Nursing Guide to Systemic Lupus Erythematosus: Nursing Diagnosis, Interventions, & Care Plans

More commonly known as lupus, systemic lupus erythematosus (SLE) is a chronic autoimmune condition that may affect multiple organs and systems in the patient’s body, including skin, joints, kidneys, heart, lungs, and the nervous system. With this condition, the immune system mistakenly attacks healthy tissues, leading to widespread inflammation and tissue damage. Lupus is characterized by periods of flare-ups, when symptoms get worse, and periods of remission, when symptoms get better. 

Lupus is most common in female patients who are childbearing age, particularly those of African, Latinx/Hispanic, Native American, or Asian descent. Early recognition and comprehensive management help with preventing complications and improving the quality of life for individuals with lupus. 

Etiology and epidemiology 

The specific cause of lupus is not fully known; however, there is some belief that it results from a complex interaction of genetic, environmental, and hormonal factors. Genetic predisposition appears to play a significant role, as lupus often runs in families. Environmental triggers, such as infections, ultraviolet (UV) light, stress, and certain medications, may precipitate the onset of lupus or trigger flares in those already diagnosed with the disease. 

Key risk factors 

• Sex (Female patients have a higher likelihood of developing lupus with a  9:1 female-to-male ratio.) 
• Age (most common between ages 15 and 45) 
• Ethnic background (higher prevalence in Black or African American, Hispanic/Latinx, Asian American, and Native American populations) 
• Family history of autoimmune diseases 
• Environmental triggers (UV light exposure, infections, medications like hydralazine or procainamide) 

ICD-10 code 

• ICD-10 code for systemic lupus erythematosus: M32.9 (Systemic lupus erythematosus, unspecified) 

Source: ICD-10 Data 

SLE Diagnosis 

Diagnosing lupus can be challenging due to the wide range of symptoms and its overlap with other diseases. Criteria from the American College of Rheumatology (ACR) and the Systemic Lupus International Collaborating Clinics (SLICC) are often used to help with diagnosis, involving a blend of clinical evaluation, laboratory testing, and imaging. 

Common lupus symptoms 

• General: Fatigue, fever, weight loss 
• Musculoskeletal: Joint pain (arthralgia), swelling, stiffness 
• Dermatological: Butterfly-shaped rash across the cheeks and nose (malar rash), photosensitivity, discoid rash 
• Renal: Proteinuria, hematuria (indicative of lupus nephritis) 
• Neurological: Headaches, seizures, cognitive dysfunction 
• Cardiopulmonary: Pleuritis, pericarditis, chest pain 
• Hematological: Anemia, thrombocytopenia, leukopenia 

Diagnostic tests 

• Antinuclear antibody (ANA) test: This is the most sensitive screening test for lupus; a positive result is seen in nearly all patients with lupus. 
• Anti-dsDNA and anti-Smith antibodies: This is more specific testing for lupus, often associated with more severe disease and lupus nephritis. 
• Complete blood count (CBC): This may show anemia, thrombocytopenia, or leukopenia. 
• Urinalysis: This checks for proteinuria and hematuria, which may indicate kidney involvement. 
• Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP): Elevated levels suggest inflammation. 
• Kidney biopsy: This may be required to assess the severity of lupus nephritis. 

Differential diagnoses include rheumatoid arthritis, Sjögren’s syndrome, scleroderma, and other autoimmune or inflammatory diseases. 

Management 

Management of lupus is highly individualized and depends on the organs involved and the severity of the disease. The main goals of treatment are to reduce inflammation, prevent flares, minimize organ damage, and improve the patient’s quality of life. 

Lupus treatment options 

Medications 

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These help to manage pain and inflammation, particularly in joints and muscles. 
• Antimalarial drugs: 
• Hydroxychloroquine (Plaquenil): A cornerstone of lupus treatment, it helps control skin and joint symptoms and may prevent flares. 
• Corticosteroids: 
• Prednisone: This is used for managing moderate to severe flares. Long-term use is limited due to side effects, including osteoporosis, diabetes, and hypertension. 
• Immunosuppressive agents: 
• Azathioprine (Imuran), methotrexate, and mycophenolate mofetil (CellCept): These are used in more severe cases or when corticosteroids are not sufficient. 
• Biologic therapies: 
• Belimumab (Benlysta): The first biologic approved for lupus, used to reduce disease activity by inhibiting a specific immune system protein (BLyS). 
• Rituximab: This is sometimes used in refractory cases. 

Preventive measures 

• Sun protection: Encourage patients to use sunscreen (SPF 50 or higher), wear protective clothing, and avoid direct sunlight, as UV exposure can trigger flares. 
• Vaccinations: Immunizations are important for lupus patients, but live vaccines should be avoided in those on immunosuppressive therapy. 
• Infection prevention: Due to immunosuppressive treatment, patients with lupus are at a higher risk for infections and should be monitored closely. 

SLE nursing care plan 

Nursing considerations 

Nurses support patients with lupus by monitoring for disease activity, managing medication side effects, and providing patient education about disease management and lifestyle changes. 

Assessment 

• Pain assessment: Monitor for joint pain, muscle pain, and headaches. Assess for changes in pain levels that may indicate disease flares. 
• Skin assessment: Observe any rashes, photosensitivity, and other skin lesions. 
• Renal function: Watch for signs of kidney involvement (e.g., proteinuria, hematuria, fluid retention, elevated blood pressure). 
• Neurological status: Assess for any cognitive changes, headaches, or seizures. 
• Emotional status: Evaluate for signs of depression or anxiety, as chronic disease can impact mental health. 

Nursing diagnosis/risk for 

• Chronic pain related to inflammation and joint involvement 
• Fatigue related to chronic disease and inflammation 
• Risk for compromised skin integrity related to photosensitivity and rashes 
• Risk for ineffective coping related to chronic illness and unpredictable disease flares 

Interventions 

• Provide pain management. Administer NSAIDs or other prescribed medications. Encourage non-pharmacological methods like heat therapy or physical therapy. 
• Education on skin protection. Educate on sun safety and the use of sunscreens and protective clothing to prevent photosensitivity-related flares. 
• Monitor for signs of lupus nephritis. Regularly assess for changes in urine output, blood pressure, and signs of fluid overload. 
• Support emotional health. Provide emotional support and refer to mental health professionals if needed. Support groups and counseling may help patients cope with the emotional aspects of lupus. 

Expected outcomes 

• The patient will experience reduced pain and improved mobility with appropriate treatment. 
• The patient will maintain skin integrity and avoid photosensitivity-related flares by following sun protection measures. 
• The patient will demonstrate improved coping strategies to manage the psychological impact of living with lupus. 
• The patient will report an understanding of the disease, medications, and the importance of follow-up care. 

Individual/caregiver education 

Education helps patients with lupus manage their disease, prevent flares, and recognize early signs of complications. Consider the following when providing patient education: 

• Medication adherence: Educate patients on the importance of taking medications as prescribed, even during remission, to prevent flares. 
• Sun protection: Teach the importance of avoiding UV exposure and using broad-spectrum sunscreen and protective clothing. 
• Recognizing symptoms: Instruct patients to monitor for symptoms of a lupus flare, such as increased fatigue, joint pain, or rashes, and to seek medical care if symptoms worsen. 
• Healthy lifestyle: Encourage a balanced diet, exercise, and stress management techniques to improve overall health and prevent flares. 

Resources 

• Lupus Foundation of America — Lupus Information and Support 
• Centers for Disease Control and Prevention (CDC) —  Lupus Information