign of SLE is that butterfly rash across the cheeks and the bridge of the nose. The rash may develop on the face, neck, chest, or extremities. Also assess your patient’s mucus membranes, and encourage oral hygiene because oral lesions and ulcers are common symptoms of lupus. Instruct your patient to rinse their mouth three times per day with half-strength peroxide. Peroxide helps you keep oral lesions clean and promote healing. It’s important to assess pain in patients with lupus as inflammation and SLE-related arthritis can cause significant pain and stiffness of the joints.

Analgesics may be necessary, but it’s also good to encourage other alternatives like active and passive range of motion, positioning for comfort and to prevent contractures, and the application of warm and cold compresses to those painful joints. Patients may also complain of pain with deep breathing, so encourage deep breathing exercises to open those airways. This will reduce their pain and relieve anxiety. Also, spirometers and splinting pillows may be beneficial for deep breathing exercises. Because fatigue is common with lupus patients, it’s important to cluster care, to reduce fatigue and conserve their energy. Encourage activity as tolerated, but discourage patients from overexertion. Lab tests like a DNA, which is the anti-nuclear antibody E S R, which is erythrocyte sedimentation rate R F rheumatoid factor and CMP or liver function tests can help determine the extent if any of organ failure or dysfunction and also the progression of the disease and response to treatment.

When considering the treatment of lupus, medications are often given to suppress the immune system, treat existing inflammation, and manage symptoms such as pain. Common medications include anti-malarials like chloroquine, corticosteroids like prednisone, NSAIDS,immunosuppressants, and opioids. Monitor for GI discomfort or irritation when giving medications, especially constipation with opioids. Finally, maintaining a healthy lifestyle and staying active can help improve immunity and reduce the frequency and number of flares. A healthy diet including fruits, vegetables, grains, also regular exercise, avoiding sun exposure, and adequate rest promotes healing and reduces inflammation.

Okay, guys, here is a look at the completed care plan for lupus. We love you guys. Now, go out and be your best self today and as always, happy nursing!