Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that causes a systemic inflammatory response in various parts of the body. The cause of SLE is unknown, but genetics and hormonal and environmental factors are involved. Under normal circumstances, the body’s immune system produces antibodies against invading disease antigens to protect itself. In individuals with SLE the body loses its ability to discriminate between antigens and its own cells and tissues. It produces antibodies against itself, called autoantibodies, and these antibodies react with the antigens and result in the development of immune complexes. Immune complexes proliferate in the tissues of the client with SLE and result in inflammation, tissue damage, and pain. Mild disease can affect joints and skin. More severe disease can affect kidneys, heart, lung, blood vessels, central nervous system, joints, and skin.
There are three type of lupus. The discoid type is limited to the skin and only rarely involves other organs. Systemic lupus is more common and usually more severe than discoid; it can affect any organ system in the body. With systemic lupus there may be periods of remission and flares. The third type of lupus is drug induced. The drugs most commonly implicated in precipitating this condition are hydralazine (Apresoline), procainamide (Pronestyl), isoniazid (INH), chlorpromazine (Thorazine), d-penicillamine, and some anti-seizure medications. Symptoms usually do not present until after months or years of continued administration. The symptoms are usually abolished when the drugs are discontinued.
Nursing Care Plans
Nursing goals of a client will systemic lupus erythematosus (SLE) may include relief of pain and discomfort, relief of fatigue, maintenance of skin integrity, compliance with the prescribed medications, and increased knowledge regarding the disease, and absence of complications.
Here are four (4) nursing care plans (NCP) for Systemic Lupus Erythematosus (SLE):
Impaired Skin Integrity: Altered epidermis and/or dermis [The integumentary system is the largest multifunctional organ of the body.
May be related to
- Exacerbation of disease process
- High-dose corticosteroid use
- Inflammation
- Use of immunosuppressant drugs
- Vasoconstriction
Possibly evidenced by
- Diffuse areas of hair loss
- Itching
- Loss of discrete patches of scalp hair
- Oral and nasal ulcer
- Pain and tenderness
- Redness
- Scalp hair loss possibly accompanied by lesions, scarring, or dry, scaling skin tissue
- Skin breakdown
- Skin rash
Desired Outcomes
- Client will verbalize ability to cope with hair loss.
- Client will identify measures to cover scalp loss as required by personal preference.
- Client will maintain optimal skin integrity, as evidenced by an absence of rashes and skin lesions.
| Nursing Interventions | Rationale |
|---|---|
| Assess the skin for integrity. | Small lesions may develop on the oral and nasal mucous membranes. Disclike lesions that appear as a dense maculopapular rash may occur on the client’s face or chest. |
| Assess the client’s description of pain. | Gathering information about pain can guide treatment. Each client may exhibit slightly different presentations. |
| Assess for an erythematous rash, which may be present on the face, neck, or extremities. | The classic “butterfly” rash may appear across the bridge of the nose and on the cheeks and is characteristically displayed in the configuration of a butterfly. This is evident in about 50% of clients. |
| Assess for photosensitivity. | Clients may respond violently to ultraviolet light or to sunlight. Disease flares or outbreaks of severe rash may occur in response to exposure. |
| Assess the degree to which symptoms interfere with the client’s lifestyle and body image. | A broad range of behaviors is associated with body image changes, ranging from totally ignoring the change to a preoccupation with it. |
| Encourage adequate nutrition and hydration. | These measures promote healthy skin and healing in the presence of wounds. |
| Instruct the client to clean, dry, and moisturize intact skin; use warm (not hot) water, especially over bony prominences; use unscented lotion. Use a mild shampoo. | Scented lotions may contain alcohol, which dries the skin. Prescribed solutions reduce dryness of the scalp and maintain skin integrity. |
| Instruct the client to avoid contact with harsh chemicals and to wear appropriate protective gloves, as needed. Avoid hair dye, permanent solution, and curl relaxers. | Chemicals aggravate this condition. |
| Recommended prophylactic pressure-relieving devices (e.g., special mattress, elbow pads). | Such devices aid in the prevention of skin breakdown. |
| For skin rash: | |
| The sun can exacerbate a skin rash or precipitate a disease flare. Special lotions, glasses, and other items may be required to protect the skin from sunlight exposure. |
| Inform the client of the availability of special makeup (at large department stores) to cover rashes, especially facial rashes. | These preparations are specially formulated to completely cover rashes, birthmarks, and darkly pigmented areas. This will help the client who is having problems adjusting to body image changes. |
| Introduce or reinforce information about the use of hydroxychloroquine. | This antimalarial drug is a slow-acting medicine used to relieve or reduce inflammation and rash. It may take 8 to 12 weeks for effect. A potential side effect is retinal toxicity. The client must follow up with an ophthalmologist every 6 months. Topical cortisone medication may likewise be used. |
| For oral ulcers: | |
| These foods might irritate fissures or ulcers in the mucous membranes. |
| Hydrogen peroxide helps keep oral ulcers clean. |
| Skin is necessary to prevent infection and promote healing. |
| Vitamin A and E may be useful in maintaining skin health. |
| For hair loss: | |
| Scalp hair loss may be the first sign of impending disease exacerbation. Scalp hair loss may not be permanent. As disease activity subsides, scalp hair begins to regrow. |
| Hair will regrow as the dose decreases. |
| Hair loss may interfere with lifestyle and self-image. |
See Also
You may also like the following posts and care plans:
- 1,000+ Nursing Care Plans List – the ultimate database of nursing care plans for different diseases and conditions! Get the complete list!
- What is a Nursing Care Plan? 9 Steps on How to Write a Care Plan – learn how to write an excellent care plan. We explain the concepts and walk you through the steps.
- Nursing Diagnosis: The Complete List – archive of different nursing diagnoses with their definition, related factors, goals and nursing interventions with rationale.
- The Ultimate Guide to Nursing Diagnosis – learn how to formulate nursing diagnoses correctly in this easy-to-follow guide!
Other Care Plans
Miscellaneous nursing care plans that don’t fit other categories:
- Alcohol Withdrawal | 5 Care Plans
- Benign Febrile Convulsions | 5 Care Plans
- Cancer | 13 Care Plans
- End-of-Life Care (Hospice Care) | 4 Care Plans
- Substance Dependence and Abuse | 8 Care Plans
- Surgery (Perioperative Client) | 13 Care Plans
- Systemic Lupus Erythematosus | 4 Care Plans
- Total Parenteral Nutrition | 4 Care Plans
Further Reading
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans
