SYSTEMIC LUPUS ERYTHEMATOSUS 1.

SYSTEMIC LUPUS ERYTHEMATOSUS

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SYSTEMIC LUPUS ERYTHEMATOSUS 2.

SYSTEMIC LUPUS ERYTHEMATOSUS

Introduction

Systemic Lupus Erythematosus (SLE) is an autoimmune disease in which the immune

system attacks healthy tissue. SLE, like most autoimmune diseases, affects the entire body. The

primary symptom that causes visual signs is inflammation (Basta et al., 2020). Patients

frequently present with butterfly-shaped rash across their face, but they may also experience joint

pain, fatigue, anemia, and headache, to name a few symptoms. Though some patients go

undiagnosed, the Lupus Foundation of America reports that there are approximately 2 million

diagnosed cases in the United States. Millions more people are affected globally. SLE can affect

anyone, but women are the most commonly diagnosed. Age, race, gender, and possibly genetics

may all play a role in who develops the disease (Basta et al., 2020).

In this paper, we are going to delve into various topics like Pathophysiology,

Predisposing factors of SLE, the clinical manifestation of this disease, the potential

complications of the disease process, cultural, ethical, and spiritual considerations when dealing

with SLE patients, presentations of diagnostic labs and procedure and then best practices in the

management of SLE.

Pathophysiology

Lupus erythematosus is an autoimmune disorder. The autoimmune system is in charge of

combating foreign and often harmful bacteria in the human body. The immune system attacks

itself in systemic lupus erythematosus; the pathology of this disease is similar to that of

rheumatoid arthritis and can affect any part of the body (Taheri et al,. 2020). Systemic lupus
SYSTEMIC LUPUS ERYTHEMATOSUS 3.

erythematosus can also manifest as periarticular inflammation affecting the tendon sheaths. The

illness causes the patient to suffer from coexisting fibromyalgia, which causes poor sleep,

chronic disease, inactivity, mood problems, and depression.

Patients with this condition have immune system abnormalities, including abnormalities

in B cell function, apoptosis, and T cell function. Systemic lupus erythematosus primarily affects

the blood vessels, skin, heart, nervous system, liver, lungs, and kidneys (Tahed et al., 2022).

Unfortunately, if Systemic Lupus Erythematosus is not treated effectively, it can lead to serious

complications such as stroke, heart inflammation, lung damage, and blood clots, as well as

miscarriage or pregnancy complications in women. According to research, the exact cause of

immune deregulation is unknown, but it could be due to endogenous metabolism interfering with

antigen function in the human system (Tahed., 2022).

Common Risk Factors

Lupus is an autoimmune disease in which your immune system malfunctions and your

body attacks its own tissues (Barber and Clarke, 2022). Some of the most common potential

culprits are as follows:

Hormones

Although research is still in its early stages, hormonal factors appear to be linked to

autoimmune disease, though the link between the two is still hazy. Lupus affects 90% of women,

indicating that hormones play a role (Barber and Clarke, 2022).

Infection
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Viruses and bacteria may play a role in lupus development, but no direct causal link has

been established. Infection, on the other hand, is cited as one of the most common potential

triggers for developing lupus. Lupus flares can also be caused by viruses and bacteria. Three

Medications Some medications are lupus and lupus flare-up triggers. This premise underpins a

subset of the disease known as drug-induced lupus (Barber and Clarke, 2022). Long-term use of

certain medications, such as anticonvulsants, antibiotics, and blood pressure medications, usually

causes this type of lupus, and symptoms almost always disappear when the drug is stopped

(Barber and Clarke, 2022).

Environmental Factors

Although not proven, environmental factors are thought to potentially trigger lupus

and/or lupus flares and may include UV light exposure (photosensitivity) from light bulbs or the

sun, silica dust exposure from soil, cigarette smoke, pottery, and cleaning powder, and also

smoking exposure. Certain hair dyes, pesticides, topicals, and even alcohol were once thought to

be lupus triggers, but this has since been proven incorrect.

