A Reporting Manuscript on

Systemic lupus erythematosus (SLE)

In Partial Fulfilment of the Requirements in NCM 212 - RLE

IMMUNOLOGY/CANCER ROTATION

Submitted to:

Mrs. Monaliza J. Lee, RN, MN

Clinical Instructor

Submitted by:

Dalipe, Marc Mhel

Amba, Lea Joy
Arancon, Danica
Arceo, Kristal
Fabian, Cheska Denise
Geron, Mary Antonette
BSN 3H Group 2 Subgroup 1

November 25 2021
 TABLE OF CONTENTS

I. Definition 1

II. Incidence 2

III. Factors or Risks 3

IV. Assessments or Signs and Symptoms 6

V. Management 11

A. Medical or Surgical 11

B. Nursing 17

VI. Summary of Reaction 20

VII. References 22
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I. Definition

According to Harding (2020), Systemic lupus erythematosus (SLE) is a

multisystem inflammatory autoimmune disease. It is a complex disorder of multifactorial
origin resulting from interactions among genetic, hormonal, environmental, and
immunologic factors. SLE typically affects the skin, joints, and serous membranes (pleura,
pericardium). Renal, hematologic, and neurologic systems are also affected. SLE is
marked by a chronic unpredictable course with alternating periods of remission and
exacerbation. Similarly, Ignatavicius et al. (2021) described Systemic lupus
erythematosus as a chronic, progressive, inflammatory connective tissue disorder that
can cause major body organs and systems to fail. In addition, according to Jameson et
al. (2018), Systemic lupus erythematosus (SLE) is an autoimmune disease in which
organs and cells undergo damage initially mediated by tissue-binding autoantibodies and
immune complexes.

SLE starts with the body’s immune system inaccurately recognizing one or more
components of the cell’s nucleus as foreign, seeing it as an antigen. The immune system
starts to develop antibodies to the nuclear antigen. In particular, B cells begin to
overproduce antibodies with the help of multiple cytokines such as B-lymphocyte
stimulator (BLyS), which is overexpressed in SLE. The antibodies and antigens form
antigen–antibody complexes and have the propensity to get trapped in the capillaries of
visceral structures which causes inflammation. The antibodies also act to destroy host
cells. It is thought that those two mechanisms are responsible for the majority of the
clinical manifestations of this disease process. It is hypothesized that the
immunoregulatory disturbance is brought about by some combination of four distinct
factors: genetic, immunologic, hormonal, and environmental (Hinkle & Cheever, 2018).
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II. Incidence

According to Bartels (2021), From the 1970s to the 2000s, estimates of the annual
incidence of SLE fluctuated from around 1 to 10 per 100,000 of the population, while the
prevalence of SLE was believed to be between 5.8 to 130 per 100,000 people.
Additionally, based on the Lupus Foundation of America, there are at least 1.5 million
cases of the condition, likely due to the inclusion of milder forms of the disease. According
as well to a report published in 2008 by the National Arthritis Data Working Group, there
are 161,000 instances of definite SLE and 322,000 cases of actual or probable SLE.

However, SLE incidence in the general population would depend on the

characteristics of the population investigated, such as age, gender, race, ethnic or
national origin, and even the time period analyzed.

In the United States, the incidence of systemic lupus erythematosus (SLE) is

estimated to be between 20 to 150 cases out of 100,000 population. The prevalence was
73 out of 100,000 in one meta-analysis. In the final 40 years of the twentieth century, the
incidence of mild disease roughly tripled due to improved detection. In North America,
South America, Europe, and Asia, estimated incidence rates range from 1 to 25 per
100,000.

Also, in the study of Stojan and Petri (2019) annual incidence for different racial or
ethnic groups was much higher for blacks than whites. There are 3.7 to 7.9 cases out of
100,000 people in Michigan, and in Georgia, there are 3.2 to 9.4 per 100,000 population.
As well as for American Indians or Alaska Natives was 7.4 per 100,000 people and
Hispanics in San Francisco County and Manhattan were 4.1 and 4.0 per 100,000 people,
respectively.

