Nursing Care Plan for Systemic Lupus Erythematosus Patient

The body of a human being is equipped to protect itself against infections and foreign material recognized in the body. This measure occurs through the production of antibodies against the antigen, which is the recognized external component, eliminating it and attaining active immunity against its potential harm and infections. However, sometimes, the body may mistake its cells and tissues for foreign antigens; consequently, the body produces antibodies against its own resulting to inflammation and damage, whose severity is categorized in established phases, called flares. This essay consists of a complete nursing care plan for persons with systemic lupus erythematosus.

Systemic Lupus Erythematosus is a medical condition, where the immune system of the body, recognizes its cells as foreign material, and produces antibodies against them, causing inflammation and damaging individual’s tissues (Martin, 2017). The medical condition is referred to as being an autoimmune disease due to the factor of the body's failure to discriminate antigens from its proteinous components; thus, the body produces subsequent autoantibodies facilitating the development of immunity complexes that manifest in damage of cells and tissue, inflammations, and painful discomfort.

There are three categories, usually based on the severity of the symptoms, mild to chronic flares. They include discoid type whose damage mostly involves the skin and not other internal organs. Secondly, is the systemic lupus type that affects systems of body organs, with a duration between remission and worsening symptoms (flares). Finally, the trio-type of lupus is usually as a result of periodic usage of certain drugs administration, whose side effects are causative of the condition (Martin, 2017). For example, usage of Thorazine, Apresoline, and other specific anti-seizure drugs may cause symptoms associated with Systemic Lupus Erythematosus. However, these symptoms subside after complete discontinuation of the use of these medications.

Pathophysiology and Etiology of Systemic Lupus Erythematosus

Systemic Lupus Erythematosus is an autoimmune ailment, where the immune system goes against one’s body tissues and cells, causing inflammation and tissue damage. The actual causes of Systemic Lupus Erythematosus remain unidentified within the medical fraternity. However, suggestions have been made relating lupus to specific environmental exposures, comprises of trauma, viruses stress, and particular prescription medication (Pat RN, 2004). Besides, others have associated triggers of lupus to an individual's genes and genetics. Currently, studies have indicated various genetic factors have been identified to increase an individual’s susceptibility to lupus (Pat RN, 2004). For instance, four defective genes that regulate apoptosis and other ineffective genes that accelerate build up of immune complexes. Besides, for mothers with SLE, the risk of the daughters contracting the condition is 1:40.

Further, the autoimmune reactions are geared against components of the cell nucleus. These autoimmune antibodies are produced to attack/ engage with specific nuclear, cytoplasmic, and cellular antigens, facilitating complement activation, and immune complexes accumulate on the walls of blood vessels (Pat RN, 2004). Due to the accumulation of immune complexes on the walls of blood vessels, the adequate blood supply to various organ systems is affected, a condition referred to as ischemia. Consequently, ischemia development leads to thickening of blood vessels linings, the degeneration of fibrinoids, and the formation of thrombus, marking the onset of Systemic Lupus Erythematosus symptoms dependent on the tissues or organ system involved.

Signs and Symptoms of Systemic Lupus Erythematosus, and Potential Complications

These signs and symptoms include sun rashes on the skin, pains in the chest with deep breathing and in the joints, swollen joints, hair loss, hair thinning, and extreme fatigue. Potential complications arising from these symptoms include mucous-membrane ulcers in the nose or the mouth (Martin, 2017). Furthermore, long-term complications include inflammation of the blood vessels (vasculitis), of the lung tissues (pleuritis), and the heart (pericarditis); seizures, kidney failure, and brain disorders (Martin, 2017). Systemic Lupus Erythematosus symptoms share significant similarities with various medical disorders, and care must be exercised in its diagnosis.

Physical Assessment of Patients

A patient complaining of hair loss, scarring of the scalp, and has recent rashes on the skin comes seeking diagnosis and treatment (Martin, 2017). The patient, with a grim face, asserts that the rashes deteriorate further with exposure to intense sunlight. Further, the patient complains sores in the mouth, bodily pains, especially in the joints, and unusual overall fatigue even after sleep. The patient occasioned numerous recent cases of unique extended sleeping patterns. Foremost, hair loss and skin rashes may be indicative of impaired integrity of the skin. The discomforts reported, in regards to hair loss and scarring scalp may be related to possible inflammation of the body’s integumentary system or a worsened disease flare. Besides, on a routine check, the patient exhibits mouth ulcers as expressed in the patient concerns of sores in the mouth (Martin, 2017). The bodily pains may be due to damaged internal tissues and affected organs, resulting in the pain experienced. Besides, the overall physical fatigue indicates the patient's body inadequate ability to restore strength even after hours of rest (Martin, 2017). These symptoms may cause a patient to indulge in oversleeping and an overall decline in the performance of their duties.

