This article discusses Nursing Care Plans for Lupus plus its causes, symptoms, preventions, treatments, and interventions.
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
Lupus is a long-term autoimmune disease in which the body’s immune system becomes hyperactive and attacks normal, healthy tissue. When a person has lupus, the immune system attacks the body’s own tissues. This leads to tissue damage and illness.
Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.
Symptoms of Lupus
The symptoms of lupus vary from one person to another. Some people have just a few symptoms, while others have many.
Lupus can affect any part of your body. Common symptoms include:
- Achy joints
- Fever higher than 100 F
- Swollen joints (arthritis)
- Constant or severe fatigue
- Skin rash
- Ankle swelling
- Pain in your chest when breathing deeply (pleurisy)
- A butterfly-shaped rash across your cheeks and nose (malar rash)
- Hair loss
- Sensitivity to the sun or other lights
- Mouth or nose sores
- Pale or purple fingers or toes when you’re cold or stressed (Raynaud’s phenomenon)
Complications of Lupus
Many people who have active lupus feel ill in general. They have a fever, weight loss, and fatigue. When their immune system attacks a certain organ or part of the body, they can also have more specific problems. Lupus can affect these body parts:
Skin problems are common with lupus. So are hair loss and mouth sores. A patient with discoid lupus has large, red, circular rashes that may scar. Sunlight usually irritates skin rashes. A common lupus rash called subacute cutaneous lupus erythematosus is often worse after a person goes out in the sun. A patient might have it on the arms, legs, and torso. A rare but serious form of lupus rash called a bulbous lupus rash causes large blisters.
Arthritis is very common in people who have lupus. It can cause pain, with or without swelling. Stiffness and pain may be worse in the morning. Arthritis may be a problem for only a few days or weeks, or it may be permanent. It’s usually not severe.
Up to half of the people who have lupus get kidney problems. They can be dangerous. These problems are more likely when you also have other lupus symptoms, such as fatigue, arthritis, rash, fever, and weight loss. But they can also happen when you don’t have any other symptoms.
People with lupus may have dangerously low numbers of red blood cells, white blood cells, or platelets (particles that help your blood clot).
Changes in blood counts may cause fatigue (with a low red cell count, also known as anemia), serious infections (with a low white cell count), or easy bruising or bleeding (with a low platelet count). But many people don’t have symptoms from low blood counts. It’s important to have regular blood tests to spot these problems.
Blood clots are more common in people with lupus. They often happen in your legs (called deep venous thrombosis or DVT), in your lungs (called pulmonary embolism or PE), and sometimes in your brain (stroke). These clots may be tied to how your body makes things called antiphospholipid (APL) antibodies. These are unusual proteins that may make your blood more likely to clot.
Brain and spinal cord
Rarely, lupus can cause problems in your brain. You might have confusion, depression, or seizures. When it affects your spinal cord (transverse myelitis), lupus can cause numbness and weakness.
Heart and lungs
Heart and lung problems are often caused by inflammation of the tissue covering your heart (pericardium) and lungs (pleura). When these become inflamed, you may have chest pain, an uneven heartbeat, and fluid buildup around your lungs (pleuritis or pleurisy) and heart (pericarditis). Your heart valves and the lung itself can also be affected, leading to shortness of breath.
Causes of Lupus
Doctors don’t know what exactly causes lupus. But they think something triggers the immune system to attack the body. That’s why most treatments are aimed at weakening your immune system. In the meantime, researchers are still searching for the cause.
Some prescription medications, such as hydralazine and procainamide, can cause lupus. The symptoms usually get better after you stop taking the drug.
Risk Factors for Lupus
According to the Lupus Foundation of America, about 1.5 million people in the U.S. have lupus. Some things may make you more likely to get it:
Race. People of African, Asian, and Native American descent have higher chances of lupus.
Sex. 90 percent of people diagnosed with the disease are women. Hormones might be part of the reason.
Age. Women 14 to 45 years old are most often affected.
Family history. Lupus sometimes affects more than one member of a family. But only about 10% of people with lupus have a close relative with the disease.
Contact with viruses and chemicals may also trigger lupus.
Types of Lupus
There are different kinds of lupus. This article will focus mainly on systemic lupus erythematosus (SLE), but other types include discoid, drug-induced, and neonatal lupus.
Systemic lupus erythematosus
A malar rash is a key symptom of lupus. SLE is the most familiar type of lupus. It is a systemic condition. This means it has an impact on the body. The symptoms can range from mild to severe.
It is more severe than other types of lupus, such as discoid lupus, because it can affect any of the body’s organs or organ systems. It can cause inflammation in the skin, joints, lungs, kidneys, blood, heart, or a combination of these.
This condition typically goes through cycles. At times of remission, the person will have no symptoms. During a flare-up, the disease is active, and symptoms appear.
In discoid lupus erythematosus (DLE) — or cutaneous lupus — symptoms affect only the skin. A rash appears on the face, neck, and scalp.
The raised areas may become thick and scaly, and scarring may result. The rash may last from a number of days to several years, and it may recur.