Females are also more likely than males to develop systemic lupus erythematosus,
with a ratio of females to males ranging from 9:1 to 3:1. In the United States, SLE
incidence in women ranges from 164 (White people) to 406 (African Americans) per
100,000 people. Also, for Caucasian females, the incidence of the said condition is
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between 6 to 18.9 cases out of 100.000 with onset before the age of 19 years. And 16 to
36.7 per 100.000 in Puerto Rican women (Stojan & Petri, 2019).

Additionally, since the incidence of SLE is higher in women and according to age,
it usually affects ages between 14 to 64 years old. SLE commonly appears after puberty,
mainly in the 20s and 30s, with 20% of all cases identified in the first two decades of life.
Also, 15-20% of all SLE patients are children. On average, 60% of patients develop SLE
after age 10, 35% between 5 and 10 years, and only 5% before age 5 (Stojan & Petri,
2019).

In the Philippines, estimated SLE incidence were 19.9 per 100,000 people and in
over 233 Filipino patients with SLE, 94% were women under 7 to 80 years of age
(Weisman et al., 2010).

III. Factors or Risks

Age SLE affects people of all ages but it is more common in

reproductive years of women- ages between 15 to 45.This is
because women of this age produce more hormones, such as
estrogen. According to Hinkle & Cheever (2018), Estrogen may
contribute to the body’s response of overreacting to its own body
tissue.

Gender According to Weckerle & Niewold (2017), SLE is more common

in women than in men (9:1 female to male ratio) . This is due to
the fact that women have higher estrogen levels than men.

Race According to Jeawett-Tenant (2021), SLE is more common in

Hispanic, Asian, and Native American descent, and women of
African-American and Hispanic descent are more prone to
develop severe lupus.
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Genetics According to Jeawett-Tenant (2021), a person may be prone to

SLE if there is already a presence of the disease in the family.
Most studies agree that genetics or inheritance has a factor in
deciding the risk of getting lupus; According to a population-
based study from Taiwan, SLE is 43.9 percent heritable, with
relative risks of: 23.68 for siblings, 11.44 for parents, and 14.42
for patients' offspring. Furthermore, SLE affects both twins in 30
percent of identical twins and 5-10% of nonidentical twins
(Bartels, 2021); however, this factor is rarely enough to cause
lupus on its own.

UV radiation UV radiation regardless of whether it's from the sun or lights can
damage the cells leaving fragments called nuclear antigen (since
it comes from the nucleus). The immune cells are more likely to
think that these are antigen and the immune cells will try to attack
them. In addition, according to Bartels (2021), keratinocytes are
stimulated by ultraviolet light, which results in the overexpression
of nuclear ribonucleoproteins (snRNPs) on their cell surfaces as
well as the secretion of cytokines that simulate enhanced
autoantibody synthesis.

Smoking According to Winnall et al. (2020), Smoke from cigarettes has

pro-inflammatory effects that trigger an inflammatory response.
The toxic chemicals present in cigarette smoke interact with
various different cell types of the immune system, increasing the
numbers of cells that accumulate at the site of inflammation and
changing the levels of cytokines and other biological molecules
that regulate inflammation.

Emotional Stress The sympathetic nervous system and the adrenal glands secrete
more adrenergic hormones in response to stress. The
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lymphocytes are activated by these adrenergic hormones, which

cause them to express and release adrenergic receptors, which
boost antibody production and secretion. Increased production
of these hormones raises the chance of aggravation by triggering
antibodies that attack the body's normal and healthy cells

EVB infection The Epstein-Barr virus is a herpesvirus that is one of the most
commonly infecting viruses in humans. According to a study, the
Epstein-Barr virus (EBV) may interact with your genes to raise
your risk of getting SLE. EBV appears to have the capacity to
turn on genes that lead your immune system to mistakenly target
harmless tissues. (Dellwo, 2021).

Oral Majority of oral contraceptives contain a combination of estrogen

Contraceptives and progestin hormones. As stated by Wael Jarhour, MD,
“estrogen can heighten the immune response, which works well
when fighting infection but causes trouble when it comes to
overstimulating the immune system resulting in autoimmunity”.
He also stated that Estrogen enhances immune system
activation by upregulating a variety of genes and cytokines,
including the X-linked toll-like receptor (TLR) 8, which is involved
in innate immunity and has been associated with SLE (Walsh,
2018).

