Lupus

Lupus Nursing Care Plans Diagnosis and Interventions

Lupus NCLEX Review Care Plans

Nursing Study Guide on Lupus

Lupus, also known as systemic lupus erythematosus (SLE), is an autoimmune disease that occurs when an environmental trigger makes the immune system attack its own tissues and organs. 

The attack causes an inflammation that can affect different systems in the body. It is clinically recognized for its butterfly-shaped rash across the face.

About one in three people in the United States alone is diagnosed with lupus.

Its incidence is higher in women than in men and seems to affect more Asian and Afro-Caribbean descent.

Signs and Symptoms of Lupus

Lupus is a systemic disease. It can affect any organ system in the body; hence, its signs and symptoms are not always the same.

The symptoms are often classified into specific and non-specific.

  1. Specific Symptoms:
  2. Malar rash. A butterfly-shaped red rash is commonly present across the cheeks.
  3. Discoid rash. These are usually red, scaly patches.
  4. Photosensitivity. Rash develops typically after exposure to sunlight.
  5. Mucosal ulcers. These are sores on the lining of the mouth and nose.
  6. Serositis. Inflammation of the serosal surfaces, such as pleura, pericardium, and peritoneum, may occur.
  7. Arthritis. The presence of arthritis is very common in people with lupus.
  8. Renal issues. Problems with the kidneys may be noted through routine bloods and urine tests. Kidneys are often the most affected organs when the condition flares up.
  9. Neurological disorders. Lupus may manifest as seizures and psychosis.
  10. Hematological disorders. Lupus may also manifest as hematologic problems such as anemia, leukopenia, or thrombocytopenia.
  11. Immunological disorders. The presence of any immunological disorder may also be a manifestation of lupus.
  12. Anti-nuclear antibody test. A positive result to this test from a person who does not take drugs may signify the presence of lupus.
  13. Non-specific Symptoms:
  14. Fatigue
  15. Weight loss
  16. Weight gain
  17. Fever
  18. Swollen glands

Causes of Lupus

Lupus is an immune-mediated condition. The mechanism of action of the disease is clear, but its origin is still unknown.

It is believed that lupus is caused by genetic and environmental predispositions.

The symptoms of lupus often show when the condition flares up. There are certain triggers that causes the condition to flare up:

  • Sunlight. People with lupus often suffer from photosensitivity. Rashes on the skin typically show up after sunlight exposure.
  • Infection. Any type of infection activates the body’s immune response. Lupus, being immune mediated, flares up causing the symptoms to appear.
  • Medication. Certain medications like blood pressure tablets, anti-seizure tablets, and some antibiotics can cause lupus flare up.

The following are the risk factors for the disease:

  • Gender. Women are more at risk of having lupus than men
  • Age. Lupus can occur at any time and age; however, cases are noted in people aged between 15 and 45 years.
  • Ethnicity. It is noted that lupus occurs more frequently in Asian, African-American, and Hispanics.

Complications of Lupus

  1. Kidney problems. Kidneys are often affected by lupus. It can cause serious kidney damage and even death in some cases.
  2. Brain and central nervous system problems. Lupus can affect the central nervous system. This can cause simple headaches, visual changes, seizures, and can even affect memory and logical thinking.
  3. Blood and blood vessels. Among the long list of medical conditions that lupus can cause, some of them are issues with blood and blood vessels. Anemia and other blood cell count disturbances may occur. Also, vasculitis may arise due to lupus.
  4. Lung issues. Lungs may be involved as well in the disease process. Pleurisy and pneumonia often stem-out from the disease.
  5. Heart infection. Pericarditis may result from the inflammatory response from lupus.