DLE does not affect the internal organs, but around 10 percent of people with DLE will go on to develop SLE, according to the Lupus Foundation of America. However, it is not clear if these individuals already had SLE and just showed clinical signs on the skin or if there is a progression from DLE or SLE.
Subacute cutaneous lupus erythematosus
Subacute cutaneous lupus erythematosus refers to skin lesions that appear on parts of the body that are exposed to the sun. The lesions do not cause scarring.
In around 10 percent of people with SLE, symptoms occur because of a reaction to certain prescription drugs. According to Genetics Home Reference, some 80 drugs may cause the condition.
These include some of the drugs that people use to treat seizures and high blood pressure. They also include some thyroid medications, antibiotics, antifungals, and oral contraceptive pills.
Drugs that are commonly associated with this form of lupus are:
- Hydralazine, a hypertension medication
- Procainamide, a heart arrhythmia medication
- Isoniazid, an antibiotic used to treat tuberculosis (TB)
- Drug-induced lupus typically goes away after the person stops taking the medication.
Most babies born to mothers with SLE are healthy. However, around 1 percent of women with autoantibodies relating to lupus will have a baby with neonatal lupus.
The woman may have SLE or no disease symptoms at all.
Sjögren’s syndrome is another autoimmune condition that often occurs with lupus. Key symptoms include dry eyes and a dry mouth.
Babies with neonatal lupus may have a skin rash, liver problems, and low blood counts at birth. Around 10 percent of them will have anemia.
The lesions usually go away after a few weeks. However, some infants have a congenital heart block, in which the heart cannot regulate a normal and rhythmic pumping action. The infant may need a pacemaker. This can be a life-threatening condition.
Women with SLE or other related autoimmune disorders need to be under a doctor’s care during pregnancy.
Diagnosis of Lupus
A doctor will look for key signs of the disease based on the symptoms and blood tests.
The American College of Rheumatology has a checklist to help doctors diagnose lupus. A patient probably has lupus if he/she has at least four of the 11 criteria, either at the same time or one after the other:
- A malar rash, the “butterfly” rash on your cheeks.
- A discoid rash, red, scaly skin patches that cause scarring.
- Photosensitivity is a skin reaction or sensitivity to sunlight.
- Oral ulcers, open mouth sores.
- Arthritis, pain, inflammation, or swelling in your joints.
- Kidney problems, with either red blood cells or extra protein in your urine (proteinuria).
- Nervous system problems, seizures, or psychosis.
- Inflammation of the tissue around your lungs (pleuritis) or around your heart (pericarditis).
- A blood disorder, either a low red blood cell count (anemia), a low white blood cell count (leukopenia), fewer lymphocytes (lymphopenia), or fewer platelets (thrombocytopenia).
- An immunologic disorder, including certain cells or proteins, or a false-positive test for syphilis.
- Unusual blood work, a positive test for things called antinuclear antibodies (ANA).
Treatment of Lupus
Lupus treatment depends on several things, including age, overall health, medical history, which part of the body is affected, and how severe the case is.
Because lupus can change over time, it’s crucial to have regular visits with a doctor, such as a specialist called a rheumatologist.
Some people with mild cases don’t need treatment. Those who have more serious symptoms, such as kidney problems, may need strong medications. Drugs that treat lupus include:
Steroids. Steroid creams can be directly applied on rashes. They’re usually safe and effective, especially for mild rashes. Low doses of steroid creams or pills can ease mild or moderate signs of lupus. A patient can also take steroids in higher doses if lupus is affecting the internal organs. But high doses also are most likely to have side effects.
Plaquenil (hydroxychloroquine). This medicine helps control mild lupus-related problems, such as skin and joint disease. It can also prevent symptom flares.
Cytoxan (cyclophosphamide). This chemotherapy drug also weakens the immune system. It treats severe forms of lupus, such as those affecting your kidneys or brain.
Imuran (azathioprine). This treats serious symptoms of lupus. It was originally used to prevent rejection after an organ transplant.
Rheumatrex (methotrexate). Another chemotherapy drug that weakens the immune system. More doctors are using it for skin disease, arthritis, and other conditions that don’t get better with medications such as hydroxychloroquine or low doses of the steroid prednisone.
Benlysta (belimumab). This drug is biologic, which means it mimics natural proteins. It weakens the immune system by targeting a protein that may contribute to lupus.
CellCept (mycophenolate mofetil). More doctors are using this medication to treat serious lupus symptoms, especially in people who have taken Cytoxan. It works on the immune system.
Rituxan (rituximab). A biologic that treats lymphoma and rheumatoid arthritis. If you have serious symptoms that don’t go away with other treatments, you might take it.
Lupus alternative treatments
Some people use complementary or alternative treatments to ease lupus symptoms. But there’s no proof that any of them treat or cure the disease. Some herbal supplements can even interact with prescription drugs or worsen the symptoms. Talk to your doctor before starting any treatments.
Research has found some benefits with certain treatments, including:
Vitamins and supplements. Vitamins C and D and antioxidants may help with symptoms and boost overall health. The omega-3 fatty acids in fish oil also might be useful.