Medications According to Harding (2020), Certain drugs can make your

immune system overreact and cause SLE-like symptoms or
known as drug-induced lupus erythematosus. These drugs
include procainamide, hydralazine, and quinidine. This type of
lupus generally occurs months to years after continuous therapy
with causative drugs and symptoms nearly always go away when
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the drug is discontinued.

IV. Assessments or Signs and Symptoms

CONSTITUTIONAL MANIFESTATION
● FEVER
R: The interior of a cell or nuclear antigens are affected in SLE. Identified as foreign
bodies by mistake. As a result, to kill these viruses, the body generates an immunological
response. Fever is one of these responses, and it is usually directed at the source of the
infection. An increase in temperature is used to destroy microorganisms.

SKIN MANIFESTATIONS

● NASOPHARYNGEAL ULCERS
R: When the antigen-antibody complex travels, this happens. It then spreads to the
nasopharynx and oropharynx, where it can be fatal. Then there was an inflammatory
response, which resulted in Presentation of an ulcer.

● RASH
R: There are two categories of rash-related symptoms:
Butterfly rash, malar rash, and discoid rash are all terms for the same thing. This is most
common when a person has a hereditary vulnerability. It begins when antigen-antibody
complexes cause inflammation in the epidermal lining of the skin.

● ALOPECIA
R: Non-scarring may be caused by alopecia areata.Alopecia in SLE patients. Another
condition is alopecia areata. autoimmune disease is a condition in which the immune
system attacks the body. Hair follicles are damaged, resulting in hair loss in small areas.

MUSCULOSKELETAL MANIFESTATIONS
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● SYNOVITIS
R: When the synovial membrane becomes inflamed as a result of
the immune system, which is a connective tissue layer
that runs along the inside of a joint such as the hip, knee, ankle, or shoulder (heat,
swelling, and discomfort).

● MYOSITIS
R: This occurs when an immune reaction causes inflammation in the muscles that move
the body.

● ARTHRITIS
R: When inflammation develops through the joint tissues, it causes swelling and
tenderness, as well as pain and stiffness in the joints.

CARDIOPULMONARY MANIFESTATIONS

● PERICARDITIS
R: Pericarditis is a condition in which the saclike tissue surrounding the heart
(pericardium) expands and thins as a result of the body's immunological response to
nuclear antigen.

● ENDOCARDITIS
R: When the immune reaction to nuclear antigens reaches the inner lining of the heart's
chambers and valves, it causes inflammation.

● MYOCARDITIS
R: When the immunological response to nuclear antigens causes inflammation in the
heart muscle or myocardium, this condition develops.
● PNEUMONITIS
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R:This occurs when the lung tissue becomes inflamed as a result of an immune
response's inflammation.

● PLEURITIS
R: Due to an immunological reaction, the pleura, a membrane that lines the outside of the
lungs and the inside of the chest cavity, becomes inflamed.

● RAYNAUD'S PHENOMENON
R: This symptom has a strong link to an SLE patient's smoking history. Smoking affects
the artery wall, making it more likely for them to bulge and inflame. Inflammation develops
as a result of the immune response activation in SLE, causing artery thickening and
narrowing, resulting in reduced blood flow in various parts of the body.

RENAL MANIFESTATIONS

● HEMATURIA
R: When the bladder, urethra, prostate, or kidney become inflamed as a result of the
body's immunological reaction to nuclear antigens, blood in the urine results.

● GLOMERULONEPHRITIS
R: It occurs when the immune response's inflammation damages the glomeruli, which are
small filters that remove excess waste and fluids from the circulation to produce urine.

● PROTEINURIA
R: When the glomeruli become inflamed, they lose their ability to filter and recapture big
proteins, resulting in an excess of protein in the urine.

