Lupus is an autoimmune disease, and it is more common in women between the ages of 20-and 40-years-old. According to Goff & Vanderbeck (2016), “women of color are affected far more often than Euro-Americans” (p.326). Lupus Foundation of America stated, the “immune system cannot tell the difference between foreign invaders and the body’s healthy tissues. As a result, it creates autoantibodies that attack and destroy healthy tissue” (2019, para. 3). Two of the main types are systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE). DLE only affects the skin. According to Gaffar Sarwar Zaman (2019), SLE is an autoimmune disease that attacks the tissues of either single parts or multiple parts of the healthy body. There may be more than one sign of organs being affected, and the parts of the body that can be affected are the joints, brain, skin and other body parts.
Subcutaneous lupus, also known as butterfly rash, is often seen with SLE. It occurs in two types. One, is caused by a sensitivity to sunlight and it is red colored pimple eruption on the skin (Zaman, 2016). The second begins as flat lesions and gets larger as they develop onto the exterior, often seen in DLE (Zaman, 2016). Rena Goldman illustrated (2017), many people who have lupus, also have Sjogren’s disease, which causes the eyes and mouth to be very dry and can lead to problems such as dysphagia and dental caries. Lupus can also affect the pancreas, either by inflammation, or by medications required to treat the disease. According to Goldman (2017), patients have a higher risk for heart disease when they have SLE. Decreased oxygen can cause a lupus patient to experience problems with memory, or in less likely occurrences, hallucinations. Arthritis can also occur due to inflammation that is caused by lupus. Lupus nephritis is the type of lupus that affects the kidneys.
When it is discovered that the patient has lupus, generally it is by the primary care physician. It is in that time when the patient is referred to a specialist. Typically, a rheumatologist who specializes in bone and joint medicine, is the specialist that treats a lupus patient. When the disease affects other body systems, the patient may also see a doctor that is specialized in the affected body system. These specialists may include cardiologists, endocrinologists, dermatologists, nephrologists, neurologists, and/or pulmonologists. It’s a complicated disease and can be a complicated treatment. According to Goff & Vanderbeck (2016), when a patient is in remission, they are healthy appearing, but during exacerbation the patient can become very sick, and require critical care.
Generally, the patient is able to manage the disease at home, they don’t typically need hospitalization unless a severe exacerbation occurs. The nurse’s role in the care of these patients is to evaluate their disease, monitor their vital signs and blood work, manage their medications, and provide education about the disease, effects of medication, and the management of care. Nursing interventions would use dependent and independent interventions. Dependent interventions would include medication administration. That medication could include topical ointments such as hydroxychloroquine, it works by decreasing absorption of ultraviolet (UV) light, which helps prevent skin lesions. Chronic steroid therapy may be prescribed to treat systemic disease processes (Goff & Vanderbeck, 2016). Immunosuppressive drugs may also be prescribed when there is renal involvement. Even when symptoms of the disease subside, these medications would be continued to help prevent future exacerbations. It would be important for the nurse to educate the patient about the effects of any medication that is given.
Independent interventions for the nurse would be giving the patient information on the best ways to avoid direct contact with sunlight. The nurse should encourage the use of sun screen, hats, long sleeves, and other items that would block the sun’s UV light. Another independent intervention that would benefit the patient, is for the nurse to encourage the patient to maintain activity that is paced at their normal limits during their mild symptoms, or during remission (Lupus Erythematosus, 2019). Fatigue can lead to exacerbations, so it is important for the nurse and the patient to go over ways that the patient can maintain activity while also preventing exhaustion.
The nurse would include teaching the patient and the family about how to recognize signs and symptoms of the disease, and how to ensure they can recognize an oncoming exacerbation. These symptoms could include inflamed red skin (butterfly rash), joint inflammation, fatigue, generalized weakness, myositis, and fever (Goff & Vanderbeck, 2016). Fever is a classic indication of an exacerbation. If the patient is on immunosuppressive drugs for renal involvement, it would be very important for the nurse to educate the patient and family the importance of the avoidance of large crowds and people who are sick, if possible. Their immunity is decreased and would further increase susceptibility to illnesses. The patient and family should also be instructed the importance of proper hand hygiene. Proper care for the patient would be to use a mild soap, fully dry off the hands and to apply lotion. Alopecia is also common with this disease, so it is important for the patient to use mild protein containing shampoo, and it is best for them to avoid harsh chemical treatments such as hair dyes and perms (Goff & Vanderbeck, 2016).
A final teaching that is equally as important for the patient and family is the fact lupus can be very stressful for the patient because when they are in remission, they appear healthy. Exacerbations can often occur unpredictably, and it takes away feelings of control from the person who is suffering from the disease. It is important for the nurse to provide information about different coping strategies, and community support systems. The Lupus Foundation is a resource specifically for people with lupus, and it offers a lot of information about this disease process. If the person is worried about not being able to attend support groups because of finances, the nurse can reassure them that many of those support groups are offered free of charge.
In conclusion, lupus is an autoimmune disease that can and often does, affect multiple body systems. This adds stress to the patient because of the fact that they go through remissions and exacerbations, and it can be unpredictable. The patient works with an inter-collaborative team consisting of primary care doctors, specialized doctors, and nurses to manage the disease. The person has to always ensure they wear protection against the sun, may have to avoid large crowds, and may have to worry about people who may be sick around them. The nurse’s role in the care of a lupus patient is important because they provide them with integral information on how to manage the disease to the best of their ability. The nurse provides them with coping strategies that can help manage stress levels. Nurses inform them about what signs and symptoms to monitor for prevention of emergencies, and how they could try to prevent future exacerbations. Finally, the nurse can assist the person with lupus to feel that they have the control over the disease, instead of allowing the disease to control them.