Diagnosis of Lupus

The diagnosis of lupus can be tricky. Its manifestations often coincide with other medical conditions. The following are performed by doctors to diagnose lupus:

  • Medical history
  • Physical Examination
  • Presence of 4 out of 11 internationally accepted symptoms (as enumerated on the list of specific symptoms) helps physicians make a firm diagnosis. 
  • Laboratory tests, such as:
    • Complete blood count. A CBC test can signify the presence of hematologic involvement.
    • Erythrocyte Sedimentation Rate. A faster than normal rate result in an ESR test may signify the presence of an autoimmune disease, cancer, or infection.
    • Kidney and Liver Assessment. Functions of the kidneys and liver through blood tests are often performed to indicate kidney and liver involvement.
    • Urinalysis. A simple urine test can indicate kidney problems.
    • ANA test. Antinuclear Antibody test when performed in people with lupus who do not do recreational drug will yield a positive result.
  • Imaging Studies.
  • Chest Xray. This imaging test is performed to check any lung involvement.
  • Echocardiogram. An ECG is performed when the physician suspects heart involvement.
  • Biopsy. Kidneys are the main organs affected by lupus. A tissue sample may be required to identify the best treatment method.

Treatment of Lupus

Lupus, being a systemic condition, may require different types of treatment depending on the organ system affected. Lupus is not treatable, but several treatment options are available to help manage the disease. Regular review of treatment is necessary to align the treatment required to the system affected by the condition as it flares up and settles down.

  1. Non-steroidal Anti-inflammatory Drugs (NSAIDs). The use of NSAIDs is beneficial in lupus. It is used to treat some of the symptoms like fever and pain.
  2. Anti-malarial drugs. Medications used to treat malaria are often useful in managing lupus. Antimalarial drugs affect immune system hence it can help settle lupus symptoms when the condition flares up.
  3. Corticosteroids. Steroids are used to counter the inflammation caused by lupus.
  4. Immunosuppressants. Drugs used to suppress the immune system are given to people with lupus.
  5. Biologics. A biologic therapy is often administered in addition to other lupus medications. It is typically given intravenously.

Nursing Care Plans for Lupus

Nursing Care Plan 1

Nursing Diagnosis: Impaired Skin Integrity related to skin rash secondary to lupus, as evidenced by malar rash on the cheeks, discoid rash on the rest of the body, and soreness

Desired Outcome: The patient will re-establish healthy skin integrity by following treatment regimen for lupus.

InterventionRationale
Assess the patient’s skin on his/her whole body.To determine the severity of skin damage caused by lupus and any affected areas that require special attention.
Administer medications as prescribed. Non-steroidal Anti-inflammatory Drugs (NSAIDs). The use of NSAIDs is beneficial in lupus. It is used to treat some of the symptoms like fever and pain.Anti-malarial drugs. Medications used to treat malaria are often useful in managing lupus. Antimalarial drugs affect immune system hence it can help settle lupus symptoms when the condition flares up. Corticosteroids. Steroids are used to counter the inflammation caused by lupus. Immunosuppressants. Drugs used to suppress the immune system are given to people with lupus. Biologics. A biologic therapy is often administered in addition to other lupus medications. It is typically given intravenously.  
Educate the patient and carer about proper hand hygiene through washing with soap and water. Advise the patient and carer to prevent scratching the affected areas.It is important to maintain hygiene by washing with mild soap and water. The rash may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent worsening of skin damage.
Teach the patient/ carer the proper administration of prescribed medications and topical treatments.To treat the skin rash.

Nursing Care Plan 2

Nursing Diagnosis: Hyperthermia related to autoimmune disease process of  lupus  as evidenced by temperature of 38.2 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

InterventionsRationales
Assess the patient’s vital signs at least every hour. Increase the intervals between vital signs taking as the patient’s vital signs become stable.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed anti-pyretic medications.Use the anti-pyretic medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan 3

Nursing Diagnosis: Fatigue related to body weakness secondary to lupus as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, lack of appetite, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to dietitian and physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity and improving nutritional intake / appetite.

Other possible nursing diagnoses:

  • Acute Pain
  • Activity Intolerance
  • Risk for Impaired Urinary Elimination

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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