NEUROPSYCHIATRIC MANIFESTATIONS
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● STROKE
R: Stroke in SLE is caused by vascular spasms, which are more likely in patients who
have high blood pressure and a history of smoking. This occurs when the arteries in the
brain become inflamed and thicken and narrow, leading to reduced blood flow and a lack
of oxygen and nutrients to the brain tissue.

● PERIPHERAL NEUROPATHY
● SEIZURE
● PSYCHOSIS
R: Certain symptoms are only seen in a small percentage of SLE patients. This could be
due to any pre-existing conditions that the person had before being diagnosed. These are
also produced by inflammation of cells reaching the head or brain, but in most cases,
individuals with SLE who are recognized early will prevent these immune cells from
reaching the brain, thereby limiting or decreasing the effect of the inflammatory process
on the brain. Because the neurological system is the body's primary governing, regulating,
and communication system, seizures, peripheral neuropathy, and psychosis can occur
when inflammation reaches the brain and damages nerve cells.

HEMATOLOGIC MANIFESTATIONS

● LEUKOPENIA
R: White blood cells are another type of blood cell that the immune system attacks. It
targets WBC and causes inflammation while lowering or increasing WBC levels in the
body.

● ANEMIA
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R: Red blood cells are also attacked by the immune system in SLE, which is why anemia
is one of the symptoms. The reason for this is uncertain, however studies have shown
that anemia in SLE is caused by the high rate of anemia in SLE patients.

● THROMBOCYTOPENIA
R: Platelets, like WBC and RBC, are attacked by the body's immune system, resulting in
a low blood platelet count. When this happens, the platelet's capacity to contribute to
hemostasis is compromised.

● LYMPHADENITIS
R: It occurs when the immune system of the body erroneously targets healthy cells,
causing inflammation to spread and impact the lymph nodes, resulting in swelling and
redness.

● SPLENOMEGALY
R: Splenomegaly, like the other manifestations, is caused by an inflammatory reaction
affecting the organ, resulting in an enlarged spleen. The immune system wrongly
detected foreign substances, which triggered the inflammatory reaction.

GASTROINTESTINAL MANIFESTATIONS

● NAUSEA AND VOMITING

R: Patients may feel nausea and vomiting as a result of viruses and diseases acquired
from the outside environment.

● ABDOMINAL PAIN
R: When you have SLE, you're likely to experience abdominal pain. Inflammation is
triggered when the body is prompted by infection and other factors that activate the
immune system, which typically affects the stomach and causes pain.
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V. Management
SLE has no cure, and complete remission is uncommon. In systemic lupus
erythematosus, the only treatment approach is to reduce disease activity, such as mild
symptoms, on the lowest possible doses of medications, which can be achieved in at
least 30-50 percent of SLE patients. Inducing acute flare remissions and then maintaining
improvements with strategies that suppress symptoms to an acceptable level while
preventing organ damage should be planned. The therapeutic approach is determined by
whether the disease manifestation is life-threatening or likely to cause organ damage,
which justifies aggressive treatments; or whether the manifestation is reversible, in which
case the best approaches to preventing disease complications and treatments are
chosen.