Lifestyle Factors

Certain decisions you make for yourself, as well as how you deal with physical and

mental challenges, can all contribute to the development of lupus. These three elements are

frequently considered: Stress, both emotional and physical, physical exhaustion, and cigarette

smoking (Barber and Clarke, 2022).

Risk Factors Based on Demographics

The risk of developing lupus (SLE) is influenced by ancestry, age, and gender.

Considering the race, people of Hispanic, Asian, and African ancestry have the highest rates of

lupus (SLE) in the United States and Europe, while people of European ancestry have the lowest

rates (Barber and Clarke, 2022). On age factors, Lupus is most commonly diagnosed between the

ages of 15 and 45, though it can occur at any age. Nine out of ten lupus patients are female.

Genetics

If you have lupus in your family, you may be predisposed to lupus and the impact of the

above factors. Most researchers agree that genetics or heredity plays a role in determining your

proclivity for developing lupus; however, this factor alone is rarely enough to cause lupus

(Barber and Clarke, 2022).

MANIFESTATIONS CLINICAL

Major clinical characteristics and organ involvement

i. Constitutional symptoms - Most patients with systemic lupus erythematosus (SLE)

experience constitutional symptoms such as fatigue, fever, and weight loss at some point

during the disease (Fava and Petri, 2019).

ii. Fatigue - is the most common complaint, affecting 80 to 100 percent of patients, and can

be disabling at times. Its presence is unrelated to other indicators of disease activity and is

more commonly associated with it.

iii. Fever – Fever can be a manifestation of active disease and is seen in over 50 percent of

patients with SLE [6]. However, in clinical practice, distinguishing fever associated with

a lupus flare from other causes of fever, such as infection, a drug reaction, or malignancy,

can be difficult. Clinically, there are no specific features that definitively distinguish
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fever due to SLE from fever due to other causes. The history may help determine the

cause of the fever.

iv. Myalgia - Myalgia is common in SLE patients, whereas severe muscle weakness or

myositis is uncommon. Myalgia and muscle weakness are discussed in greater depth

elsewhere.

v. Weight loss - Weight loss is common in SLE patients and may be related to the disease

or its treatment. Weight loss is common before the diagnosis of SLE. Unintentional

weight loss can be caused by a decrease in appetite, medication side effects (particularly

diuretics and, in rare cases, hydroxychloroquine), and gastrointestinal disease.

vi. Arthritis and arthralgias - Arthritis and arthralgias affect over 90% of SLE patients

and are frequently one of the first symptoms. Arthritis with visible inflammation affects

65 to 80% of the population (Feldma et al., 2019)

vii. Mucocutaneous involvement — During the disease, the majority of patients develop

skin and mucous membrane lesions. The type of skin involvement in SLE is extremely

variable. The most common lesion is a facial eruption characterized by acute cutaneous

lupus erythema (also known as "the butterfly rash") that appears after sun exposure as

erythema in a malar distribution over the cheeks and nose.

viii. Involvement of the heart and vascular manifestations — SLE patients can develop a

variety of cardiac and vascular abnormalities. Cardiac disease is common in SLE patients

and can affect the pericardium, myocardium, valves, conduction system, and coronary

arteries. The most common cardiac manifestation of SLE is pericarditis, with or without

effusion (Rodriguez et al., 2022).

ix. Raynaud phenomenon - Raynaud phenomenon in SLE is a vasospastic process caused

by cold that affects up to 50% of SLE patients. Raynaud's syndrome is distinguished by

intermittent acral pallor, which is followed by cyanosis and erythroderma. The Raynaud

phenomenon is discussed in depth elsewhere.

x. Vasculitis - Prevalence estimates from large cohorts range from 11 to 36 percent among

