Mariano Marcos State University

College of Health Sciences

Department of Nursing
Batac City

SYSTEMIC LUPUS ERYTHEMATOSUS

In Partial Fulfilment of the Requirements in the Subject RLE 103

Presented by:
Noreeka Nia J. Tamayo
BSN III - B

Presented to:
Sir Lordley Pagdilao
Clinical Instructor

2016
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

I. DESCRIPTION

Systemic - affects multiple organs

Lupus - latin for wolf, to describe erosive skin lesions evocative of a wolfs bite

Erythematosus - reddening of skin

SYSTEMIC LUPUS ERYTHEMATOSUS

is a chronic multisystem autoimmune inflammatory disorder resulting from disturbed

immune regulation that causes an exaggerated production of autoantibodies. It can
affect many parts of the body, including the joints, skin, kidneys, heart, lungs, blood
vessels, and brain.
It is characterized by the formation of autoantibodies and immune complexes.
The disease has been called the great imitator because it has the capacity for affecting
many different body systems, including musculoskeletal system, the skin, the
cardiovascular system, the lungs, the kidneys, the central nervous system, the red blood
cells and platelets.

RISK FACTORS OF SLE

Factors that may increase your risk of SLE include:

Sex. Lupus is more common in women.

Age. Although lupus affects people of all ages, its most often diagnosed between the
ages of 15 and 40.
Race. Lupus is more common in African-Americans, Hispanics and Asians
Susceptible genes
MANIFESTATIONS of SLE

Systemic Lupus Erythematosus can manifest in a variety of ways. The onset may be
acute or insidious, and the course of disease is characterized by exacerbations/flares and
remissions.

SLE symptoms include:

Fatigue
Weakness
Lack of energy
Weight loss
Fever
Joint and muscle pain, stiffness and swelling (most frequently in hands and feet)
Malar rash or butterfly rash (redness over the cheeks and nose)

Skin lesions that appear or worsen with sun exposure (photosensitivity)

Raynauds phenomenon (disorder that affects the blood vessels poor circulation in to
the fingers and toes)
Mouth ulcers
Alopecia
Reduced number of red blood cells, white blood cells and platelets
Pericarditis inflammation of the pericardium
Pleurisy inflammation of pleurae, which impairs their lubricating function and causes
pain when breathing
Inflammation of the kidneys
Anxiety and depression
Headaches, migraines, confusions and memory loss
II. PATHOPHYSIOLOGY

This disturbance is brought about by the development of antibodies resulting from a

combination of factors, including genetic, hormonal (as evidenced by the usual onset during the
childbearing years), immunologic and environmental factors (sunlight, thermal, burns). Also,
certain drugs may provoke a lupus-like disorder in susceptible persons such as hydralazine
(Apresoline) and procainamide (Pronestyl). Other drugs such as isoniazid or INH (Nydrazid),
quinidine, methyldopa, chlorpromazine (Thorazine), and some antiseizure medications like
phenytoin, have been implicated in chemical or drug-induced SLE. The drug usually recedes
when use of the drug is discontinued. Specifically, B cells and T cells both contribute to the
immune response in SLE. B cells are instrumental in promoting the onset and flares of the
disease.

Persons with SLE appear to have B-cell hyper reactivity and increased production of
antibodies against self (example: autoantibodies) and non self antigens. These B cells are
polyclonal, each producing different type of antibody. The autoantibodies can directly damage
tissues or combine with corresponding antigens to form tissue-damaging immune complexes.
Antibodies have been identified against an array of cell components and cell types. Some
autoantibodies that have been identified in SLE are anti-nuclear antibodies (ANA), including
anti-deoxyribonucleic acid (anti-DNA).

Other antibodies may be produced against cell surface antigens of blood cells, including
red blood cells, white blood cells and platelets. Autoantibodies against RBC can lead to anemia,
those against WBC can lead to leucopenia and those against platelets to thrombocytopenia.
III. MEDICAL and NURSING MANAGEMENT
a. DIAGNOSTIC
The diagnosis of the SLE is based on a complete history, physical examination, and
analysis of blood work but no single laboratory test can diagnose or confirm SLE.

The most common laboratory test performed is the immunofluoresence test for ANA -
laboratory technique to identify specific antibodies or antigens. Although, this test is not specific
for lupus, it establishes that the differential diagnosis includes autoimmunity.

The anti-DNA antibody test is more specific for the diagnosis of SLE. This test is
ordered when a person shows signs and symptoms that could be due to lupus and has had a
positive ANA test, especially when the result of the ANA test presents as a "homogeneous" or
"speckled" fluorescent pattern.

Other serum tests may reveal moderate to severe anemia, thrombocytopenia, and
leukocytosis or leukopenia.

Additional immunologic tests may be done to support the diagnosis or to differentiate

SLE from other connective tissue disease.

b. MEDICAL MANAGEMENT
Treatment of SLE focuses on managing the acute and chronic symptoms of the disease.
The goals of treatment include:
Preventing progressive loss of organ function
Reducing the possibility of exacerbations
Minimizing disability from the disease process
Preventing complications from medication therapy

Monitoring is performed to assess disease activity and therapeutic effectiveness.

c. THERAPEUTIC and DRUGS

Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation. NSAIDs control
fever, arthritis, and mild pleuritis.
 Cutaneous, musculoskeletal, and mild systemic features of SLE are managed with
antimalarial drugs (hydroxychloroquine).
Corticosteroids are used to treat more significant symptoms of SLE, such as renal and
CNS disorders. It is also used topically for cutaneous manifestations.
High dose for corticosteroid treatment is used for acute symptoms, and the drug is
tapered to the lowest therapeutic dose as soon as possible to minimize adverse effects.
Immunosuppressant drugs are reserved for the most serious cases of SLE that have not
responded to conservative therapies.