A. Medical

a) Antimalarial drugs
Antimalarial medications such as hydroxychloroquine, chloroquine, and
quinacrine frequently lessen dermatitis, arthritis, and fatigue, and they may
also lower the risk of thrombotic events. Hydroxychloroquine also reduces
the accumulation of tissue damage, including renal damage, over time. This
drug's typical dosage is 200-400mg taken orally per day and should not
exceed more than 400mg. Some experts recommend a hydroxychloroquine
blood level of 750 ng/mL to optimize responses in active SLE; doses should
be reduced after response. Long-term use of this medication requires 6-
month monitoring for retinal pigment changes. Adverse effects are
uncommon and include eye changes, GI symptoms (the most common of
which is diarrhea), and CNS changes. Furthermore, antimalarial drugs
inhibit the synthesis of DNA, RNA, and proteins by interacting with nucleic
acids. Antimalarial medications suppress the immune system, act as
antioxidants, and interfere with prostaglandins.
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b) Glucocorticoids
These drugs have anti-inflammatory and immunosuppressive properties, as
well as profound and varied metabolic effects and the ability to modify the
body's immune response to a variety of stimuli. The dose varies according
to the severity of SLE on the organ system involved, as well as in individuals
with serologic disease activity. The mainstay of treatment for any
inflammatory life-threatening or organ-threatening manifestation of SLE is
systemic glucocorticoids (0.5–1 mg/kg/day of prednisone PO for or 500-
1000 mg of Methylprednisolone IV per day for 3 days followed by 0.5-1
mg/kg of daily prednisone). Prednisone should not exceed 150-250mg and
the Maintenance dose ranges from 5mg - 10mg of prednisone per day. For
lupus nephritis, initiated therapy is high-dose of IV glucocorticoids pulses
ranging 500-1000 mg/day for 3-5 days. Methylprednisolone reduces
inflammation by suppressing the immune system in a similar way to
prednisone, but it has fewer mineralocorticoid effects. Intravenous high-
dose steroids can be administered in a hospital setting as well as by home
health care teams. Patients taking glucocorticoids are at increased risk for
infection and should be tapered to avoid withdrawal symptoms. Topical
corticoids in combination with hydroxychloroquine is used to treat topical
dermatitis such as butterfly rash which is a common symptom of SLE.

c) Cytotoxic/Immunosuppressants
Cytotoxic/immunosuppressive agents added to glucocorticoids are
recommended to treat serious SLE. Almost all prospective controlled trials
in SLE involving cytotoxic agents have been conducted in combination with
glucocorticoids in patients with lupus nephritis. Therefore, the following
recommendations apply to treatment of nephritis. Either cyclophosphamide
(an alkylating agent) or mycophenolate mofetil (a relatively lymphocyte-
specific inhibitor of inosine monophosphatase and therefore of purine
synthesis) is an acceptable choice for induction of improvement in severely
ill patients; azathioprine (a purine analogue and cycle-specific
 13

antimetabolite) may be effective but is associated with more flares. The

effects of the mentioned medications are complicated by race, since higher
proportions of African Americans (and other non-Asian, nonwhite races)
respond to mycophenolate than to cyclophosphamide, whereas similar
proportions of whites and Asians respond to each drug. For white patients
with northern European backgrounds, low doses of cyclophosphamide (500
mg every 2 weeks for six total doses, followed by azathioprine or
mycophenolate maintenance) are as effective as standard high doses, with
less toxicity while for African Americans and Latinas, high-dose
cyclophosphamide (500–1000 mg/m2 body surface area given monthly IV
for 6 months, followed by azathioprine or mycophenolate maintenance) is
an acceptable approach for patients with severe nephritis. The dosage for
mycophenolate mofetil is 2–3 g/d PO total given bid for induction therapy,
1–2 g/d total given bid for maintenance therapy; max 1 g bid if CrCl <25
mL/min. Begin with a low dose and increase every 1–2 weeks to minimize
GI side effects. Start treatment at 0.5 g bid. Azathioprine dosage is 2–3
mg/kg per day PO for induction; 1–2 mg/kg per day for maintenance and is
usually combined with prednisone. Early treatment with combination of
glucocorticoids and cyclophosphamide decreases ESRD and death.

Belimumab is also given for severe patients who are not responsive to
glucocorticoids and is effective for 50% of patients with fatigue, rash, and/or
the arthritis of SLE. However, it is expensive and should be considered after
other approaches fail or are not tolerated. Common side headache and
diffuse body aching while for severe side effects are Infusion reactions,
allergy, infections. The dosage for Belimumab is Dosage: 10 mg/kg IV wks
0, 2, and 4, then monthly OR subcutaneous 200 mg each week. For patients
resistant to the above therapies, Rituximab is given 375 mg/m2 per week
for 4 weeks or 1g twice a week for 2 weeks.
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d) Calcium and Vitamin D supplements

All patients with systemic lupus erythematosus (SLE) who are on
corticosteroids or have arthritis are at a higher risk of osteopenia and its
complications. Diet and appropriate vitamin D and calcium supplementation
are important tools for bone health in these patients. Notably, natural
vitamin D production requires skin exposure to sunlight, which is
discouraged in the SLE population, increasing the risk of vitamin D
deficiency.