SLE patients. Because of the possibility of inflammatory involvement of vessels of all

sizes, the clinical spectrum of vasculitis in the setting of SLE is broad. The most common

type of vessel involvement is small vessel involvement, which often manifests as

cutaneous lesions; however, medium- and large-vessel involvement has also been

observed (Fava & Petri, 2022).

xi. Thromboembolic disease - Thromboembolic disease can complicate SLE, especially

when antiphospholipid antibodies are present. Even though the precise

xii. Kidney involvement is clinically evident in approximately 50% of SLE patients and is a

significant cause of morbidity and mortality [18]. Thus, periodic screening for lupus

nephritis with urinalyses, quantification of proteinuria, and estimation of the glomerular

filtration rate is an important component of SLE patients' ongoing management. There

are several types of glomerulonephritis, and a kidney biopsy can help to determine the

type and extent of kidney involvement. Lupus nephritis has a wide range of clinical

manifestations, from asymptomatic hematuria and/or proteinuria to nephrotic syndrome

and rapidly progressive glomerulonephritis with loss of kidney function. Some lupus

nephritis patients also have hypertension.

Infection
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Up to 50% of SLE patients develop serious infectious complications, particularly of the

skin, respiratory, and urinary systems. A large cohort of 33,565 SLE patients, 7113 of whom had

lupus nephritis, from a Medicaid database, discovered that the incidence rate (per 100 person-

years) of serious infections requiring hospitalization was 10.8 in the SLE cohort and 23.9 in the

lupus nephritis subcohort.

Complications of Lupus

Many people with active lupus experience general malaise. They have a fever, are losing

weight, and are exhausted. When their immune system attacks a specific organ or part of the

body, they may experience more specific symptoms. Lupus can affect the following body parts:

Skin Infections

Lupus frequently causes skin problems. Hair loss and mouth sores are also symptoms. If

you have discoid lupus, you will develop large, red, circular rashes that may scar you. Sunlight

typically causes skin rashes. Subacute cutaneous lupus erythematosus is a common lupus rash

that gets worse after being exposed to sunlight. It could be on your arms, legs, or torso. Bullous

lupus rash is a rare but serious form of lupus rash that causes large blisters.

The joints

Lupus patients frequently develop arthritis. It can cause pain as well as swelling. In the

morning, stiffness and pain may be worse. Arthritis can be a temporary problem that lasts only a

few days or weeks, or it can be chronic.

The kidneys
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Up to half of lupus patients have kidney problems. They can be hazardous. These

complications are more likely if you have other lupus symptoms such as fatigue, arthritis, rash,

fever, and weight loss. They can, however, occur when you have no other symptoms.

Blood-lupus

Patients may have dangerously low levels of red blood cells, white blood cells, or

platelets (particles that aid in blood clotting). Blood count changes can cause fatigue (due to a

low red cell count, also known as anemia), serious infections (due to a low white cell count), or

easy bruising or bleeding (due to a low platelet count). However, many people do not experience

symptoms of low blood counts. It is critical to have regular blood tests (Feldman et al., 2022)

Heart and lung problems are frequently caused by inflammation of the tissue that covers

your heart (pericardium) and lungs (pleura). When these become inflamed, you may experience

chest pain, an irregular heartbeat, and fluid buildup around your lungs and heart (pleuritis or

pleurisy). Shortness of breath can be caused by damage to your heart valves and the lung itself

(Hannah and D’cruz, 2019).

Cultural, ethnic Religion, Spiritual Support, and Depression on the Quality of Life for

Lupus Patients

Healthcare organizations are caring for more culturally diverse individuals and families

as global migration increases. This culturally, ethnically, and spiritually diverse environment is

also expanding in the healthcare workforce, particularly in countries that hire foreign-educated

and trained health professionals (Tabudlo & Saligan, 2022). These unavoidable changes in the

current landscape may have an impact on accurate symptom assessment and culturally congruent

care, particularly in fatigue, which has strong psycho-sociocultural underpinnings but currently
SYSTEMIC LUPUS ERYTHEMATOSUS 10.

lacks a universal definition or standard of measurement. Given this situation, there is a need for a

better understanding of fatigue across cultures.