d. NURSING MANAGEMENT
Be sensitive to the psychological reactions of the patient due to the changes and the
unpredictable course of SLE; encourage participation in support groups, which can
provide disease information, daily management tips, and social support.
Teach patient to avoid sun and ultraviolet light exposure or to protect themselves with
sunscreen and clothing.
Because of the increased risk of involvement of multiple organ systems, teach patients
the importance of routine periodic screenings as well as health promotion activities.
Refer to dietician if necessary.
Instruct the patient about the importance of continuing prescribed medications, and
address the changes and potential side effects that are likely to occur with their use.
Remind the patient of the importance of monitoring because of the increased risk of
systemic involvement, including renal and cardiovascular effects.
Provide instruction about fatigue: Describe relationship of disease activity to fatigue;
describe comfort measures while providing them; develop and encourage a sleep
routine (warm bath and relaxation techniques that promote sleep); explain importance of
rest for relieving systematic, articular, and emotional stress.
Explain how to use energy conservation techniques (pacing, delegating, setting
priorities).
Identify physical and emotional factors that can cause fatigue.
Facilitate development of appropriate activity/rest schedule.
Encourage adherence to the treatment program.
Refer to and encourage a conditioning program.
Encourage adequate nutrition, including source of iron from food and supplements.
IV. NURSING DIAGNOSIS and NURSING INTERVENTIONS
A. Impaired skin integrity related to photosensitivity as manifested by skin rash.

NURSING INTERVENTIONS RATIONALE

1. Assess and monitor location and To plan appropriate and effective

progression of rash. interventions.

2. Instruct patient to avoid direct exposure to

sunlight and encourage use of sunscreen and To reduce chance of exacerbations or flares.
wear protective clothing.

3. Instruct the patient to keep skin clean and

To avoid secondary infection.
dry.

4. Instruct the patient to avoid scratching the To avoid worsening of the condition and
areas of skin with rash. disruption of the skin.

5. Instruct patient to take medications and

To control skin manifestations.
apply topical ointments as ordered.

B. Disturbed body image related to presence of rash, lesions, oral ulcer, alopecia, weight
loss and weakness.

NURSING INTERVENTIONS RATIONALE

1. Encourage good nutrition, sleep habits, To improve general health and help prevent
exercise, and rest and relaxation technique. infection.

To avoid oral ulcer and worsening of the oral

2. Encourage good oral hygiene.
ulcer.

3. Suggest alternative hairstyles or wearing of

To cover significant areas of alopecia.
scarves or wigs.

4. Instruct patient to avoid direct exposure to To reduce chance of exacerbations or flares.

sunlight and encourage use of sunscreen and
wear protective clothing.

5. Instruct the patient to keep skin clean and

To avoid secondary infection.
dry.

6. Instruct the patient to avoid scratching the To avoid worsening of the condition and
areas of skin with rash. disruption of the skin.

7. Teach the patient relaxation techniques

To reduce emotional stress that may cause
such as deep breathing exercises, progressive
fatigue.
muscle relaxation and imagery.

8. Instruct patient to take medications and

To control skin manifestations.
apply topical ointments as ordered.

C. Acute pain related to inflammation, swelling and tissue damage.

NURSING INTERVENTIONS RATIONALE

To serve as a baseline data and to plan

1. Assess pain location and severity.
appropriate intervention.

2. Implement actions like giving warm

compresses, massage, change of position,
rest, foam mattress, pillow support, splint, To relief pain and improve comfort level.
relaxation techniques, activities that divert
attention.

3. Encourage patient to take anti-inflammatory

To help lessen inflammation and pain.
preparations and analgesics as ordered.
 D. Fatigue related to disease process as manifested by lack of energy.
NURSING INTERVENTIONS
1. Assist patient to develop a schedule for
daily activity and rest.
2. Help the patient set priorities for desired
activities and role responsibilities.
3. Monitor the patients nutritional intake.
4. Minimize environmental stimuli, especially
during times for rest and sleep. (bright lighting,
noise, visitors, frequent distractions etc.)
RATIONALE
A plan that balances periods of activity with
periods of rest can help the patient complete
desired activities without adding to levels of
fatigue.
Setting priorities is one example of an energy
conservation technique that allows the patient
to use available energy to accomplish
important activities. Achieving desired goals
can improve the patients mood and sense of
emotional well-being.
The patient will need adequate intake of
carbohydrates, protein, vitamins and minerals
for adequate energy resources and metabolic
requirements.
This can inhibit relaxation, interrupt sleep and
contribute to fatigue.
References
Porth, C. M. (2007). Essentials of PATHOPHYSIOLOGY Concepts of Altered Health States
(Second Edition). Lippincott Williams & Wilkins a Wolters Kluwer business.(1029-1031).

Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarths
textbook of medical-surgical nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.

Anon. The American College of Rheumatology nomenclature and case definitions for
neuropsychiatric lupus syndromes. Arthritis Rheum 1999;42:599608.

Wallace D, Hahn BHH, eds. Dubois lupus erythematosus, 7th edn. Lippincott Williams and
Wilkins, 2007.

Arntfield RT, Jicks CM. Systemic lupus erythematosus and the vasculitides. In: Marx JA,
Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine. Philadelphia, PA: Elsevier
Saunders; 2014:chap 118.

http://emedicine.medscape.com/article/332244-overview#a3

http://patient.info/health/systemic-lupus-erythematosus-leaflet