Systemic Lupus Erythematosus (SLE) 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 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. 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. Monitor lab / diagnostic tests ANA (antinuclear antibody) ESR (erythrocyte sedimentation rate) RF (rheumatoid factor) 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. 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. 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.