Although there is no universally accepted definition of fatigue, it can be defined as an

overwhelming, unusual, and extreme tiredness. Fatigue is the most common and prevalent

symptom in patients with systemic lupus erythematosus (SLE). Fatigue is present even in mild

and inactive SLE cases. Even though numerous studies and reviews have identified SLE-related

fatigue as the most burdensome and frequently reported symptom of SLE, it is still poorly

assessed and managed across cultures (Tabudlo & Saligan, 2022).

A transcultural and ethical perspective integrates cultural similarities and differences to provide

culturally congruent health care. As a result, a transcultural perspective of SLE-related fatigue

based on empirical studies may allow for more accurate and culturally congruent symptom

assessment, evaluation, and management.

This article offers a transcultural (nursing) viewpoint. Based on the domains of the CCT and

sunrise enabler, such as "technology, religion, family and kinship, politics, cultural beliefs and

practices, economics, physical conditions, and biological factors," this perspective seeks to

provide culturally congruent care and practice (Tabudlo & Saligan, 2022).

PRESENTATION OF DIAGNOSTIC LABS AND PROCEDURE

Nursing care model for a lupus erythematosus patient

Nursing diagnosis I: Degenerative changes in the locomotor system cause chronic pain in

the joints and head.

Care goals include reducing pain and improving the patient's condition within 24 hours.
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Plan of Care:

 Using the visual analog scale (VAS), assess the intensity, nature, and location of pain, as

well as observe nonverbal signs of pain, such as a facial grimace and clenching the

patient's hand into a fist twice a day.

 Observation of factors causing and exacerbating pain twice daily,

 Raising the pain threshold through basic psychotherapy, ensuring a comfortable sitting

and lying position, and relaxation

 Using analgesics according to the individual order sheet,

 Performing upper and lower limb active and passive exercises

 Assisting the patient in performing daily activities that are difficult for her during a pain

flare-up VAS 10,

 Give the patient comfortable pants that won't restrict her movements.

 Provide comfort and a secure environment

Nursing diagnosis II: Joint mobility limitations and muscle weakness impairing movement

and self-care.

Within a week, the care objectives are to facilitate locomotion and daily activities by increasing

joint mobility.

Care Plan:

 Encouraging the patient to perform regular active and passive exercises tailored to her

abilities, preferably twice daily

 Working with a physiotherapist and assisting the patient with rehabilitation exercises
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 Assisting the patient in performing daily activities that are physically too difficult for her,

100 points on the Barthel scale

 Providing the patient with locomotion-improving equipment

 Removing potentially hazardous objects from the patient's movement area.

 Allowing the patient to move safely by using handles and handrails, and ensuring

adequate lighting.

 Twice-daily observation and monitoring of the patient's vital signs (BP, heart rate,

temperature), as well as their documentation

 Creating restful conditions, ensuring peace, and ventilating the rooms

 The patient taking medications as prescribed by the doctor.

Nursing diagnosis III: Risk of complications due to the treatment with glucocorticoids:

Care objectives: Prevention and early reduction of adverse effects of pharmacological

treatment.

Care Plan:

 Using the individual medical order sheet, inform the patient about the need to take

medications.

 Medication adherence, i.e. ensuring that prescribed medications are taken at the

appropriate times

 Observing the patient for the appearance of alarming symptoms and encouraging her to

perform self-observation and daily symptom documentation

 Informing the patient of the need to report any worsening of symptoms

 Regular monitoring of vital signs, such as blood pressure

 Daily monitoring of vital signs such as heart rate, blood pressure, and temperature

 Blood glucose control after each change in steroid treatment,

 Monthly monitoring of calcium, cholesterol, and potassium level

 Performing general fitness exercises tailored to the patient's condition and feelings,

preferably twice a day.