e) Nonsteroidal anti-inflammatory drugs (NSAIDs)

A child with mild disease who does not have nephritis,
hypocomplementemia, or elevated anti–double-stranded DNA antibodies is
treated symptomatically and closely monitored for signs of disease
progression. NSAIDs are used to treat arthritis. Choose an agent based on
the patient's response to medication, a history of previous drug allergy or
reaction, and ease of use. NSAIDs should be used with caution in patients
with renal or liver disease, and they should be avoided during pregnancy.
Gastritis, bone marrow suppression, hepatitis, interstitial nephritis, and CNS
changes are some of the side effects of NSAIDs that should be monitored.
A patient with systemic lupus erythematosus (SLE) may occasionally have
a hypersensitivity reaction to NSAIDs; this is most often characterized by
hepatotoxicity, but the reaction can include other symptoms and should be
considered.

f) Topical sunscreen/Appropriate clothing

Patients with any form of lupus dermatitis should minimize exposure to
ultraviolet light. Overexposure of sunlight or ultraviolet light triggers flares
which is why using appropriate clothing and sunscreens with a sun
protection factor of at least 30 is a must.
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g) Diet
Dietary restrictions are influenced by the patient's medical treatment. Most
patients require a course of corticosteroids and should follow a low-fat, no-
added-salt diet rich in calcium due to water retention and thinning of bones
caused by corticosteroids. Patients with SLE should eat healthy foods and
avoid processed foods as much as possible to minimize flare ups and
complications such as lupus nephritis. It should be noted that L-canavanine,
found in alfalfa sprouts, has been linked to the development of lupus, and
that excessive consumption should be avoided.

h) Exercise and rest

Exercise, such as aerobic exercise, is recommended for people with lupus
because it releases endorphins, which reduces pain and fatigue. Rest is
also essential for SLE patients. Getting enough sleep can help you avoid
lupus flares, manage fatigue, and keep your immune system in good shape.

i) Stress reduction
Stress can cause flare-ups in SLE patients, and it is thought that stress is
primarily linked with the onset of lupus. However, the exact reason why
stress can initiate lupus symptoms is unknown, which is why reducing stress
is critical for people with lupus.

B. Surgical

a) Kidney Dialysis
Dialysis is usually required for lupus nephritis when there is 50-90 percent
damage to the blood vessels of the kidneys and their ability to function.
Dialysis is a procedure that removes waste products and excess fluid from
the blood when the kidneys fail to function properly. Dialysis will keep your
fluids and electrolytes in balance because the kidneys are unable to do so.
It frequently entails diverting blood to a machine for cleaning.
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b) Kidney transplant
The majority of people with systemic lupus erythematosus (SLE) develop
lupus nephritis. Even with aggressive treatment, 5 to 20% of people with
lupus nephritis will develop end-stage renal disease within 10 years of
diagnosis, necessitating a kidney transplant. A kidney transplant is a
surgical procedure that replaces one diseased kidney with a healthy kidney
from either a living or deceased donor.

c) Total hip replacement

d) In recent years, the prognosis of systemic lupus erythematosus (SLE) has

greatly improved, resulting in an increase in the number of patients reporting
musculoskeletal complications such as femoral head osteonecrosis. Total
hip arthroplasty (THA) can be used to relieve the pain associated with this;
however, postoperative outcomes in SLE patients are uncertain due to an
increased risk of rejection and infection. Hip replacement is a surgical
procedure that replaces the hip joint with a prosthetic implant, also known
as a hip prosthesis. Hip replacement surgery can be performed as a total or
half replacement.

e) Plasmapheresis
Plasmapheresis is a blood filtering and purification procedure that
removes harmful antibodies found in plasma, preventing them from
attacking the body. The blood is mechanically removed from the
body and separated into red blood cells and plasma, which is then
discarded and replaced with fresh plasma containing a solution of
frozen plasma, albumin, and/or plasma substitute. This procedure is
frequently used to treat several autoimmune diseases.
C. Nursing
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The disease or its treatment may produce dramatic changes in appearance

and considerable distress for the patient. The changes and the unpredictable
course of SLE necessitate expert assessment skills and nursing care with
sensitivity to the psychological reactions of the patient. In particular, patients with
SLE report feelings of depression and anxiety as well as difficulty coping with the
disease and the financial strain associated with it. The patient may benefit from
participation in support groups, which can provide disease information, daily
management tips, and social support.