Dehydroepiandrosterone (DHEA). This hormone may lessen symptom flare-ups but can also have mild side effects like acne or hair growth.
Acupuncture. Small studies show that acupuncture can lessen pain and fatigue.
Mind-body therapy. Meditation and cognitive behavioral therapy could ease the pain as well as mental health issues like depression and anxiety.
Some daily changes can ease symptoms and improve your quality of life:
Exercise. Low-impact exercises such as walking, swimming, and biking can help keep muscle and lower the chances of osteoporosis (thinning of the bones). It might also boost mood.
Eat well. Get a healthy, well-balanced diet.
Avoid alcohol. Alcohol can interact with your medications to cause stomach or intestinal problems, including ulcers.
Don’t smoke. Smoking can hurt blood flow and make lupus symptoms worse. Tobacco smoke also harms your heart, lungs, and stomach.
Play it safe in the sun. Limit your time in the sunlight, especially between 10 a.m. and 2 p.m. Wear sunglasses, a hat, and sunscreen when you’re outdoors.
Treat fevers. Take care of high temperatures right away. A fever may be a sign of an infection or a lupus flare-up.
Nursing Care Plans for Lupus Based on Diagnosis
Nursing Care Plan 1: Diagnosis – Hyperthermia related to the autoimmune disease process of lupus
It is evidenced by a temperature of 38.2 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and a weak pulse.
Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
|Assess the patient’s vital signs at least every hour. Increase the intervals between vital signs taking as the patient’s vital signs become stable.
|To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.
|Remove excessive clothing, blankets, and linens. Adjust the room temperature.
|To regulate the temperature of the environment and make it more comfortable for the patient.
|Administer the prescribed antipyretic medications.
|Use the antipyretic medication to stimulate the hypothalamus and normalize the body temperature.
|Offer a tepid sponge bath.
|To facilitate the body in cooling down and to provide comfort.
|Elevate the head of the bed.
|Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.
Nursing Care Plan 2: Diagnosis – Impaired Skin Integrity related to skin rash secondary to lupus
Evidenced by a malar rash on the cheeks, discoid rash on the rest of the body, and soreness
The patient will re-establish healthy skin integrity by following a treatment regimen for lupus.
|Assess the patient’s skin on his/her whole body.
|To determine the severity of skin damage caused by lupus and any affected areas that require special attention.
|Administer medications as prescribed.
|Non-steroidal Anti-inflammatory Drugs (NSAIDs). The use of NSAIDs is beneficial in lupus. It is used to treat some of the symptoms like fever and pain. Antimalarial drugs. Medications used to treat malaria are often useful in managing lupus. Antimalarial drugs affect the immune system; hence, they can help settle lupus symptoms when the condition flares up. Corticosteroids. Steroids are used to counter the inflammation caused by lupus. Immunosuppressants. Drugs used to suppress the immune system are given to people with lupus. Biologics. Biologic therapy is often administered in addition to other lupus medications. It is typically given intravenously.
|Educate the patient and carer about proper hand hygiene through washing with soap and water. Advise the patient and carer to prevent scratching the affected areas.
|It is important to maintain hygiene by washing with mild soap and water. The rash may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to worsen skin damage.
|Teach the patient/ carer the proper administration of prescribed medications and topical treatments.
|To treat the skin rash.
Nursing Care Plan 3: Diagnosis – Fatigue related to body weakness secondary to lupus
Evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, lack of appetite, and shortness of breath upon exertion
The patient will demonstrate active participation in necessary and desired activities and demonstrate an increase in activity levels.
|Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living and actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.
|To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
|Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media for long periods. Alternate periods of physical activity with rest and sleep.
|To gradually increase the patient’s tolerance to physical activity.
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.
|To allow the patient to relax while at rest. To allow enough oxygenation in the room.
|Refer the patient to a dietitian and physiotherapy / occupational therapy team as required.
|To provide more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity and improving nutritional intake/appetite.
1. What are three symptoms of lupus?
The most common lupus symptoms (which are the same for men and women) are:
- Extreme fatigue (feeling tired all the time)
- Pain or swelling in the joints.
- Swelling in the hands, feet, or around the eyes.
- Low fevers.
- Sensitivity to sunlight or fluorescent light.
- Chest pain when breathing deeply.
2. What does lupus do to a person?
If you have lupus, you might experience joint pain, skin sensitivities and rashes, and issues with internal organs (brain, lungs, kidneys and heart). Many of your symptoms might come and go in waves — often called flare-ups. At times, symptoms of lupus might be mild or not noticeable (meaning they’re in remission).
3. What foods trigger lupus flare ups?
Alfalfa and garlic are two foods that probably shouldn’t be on your dinner plate if you have lupus. Alfalfa sprouts contain an amino acid called L-canavanine. Garlic contains allicin, ajoene, and thiosulfinates, which can send your immune system into overdrive and flare up your lupus symptoms.
4. Does lupus cause weight gain?
Muscle pain — Muscle pain or tenderness is common in people with lupus; rarely, some people also notice muscle weakness. Weight changes — Lupus can sometimes cause weight loss or weight gain.