A. Pusey Murray (Mrs)RN, Cert Psych Nursing & Nursing Admin,
BSc (Hons), MPH, PgD. Education, PhD (c)
Systemic Lupus Erythematosus
Objectives At the end of this session students will be able
to:Define the term Systemic Lupus Erythematosus.State the etiology
of Systemic Lupus Erythematosus.Outline the pathophysiology of
Systemic Lupus Erythematosus.
Objectives contd List at least ten (10) clinical manifestations
of Systemic Lupus Erythematosus.Describe the nursing management of
Systemic Lupus Erythematosus.
Definition Systemic Lupus Erythematosus is a chronic multisystem
inflammatory disease of connective tissue that often involves the
skin, joints, serous membranes (pleura, pericardium), kidneys,
hematologic system and central nervous system.
Etiology The etiology of SLE is unknown. However factors
implicated in the etiology of SLE includes genetic predisposition,
sex hormones, race, environmental factors (ultra violet radiation,
drugs, chemicals), viruses, infections and stress.
Pathophysiology Pathophysiology depends on auto immune reactions
directed against constituents of the cell nucleus, particularly
DNA. In SLE, auto antibodies are produced against nuclear antigens,
cytoplasmic antigens and blood cell surface antigens, platelets and
granulocytes. When auto antibodies bind to their specific antigens,
complement activation occurs.
Pathophysiology contd Accumulation of immune complexes within
the blood vessel walls and subsequent complement activation leads
to a condition called lupus vasculitis. The ensuing ischemia within
the blood vessel walls gradually leads to the thickening of the
internal cell lining, fibrinoid degeneration and thrombus
Pathophysiology contdThe specific manifestation of SLE depends
on which cell types or organs are involved.SLE may be precipitated
or aggravated by certain drugs such as procainamide and a number of
anticonvulsant agents. Some antiinfective agents such as
penicillin, sulfonamide and oral contraceptives may also aggravate
Clinical ManifestationsFatigueFever (>100 F)Skin rashesFacial
rashAlopecia (hair loss)SeizuresArthritis
Clinical ManifestationsMouth or nose ulcersFatigue Butterfly
rash on cheeks and bridge of nose
Blotchy Erythema of Dorsum of the Hands
Malar Rash Butterfly rash
Nursing ManagementImpaired skin integrity related to
photosensitivity evidenced by areas of ulceration on finger tips,
alopecia, butterfly rash on face.Altered nutrition less than body
requirements related to oral ulcerations, immunosuppresive therapy
evidenced by weight loss.
Nursing Management ContdAssess and monitor location and
progression of rash.Administer prescribed medications and apply
ointments as ordered to control skin manifestations.Keep skin dry
and clean to prevent secondary infections.
Nursing Management ContdEncourage discussion about feelings and
positive attributes to reduce clients sense of isolation and poor
body image and redirect self-focus to positive attributes.Encourage
client to rest regularly and as needed to temporarily reverse
effect of fatigue.Provide range of motion exercises to unaffected
joints to prevent contractures.
Nursing Management ContdProvide good oral hygiene before and
after meals to provide comfort and prevent exacerbating oral
ulcerations.Encourage patient to assist in setting activity
schedule to allow patient a sense of control and foster
cooperation.Monitor pertinent laboratory values such as hemoglobin,
electrolytes and protein levels.
Nursing Management ContdNursing interventions should be directed
towards assisting the patient and family to eliminate or minimize
exposure to precipitating factors. Patient understanding and
cooperation are important to this goal. Patient and family
education should include the following:
Nursing Management ContdAn abnormal reaction to the ultraviolet
(UV) rays of the sun, photosensitivity results in the development
or exacerbation of a rash that is sometimes accompanied by systemic
symptoms. All people with lupus should avoid direct, prolonged
exposure to the sun. Sun-sensitive patients should frequently apply
Nursing Management Contd Sun-sensitive patients should also
avoid unprotected exposure between 10 a.m. and 4 p.m., and wear
protective clothing, such as wide-brimmed hats and long sleeves. In
severe cases, patients may wish to purchase special UV-blocking
Nursing Management ContdEducation on the disease process.Names
of medications, and actions, side effects, dosage and
administration.Avoidance of physical and emotional stress, over
exposure to ultra violet light and unnecessary exposure to
infections.Regular medical and laboratory follow up.
Nursing Management ContdTeach your patient and her family to
watch for signs of exacerbation: fever, rash, cough, or worsening
muscle and joint pain. Decreased urine output or unexplained weight
gain may signal renal problems.
Nursing Management Contd Teach client about medications and
discuss the common adverse effects. For example, taking
cortico-steroids with a meal will help her avoid gastrointestinal
irritation. To promote adequate nutrition, teach your patient to
eat small, frequent meals. Good oral hygiene may help prevent the
development of oral ulcers.
Nursing Management contdTo prevent joint pain and deterioration,
teach her joint conservation measures. For example, when arising
from a chair, she should push with her arms to decrease the strain
on her hips and knees.
Nursing Management contdMedications (such as aspirin or NSAIDs),
warm and cold compresses, and relaxation techniques all may help
control pain.Referral resources to community and health care
Critical Thinking QuestionWhat are the lifestyle implications of
being diagnosed with Systemic Lupus Erythematosus?
References Beers. M. (2004). The Merrick Manual of Medical
Information (2nd ed.).
Greener, M.(1991)."SLE: A Clinical Challenge," Professional
Nurse. 6(10), 589-592
White, L., Duncan, G., & Baumle, W. (2013). Medical Surgical
Nursing. An Integrated Approach.(3rd ed.), Delmar, Cengage
References Williams & Wilkins (2006). Handbook of Medical
Surgical Nursing (4th ed.). Lippincott