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

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Outline

Pathophysiology

Lupus is a chronic autoimmune 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, joints, heart, lungs, kidneys, blood vessels and brain. Patients with lupus may have phases of worsening symptoms called “flares” and other periods of milder symptoms. Lupus symptoms may mimic other disorders and may go undetected for several years. Management by a rheumatologist is recommended.

Etiology

The exact cause of SLE is not known, but scientists believe it may be in part related to genetics.  Environmental factors that seem to trigger lupus include sunlight, stress, viruses, trauma and some medications.  

Desired Outcome

Reduce inflammation, regain optimal mobility, reduce organ dysfunction, reduce number and frequency of “flares”

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 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.

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

A Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


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!

 

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