Diagnostic and Laboratory Studies Normal Values

To truly ascertain and identify the actual cause of the pains and discomforts, laboratory tests, imaging tests, and final biopsy tests, are applied. The patient can be subjected to blood and urine tests to ascertain various factors through laboratory testing. These checks are inclusive of blood count tests, erythrocytes sedimentation rate, urinalysis, and antinuclear antibody (ANA) tests ('Lupus - Diagnosis and treatment - Mayo Clinic', 2017). The blood count assessment ascertains the proportions of blood constituents. For instance, below normal red blood cells levels would explain the patient’s fatigue incidences.

In Urinalysis tests, presence of protein components in the urine may indicate lupus affecting the kidney ('Lupus - Diagnosis and treatment - Mayo Clinic', 2019). A positive ANA test points out to a stimulated immune system, explaining lupus progression, and not necessarily actual lupus, thus informing specific antibody tests. Besides, a faster than average rate of red-blood cells sedimentation in an hour will indicate the presence of systematic condition; suggesting possible lupus ('Lupus - Diagnosis and treatment - Mayo Clinic', 2017). With biopsy examination, the extent of harm on an organ can be determined, informing the type of treatment to be undertaken by the patient, especially for the integumentary system- affected skin.

ALL RELEVANT NANDA- Nursing Diagnoses

The North American Nursing Diagnosis Association (NANDA) is a professional body of nursing that develops and refines nursing diagnoses. There are various nursing diagnoses already established by NANDA (Kamitsuru, & Herdman, 2014). Under safety and protection: “Risk for impaired oral mucous membrane, Risk for impaired tissue integrity, and risk of pressure ulcers” (p. 400). For example, the patient's mouth sores, scarred scalp, and skin rashes. Further, Domain 12 of NANDA, comfort, highlights chronic pain syndrome, impaired physical and environmental. For example, an altered sleep pattern, as raised by the patient, falls herein. Besides, domain four, rest/ activity include severe exhaustion, “Risk for impaired cardiovascular function, and Risk for decreased cardiac output” (Kamitsuru, & Herdman, 2014). Under impaired physical mobility, the patient, complains of joint pains.

Three NANDA Priority Nursing Diagnoses

During patient treatment, the desired outcome will include: improved physical mobility, reduce inflammation and pain, reduce any organ dysfunction, and any subsequent frequency of flares. (Martin, 2017) Three priorities in patient Systemic Lupus Erythematosus treatment will be aligned with the desired goal. For instance, for the pain experienced based upon the reported intensity of pain during patient interaction, pain management strategies can be employed, both pharmacological and non-pharmacological techniques (Kamitsuru, & Herdman, 2014). Besides, the reported fatigue, characterized by tiredness, reduced performance of roles, may be related to physiological conditioning, such as anemia and lupus disease. The nurse should strive to minimize the level of fatigue reported, increase rejuvenation and performance of responsibilities.

Further, the nurse should encourage comfortable activity without patient overexertion (Kamitsuru, & Herdman, 2014). Finally, measure to cater to impaired skin integrity should be pursued. They may be related to pharmaceutical agents, impaired blood circulation, psychogenetic factors, and increased sensitivity (Kamitsuru, & Herdman, 2014). These nursing priorities should be undertaken to increase the effectiveness of the patient recovery process.

Intervention for Each Priority Nursing and Scientific Rationale for Intervention

In regards to impaired integrity of the skin, assessment of patient's skin integrity is conducted. The evaluation is due to the development of maculopapular rashes on the facial skin and ulcers on the mucous membrane of the nasal cavity and the mouth (Martin, 2017). Further, assessment of photosensitivity of skin because the client reacts with exposure to sunlight. Besides, proper nutrition and hydration are encouraged to reduce the dryness of the scalp, as expressed, maintaining the integrity of the client skin. Oral and nasal ulcers, avoidance of spicy and acidic foods is recommended, to reduce irritation (Martin, 2017). Besides, pharmacological intervention to ensure improved oral hygiene, through rinsing the mouth with half concentrated hydrogen peroxide.

The pain experienced by the patient should be addressed. The nurse should assess a patient’s description of the painful discomfort because SLE patients exhibit such pain in the joints due to immune complexes reactions (Martin, 2017). Furthermore, the impact of hurt on client activities should be assessed to establish coping strategies, to maintain standard functionality. Besides, previous patient intervention to reduce pain is developed to inform pain management measures while making the necessary adjustments for effectiveness. In cases where mobility may be barred significantly, ambulation aids are prescribed as a coping technique. In later stages of recovery, patient mobility exercises should be conducted to facilitate a smooth transition to improve mobility recovery.

Where non-opioid analgesics were prescribed, after sometimes into the recovery period, non-pharmacological techniques can be used to augment the pains, and suitably substitute drug-use (Martin, 2017). With time, instead of the ambulation aids, wearing of splints is done to rest inflaming joints. Further, on the event that the patient was under immuno-suppressant drugs during treatment, decreased dosage and progressive recovery would cause hair re-growth over time. In conclusion, a proper plan for nursing care is essential to active recovery of a Systemic Lupus Erythematosus Patients and facilitates the meeting of client targets.