Systemic Lupus Erythematosus (SLE)
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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”
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
Assess and monitor skin for rash
RATIONALE
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
RATIONALE
Oral lesions and ulcers are common symptoms; peroxide helps to keep oral lesions
clean and promote healing
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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
RATIONALE
Inflammation and SLE related arthritis can cause significant pain and stiffness of joints;
Medication may be necessary, but encourage other alternatives as well.
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Encourage deep breathing exercises to promote adequate gas exchange and prevent
lung diseases
Splinting
Incentive spirometer
Relaxation
RATIONALE
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
RATIONALE
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.
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Monitor lab / diagnostic tests
ANA (antinuclear antibody)
ESR (erythrocyte sedimentation rate)
RF (rheumatoid factor)
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CMP / liver function tests
RATIONALE
Lab tests can help determine the extent, if any, of organ failure or dysfunction and
therefore determine progression of disease and response to treatments.
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Administer medications appropriately
Antimalarials (chloroquine)
Corticosteroids (prednisone)
NSAIDs
Immunosuppressants (cyclophosphamide)
Opioids
RATIONALE
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.
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Nutrition and lifestyle education
Healthy diet (fruits, grains, vegetables)
Regular exercise
Avoid sun exposure
Adequate rest
RATIONALE
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.