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.
- Malar rash. A butterfly-shaped red rash is commonly present across the cheeks.
- Discoid rash. These are usually red, scaly patches.
- Photosensitivity. Rash develops typically after exposure to sunlight.
- Mucosal ulcers. These are sores on the lining of the mouth and nose.
- Serositis. Inflammation of the serosal surfaces, such as pleura, pericardium, and peritoneum, may occur.
- Arthritis. The presence of arthritis is very common in people with lupus.
- 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.
- Neurological disorders. Lupus may manifest as seizures and psychosis.
- Hematological disorders. Lupus may also manifest as hematologic problems such as anemia, leukopenia, or thrombocytopenia.
- Immunological disorders. The presence of any immunological disorder may also be a manifestation of lupus.
- Anti-nuclear antibody test. A positive result to this test from a person who does not take drugs may signify the presence of lupus.
- Weight loss
- Weight gain
- 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
- Kidney problems. Kidneys are often affected by lupus. It can cause serious kidney damage and even death in some cases.
- 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.
- 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.
- Lung issues. Lungs may be involved as well in the disease process. Pleurisy and pneumonia often stem-out from the disease.
- 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.
- 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.
Lupus Nursing Diagnosis
Nursing Care Plan for Lupus 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.
|Nursing Interventions for Lupus||Rationale|
|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 for Lupus 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.
|Nursing Interventions for Lupus||Rationales|
|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 for Lupus 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.
|Nursing Interventions for Lupus||Rationales|
|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.|
Nursing Care Plan for Lupus 4
Nursing Diagnosis: Acute Pain related to inflammation secondary to lupus as evidenced by the patient’s complaint of joint pain on a scale of 7/10, facial grimace, stiffness, and restriction on the mobility of affected joints.
- Within 24 hours of nursing intervention, the patient will express reduced pain on a scale of 3 out of 10.
- The client will observe the recommended pain control methods, including pharmaceutical and nonpharmacological interventions.
- The patient will be able to engage in self-care activities.
|Nursing Interventions for Lupus||Rationale|
|Evaluate the patient’s statement about their discomfort.||Joint stiffness caused by systemic lupus erythematosus (lupus) may not be due to exercise or overuse but rather to immune complexes multiplying and triggering an inflammatory response in that specific body component. Patients with lupus frequently have arthralgias of many joints and morning stiffness. Patients with lupus may also have arthritis. Therefore, stiffness and discomfort involve a variety of causes.|
|Evaluate the origin of the pain by requesting the patient to point to the area affecting them.||The particular location is significant when evaluating pain in older clients or children. The patient can get assistance from charts or anatomy diagrams, and the nurse pinpoints specific pain points. Asking the client to specify the area might help clients with limited language understand the pain evaluation.|
|Check the joint for symptoms of inflammation (warmth, redness, swelling) or restricted motion.||This condition may not show typical indications of inflammation.|
|Reevaluate pain severity after 30 minutes of nursing interventions.||After giving interventions, the nurse must reevaluate the pain to see if the patient’s pain control has attained its objectives and if the therapies were successful.|
|Review prior pain-relieving measures.||Clients may be unaware of or have not tried all currently accessible treatment options. Because relief techniques may alter the affected joints, pain management focuses on resolving discomfort as it manifests.|
|Instruct the patient on the proper scheduling of medicine dosages before any activities that aggravate pain and on how to avoid times of extreme pain.||Patients can assist in controlling their pain more successfully if they know when to take pain medication to increase its efficacy and avoid severe pain episodes.|
|Promote using ambulatory devices when the pain from weight-bearing is present.||Patients can use crutches, walkers, and canes to take some weight off the painful extremity.|
|Advise the patient to stay active and avoid sitting still for extended periods.||Exercise is necessary to avoid more stiffness, stop joints from freezing, and keep muscles from atrophying.|
|Encourage the patient to do two repetitions of range-of-motion (ROM) movements after bathing or showering.||These activities assist in the reduction of stiffness and the preservation of joint mobility.|
|Advise the patient to provide enough time for all activities.||Even simple activities can take longer when there is severe joint stiffness.|
|Promote a 15-minute warm shower or bath upon waking up.||Warmth improves stiffness and pain. Test first the temperature of the water because overheating could cause skin damage.|
|Facilitate nonpharmacological pain management techniques such as guided visualization, relaxation, and diversion.||These techniques may enhance the effect of other pain-relieving drugs.|
|Encourage the patient to use a bed cradle.||Inflamed lower extremities are protected from bed cover pressure by protective devices.|