Nursing diagnosis IV: Due to hair loss in the parietal lobe, the patient has low self-esteem.

Within a month, the patient's self-esteem will be improved and she will receive mental support.

Plan of Care:

 Observing the patient, her mood, and general state of mind

 Conversing with the patient and spending time with her

 Gaining the patient's trust while demonstrating empathy, comprehension, and acceptance

 Describing the sources of discomfort

 Promoting positive thinking

 Assisting the patient and providing hope

 Encouraging the patient to spend her free time doing things she enjoys

 Using a headscarf or wig to alleviate the patient's discomfort caused by excessive hair

loss

 Encourage the patient to keep in touch with family and friends regularly.

Evidenced best practices in advanced care management

This disease can now be diagnosed early and successfully thanks to ongoing medical

advances (Tamirou et al., 2019). Taking appropriate, individually designed treatment and
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education on SLE exacerbation prevention allows for long-term remission of the disease and

prevents organ and tissue damage. In this case, it was discovered that:

i. The symptoms of systemic lupus erythematosus reduced the ill person's functional fitness;

in the examined patient, the assessment of mobility indicates limitations requiring little

help, which is associated with the disease's current remission.

ii. The patient understands the disease and knows how to avoid exacerbations, which is why

there have been no symptoms of SLE exacerbation since 2007 (Tamirou et al., 2019).

However, complementary health education concerning diet, activity, stress management,

and physical exercises can improve the patient's quality of life even further.

iii. Social support is essential in dealing with the disease. It gives the patient a sense of

security, both physical and psychological, and motivates them to fight the illness,

especially during times of exacerbation. The nurse's role is to provide support, keep hope

alive, and inspire the patient to maintain positive social relationships.

iv. Due to degenerative changes in the limb joints, a person with SLE may experience balance

and gait disorders, as well as pain and dizziness. Nursing interventions should be planned

to avoid such situations; regular general improvement exercises supervised by a nurse and a

physiotherapist are also essential.

v. Pain is caused by an exacerbation of the course of systemic lupus erythematosus. As a

result, this is a critical issue for the patient, particularly during an exacerbation of the

disease (Tamirou et al., 2019).

Nursing care is very important in the treatment of systemic lupus erythematosus. It assists

patients in handling the disease in their daily lives, teaches them how to manage lupus

symptoms, and prevents SLE exacerbations. The nurse encourages and mobilizes the patient's
SYSTEMIC LUPUS ERYTHEMATOSUS 15.

family to provide the necessary assistance so that the patient does not feel alone in his or her

fight against the disease. Furthermore, by engaging in educational activities related to lifestyle

and rehabilitation, she can help to improve their quality of life (Tamirou et al., 2019).

Suggestion

I've decided to look into autoimmune disorders, which are uncommon in my clinical

experience. In these conditions, it's fascinating to see how the immune system interacts with the

body's tissues. I'm interested in learning more about autoimmune diseases, how they work, and

potential treatments. This is in line with my interest in immunology and allows me to learn about

conditions that aren't commonly discussed in clinical settings.

Conclusion

Systemic lupus erythematosus is a chronic autoimmune connective tissue disorder that

manifests itself in a variety of ways. Systemic lupus erythematosus is an immune-mediated

systemic disease characterized by a variety of skin, kidney, hematological, and musculoskeletal

abnormalities. The general symptoms are vague. Arthralgias and arthritis are common

manifestations, as are malar and other skin rashes, pleuritis or pericarditis, renal or CNS

involvement, and hematologic cytopenias (Feldman et al., 2022). Preventing and treating

systemic lupus erythematosus in patients with endometriosis, celiac disease, and periodontitis

should be prioritized. Increase serum iron and selenium levels with appropriate dietary

supplements to reduce the risk of systemic lupus erythematosus. Excessive intervention in

lifestyle choices such as smoking and drinking should be avoided.

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