Because sun and ultraviolet light exposure can increase disease activity or
cause an exacerbation, patients should be instructed to avoid exposure or to
protect themselves with sunscreen and clothing. Because of the increased risk of
involvement of multiple organ systems, patients should understand the need for
routine periodic screenings as well as health promotion activities. A dietary
consultation may be indicated to ensure that the patient is knowledgeable about
dietary recommendations, given the increased risk of cardiovascular disease,
including hypertension and atherosclerosis. Smoking tobacco accelerates
complications in patients with SLE. In the healthy population, smoking increases
the incidence of respiratory infections, lung cancer, risk of coronary artery disease;
increases blood pressure, which can worsen kidney function; inhibits liver function
(which can also inhibit treatment medications from working appropriately, such as
hydroxychloroquine); increases the risk for skin diseases; and increases the risk
for osteoporosis. Patients diagnosed with SLE are at even higher risk of developing
lung cancer and other rare cancers. Therefore, smoking cessation programs
should be offered to all patients who report smoking habits.

The nurse educates the patient about the importance of continuing

prescribed medications and addresses the changes and potential side effects that
are likely to occur with their use. The patient is reminded of the importance of
monitoring because of the increased risk of systemic involvement, including renal
and cardiovascular effects. Because of the immunosuppression associated with
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systemic corticosteroid usage, the nurse must watch for signs and symptoms of
infection, especially with acutely ill patients.

The nurse should also screen the patient for osteoporosis, because long
term use of corticosteroids increases the incidence of osteoporosis. Patients
should have a bone mineral density test performed at diagnosis and prior to
beginning steroid use to determine a baseline status and then every 2 years
thereafter. Educating the patient regarding calcium and Vitamin D supplementation
daily is encouraged, along with the benefits of weight bearing activities to support
bone health.

Nursing Interventions
● Assess and monitor skin for rash
R: 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
R: 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
R: 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
R: 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

R: 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
R: 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
R: Medications are often given to suppress the immune system, treat
existing inflammation and manage symptoms such as pain. Monitor for GI
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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
○ Wear sunscreen at least spf 30
○ Wear mask if in crowded places
○ Avoid person with respiratory disease
○ Adequate rest
R: 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.

VI. Summary of Reaction

SLE is an autoimmune disease in which the body mistakenly attacks itself. This
illness typically affects several organs, including the skin, heart, brain, and kidney. As of
now, there is no cure for SLE; instead, it is only possible to treat the symptoms and
prevent flare-ups. This disease is also considered expensive because it requires long-
term management, which includes annual check-ups and costly lab tests such as ANA,
Anti-DNA, and others. Furthermore, the medications for this disease are costly, as is the
recommended diet. I understand how difficult it is to live with SLE. There are many things
you can't do, such as going to the beach or going to crowded places, and you should think
about getting pregnant because pregnancy can be complicated if it isn't planned and your
disease isn't stable enough. Lupus fog is common in this disease and can make a person
with SLE feel bad about himself/herself because he/she cannot retain and process
information as well as he/she used to, affecting his/her mental health. The good news is
that SLE management is better than ever before, and a person with SLE can live a normal
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lifespan if properly managed. Scientists are still trying to figure out what is causing this
disease, and hopefully, once they do, they will be able to develop a cure. As a nursing
student and future registered nurse, it is critical to understand SLE because, while it is
not as common as other diseases, we may encounter this type of disease. Having
knowledge will allow us nurses to have a better understanding of the disease and, most
importantly, provide better care to the patient.
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VII. References

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Dellwo, A. (2021). Is Epstein-Barr Virus Linked to Autoimmune Disease? Verywell Health.

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Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's textbook of medical-surgical
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