|Advise the patient to take anti-inflammatory drugs as directed.||Do not consume anti-inflammatory medications on an empty stomach. Discuss the significance of having the first-day dose with a small snack as early in the morning as possible. The sooner the client takes the prescription, the faster will resolve the stiffness.|
|As needed, recommend nonopioid analgesics.||Opioid analgesia does not seem as effective in treating inflammation-related pain and performs better on mechanical pain. Opioids may cause addiction.|
|Seek advice from an occupational therapist for correct splinting of afflicted joints.||This kind of situation calls for specialized knowledge.|
|Instruct the client to put on the splints as prescribed.||Splints provide swollen joints some relief and may lessen muscle spasms.|
Nursing Care Plan for Lupus 5
Nursing Diagnosis: Deficient Knowledge related to incorrect interpretation of details secondary to lupus as evidenced by multiple inquiries, giving incorrect information, and failure to follow through on instructions.
- The patient will verbally express their understanding of the disease process and treatment.
- The patient will understand the learning challenges and how to overcome them.
|Nursing Interventions for Lupus||Rationale|
|Determine the patient’s understanding of the condition, treatment, and complications.||Inadequate knowledge regarding lupus and its chronic and progressive characteristics can impair the patient’s capacity to care for themselves and adapt successfully.|
|Discuss the disease process information: unknown etiology, lupus chronicity, inflammation and fibrosis processes, recurrences and worsening condition, and control versus cure.||The purpose of treatment is to lessen inflammation, lessen symptoms, and keep the body functioning normally. Flares can be avoided by following a healthy diet and regular exercise.|
|Explain standard diagnostic procedures.||The primary care doctor may request numerous immunologically based testing such as antinuclear antibody [ANA], erythrocyte sedimentation rate [ESR], serum protein electrophoresis, rheumatoid factor, and serum complement). The doctor may also recommend Certain blood tests to evaluate for vital organ or systemic involvement, including kidney and liver screenings.|
|Describe or reinforce the use of medication therapy.||Inform the patient about the potential adverse effects of steroids, immunosuppressive medications, and other medications used to treat lupus. Clients are more able to ask inquiries when they know what to expect.|
|Emphasize to the patient the significance of not changing the steroid dosage or discontinuing the medicine abruptly.||The patient must gradually wean steroids following high-dose or long-term consumption. The adrenal glands in the body create cortisol. The body no longer produces appropriate cortisol levels after large doses or long-term use of exogenous steroids. Stressful situations call for higher cortisol levels. A steroid-dependent patient will have an Addisonian crisis in the absence of supplementation. The nurse must emphasize the need always to wear a medical alert tag that shows the patient is on steroids and immunosuppressants.|
|Advise the patient to keep an eye out for signs of fever.||In the active phase of lupus, fever is a common symptom. Patients should also report chills, shaking, and diaphoresis. Patients receiving aspirin as medication for fever should have regular liver tests because aspirin use in lupus patients is at risk of developing transient hepatotoxicity.|
|Encourage participation in lifestyle practices that can help prevent flare-ups, such as:Maintaining a healthy diet that includes fruits, grains, and vegetables.routine exercise limit exposure to the sungetting enough rest||A positive attitude toward therapeutic interventions enables the patient to manage this chronic condition actively.|
|Give details on relevant clinical trials.||Developing new lupus treatments is continuous all the time. Qualified patients may obtain an alleviation of their symptoms and prevention of further complications.|
|Advise on available support groups within the local community or trusted internet portals.||Members of organizations that get together to overcome technological challenges can be beneficial to one another.|
|Establish a pleasant learning atmosphere.||When a lupus patient is in discomfort, anxious, irritated, or exhausted, they are not in a condition of mind to absorb knowledge. The nurse should refrain from intervening until the patient can focus on the discussion without distraction.|
|Involve the patient in the planning process.||Instructing patients on what they should or should not do will only sometimes result in adherence. Creating a strategy that fits the client’s lifestyle will increase the likelihood of compliance and commitment.|
|Avoid overloading.||Too much knowledge can be confusing at times and overwhelming. Deliver information in little bits throughout time.|
|Set priorities.||A patient may be coping with a recent diagnosis, diet, medications, and other instructions simultaneously. Given the volume of information, the nurse should decide which is most urgent and which implementation the patient can handle.|
|Make use of constructive feedback.||Patients who exhibit appropriate learning, such as recalling a drug’s action or demonstrating how to operate an assistive gadget, are rewarded and given feedback.|
|Encourage patients to ask questions.||Patients should feel free to ask inquiries without fear of being judged or embarrassed. Sitting down, keeping eye contact, seeming calm and unhurried, and asking encouraging questions will instill confidence in the patient.|
Nursing Care Plan for Lupus 6
Nursing Diagnosis: Disturbed Body Image related to severe inflammation of joints secondary to lupus as evidenced by self-doubt, behavioral changes, a decrease in engagement in activities of daily living, and attention to joint deformity.
- The patient is free to communicate their opinions about their condition.
- The patient will be able to arouse favorable feelings toward their appearance.
- The patient will recognize unreasonable ideas and employ new coping methods to enhance the perception of their body image.
|Nursing Interventions for Lupus||Rationale|
|Identify the perceived impact of changes in ADLs, social involvement, personal connections, and occupational activities.||Changes in body image may affect a patient’s capacity to perform everyday tasks and duties.|
|Evaluate the patient’s developmental stage about the patient’s body image disturbance.||Adolescents and young adults may be influenced individually by alterations in the structure or functionality of their bodies during a stage when developmental changes are generally fast, and forming social and emotional ties is crucial.|
|Assess the patient’s behavior in connection with the actual or observed alteration in a body part or functionality.||Body image disturbance is related to a wide range of actions, from completely disregarding the altered structure or function to being preoccupied with it.|
|Recognize and accept the expression of frustration, reliance, rage, despair, and hatred. Keep an eye out for denial and withdrawing behavior.||They are accepting these emotions as a normal reaction to what has happened assists in resolution. It is not helpful or practical to drive patients before they are prepared to handle the issue. Denial may be sustained as an adaptive technique when the patient is unprepared to deal with personal concerns.|
|Acknowledge the normalcy of the Response to an alteration in the body’s structure or function.||It’s common to mourn after losing a body part or function. Usually, this process starts with a denial stage, the duration of which differs depending on the person.|
|Place restrictions on inappropriate behavior. Keep a non-judgmental attitude when providing care, and assist the patient in identifying positive habits that will help in recovery.||The patient and family members frequently approach these crises in the same manner that they have in the past. Staff may find it challenging and unpleasant to deal with disruptive and unhelpful conduct. However, they should remember that the intention of the behavior is for the setting and not for the caregiver.|
|Encourage the expression of positive or negative emotions over the perceived or actual loss.||It is essential to advise the patient to keep their feelings of self-worth separate from those they have regarding changes to their body’s structure or function. Expression of feelings can improve a patient’s coping mechanism.|
|Help patients adapt meaningful changes to their ADLs, social lives, interpersonal interactions, and work activities.||The more visible the change in physical structure or functionality, the more concerned the patient may be about how others react. Positive responses and achievement in social situations accelerate adaptation.|
|Display positive caring in everyday activities.||Positive comments from the nurse inspire the patient to respond more positively to their body’s changes.|
|Be optimistic and practical when providing treatment, health teaching, and having a goal within boundaries.||It improves the relationship and trust between the patient and the nurse.|
|Provide hope within the boundaries of the individual circumstance; do not provide false assurances.||It encourages a positive outlook and allows one to make realistic plans and set goals.|
|Teach the patient to be adaptive (For example, using assistive devices, wigs, cosmetics, apparel that hides the altered body part or improves the remaining portion or function, and using deodorants).||Adaptive behaviors assist the patient in compensating for changes in bodily structure and function.|
More Nursing Diagnosis for Lupus
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. (2022). 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. (2020). 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
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