SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

A. DEFINITION OF THE DISEASE

 Also known as Lupus, is an autoimmune disease wherein the body’s immune system mistakenly attacks its own cells and
tissues, leading to damage in organs or systems.
 The cause of abnormal immune response ins SLE is still unknown.
 CLINICAL MANIFESTATION
 The most commonly affected systems include the nervous, cardiovascular, musculoskeletal, mucocutaneous, and
respiratory. The liver, gastrointestinal tract, and eye system are less frequently affected.
 COMMON S/Sx:
 Fever
 Fatigue
 Achy joints (arthralgia) and swollen joints (arthritis)
 Buttery-shaped rashes over your cheeks and nose or rashes elsewhere on the body
 Skin lesions that appear with sun exposure
 Shortness of breath
 Chest pain
 Dry eyes
 Headaches, confusion and memory loss
 Pale or purple fingers or toes when feeling cold or stress (Raynaud’s Phenomenon)
 OTHER SYMPTOMS:
 Baldness
 CNS Symptoms
 Oral Ulcers
 Pleuritis
 Pneumonitis
 Anemia
 Thrombocytopenia
 Myositis
 Lymphadenopathy
 Spleomegaly
 Osteoporosis
 Pericarditis
 Myocarditis
B. ASSESSMENT
 CLINICAL ASSESSMENT
 SLE is diagnosed through a comprehensive history, physical examination, and blood test. Special features apply to
assessment for known or suspected SLE patients, in addition to the general evaluation conducted for any patient with a
rheumatic disease.
 Skin Assessment
 For erythematous rashes, the skin is examined. It is possible to see cutaneous erythematous plaques with an
adherent scale on the neck, face, or scalp. Depending on the disease's stage and kind, areas of hyperpigmentation
or depigmentation may be identified. Asking the patient about skin changes which might be temporary and in
particular about their sensitivity to UV light from the sun or artificial sources should be done. Alopecia should be
checked on the scalp, and ulcerations in the mouth and throat that indicate gastrointestinal involvement should be
looked for.
 Cardiovascular Assessment
 Auscultation for pericardial friction rub is part of this, as it may be linked to myocarditis and concurrently pleural
effusions. Abnormal lung sounds indicate pleural effusions and infiltrations, which are indicative of respiratory
insufficiency. Vascular involvement can be detected due to papular, erythematous, and purpuric lesions that
develop on the lateral sides of the hand, fingertips, elbows, toes, and extensor surfaces of the forearms. These
lesions have the potential to become necrotic.
 Physical Examination
 Edema, stiffness, warmth, soreness when moving, and swelling in the joints may be found through physical
inspection. The joint involvement is frequently symmetrical and resembles that of RA.
 Neurologic Examination
 Its goal is to locate and characterize any alterations to the central nervous system. Questions regarding any
behavioral changes, including signs of psychosis or neurosis, are being asked to the patient and their family.
Notable are reports of seizures, chorea, or other symptoms related to the central nervous system, as well as
indications of depression
 DIAGNOSTIC EXAMS
 Antinuclear Antibody (ANA) - also called FANA (Fluorescent Antinuclear Antibody) Test, is a blood test that searches your
body for specific types of antibodies.
 Anti-DNA - antibody that forms in opposition to the patient's DNA
 Anti-ds DNA - antibody against highly specific DNA associated with SLE, aiding in its distinction from drug-induced lupus
 Anti-Sm - antibody directed against Sm, a particular protein present in the nucleus
 CBC - may reveal anemia, thrombocytopenia, leukocytosis, or leukopenia.
C. PATHOPHYSIOLOGY

ANATOMY AND PHYSIOLOGY OF SYSTEMATIC LUPUS ERYTHEMATOUS (SLE)

1. Immune System
 Overview: The immune system is the body’s defense against pathogens. It comprises various cells (e.g., lymphocytes,
macrophages) and organs (e.g., spleen, thymus).
 Role in SLE:
 In SLE, the immune system becomes hyperactive, producing autoantibodies that target the body’s own tissues,
particularly affecting organs such as the skin, kidneys, joints, and central nervous system.
 Key Cells:
 B Cells: Produce antibodies, including autoantibodies that cause tissue damage.
 T Cells: Regulate immune responses; dysregulation can lead to an inappropriate immune attack on self-tissues.
2. Skin
 Anatomy: The skin is the largest organ, consisting of three layers: epidermis, dermis, and subcutaneous tissue.
 Physiology in SLE:
 In SLE, skin lesions like the malar rash (butterfly rash) and discoid lupus occur due to immune complex deposition
and inflammation in the dermis.
 Photosensitivity in SLE patients can exacerbate skin symptoms due to UV light triggering immune responses.
3. Musculoskeletal System
 Overview: Comprises bones, joints, and connective tissues, providing structure and facilitating movement.
 Physiology in SLE:
 SLE can lead to arthritis characterized by joint pain and inflammation due to synovial membrane inflammation
(synovitis).
 Inflammation: The release of pro-inflammatory cytokines contributes to joint damage and pain.
4. Renal System
 Anatomy: The kidneys filter blood to produce urine, consisting of nephrons that include glomeruli and tubules.
 Physiology in SLE:
 Lupus nephritis occurs when autoantibodies and immune complexes deposit in the kidney, leading to
glomerulonephritis.
 Symptoms include proteinuria, hematuria, and hypertension due to impaired kidney function and inflammatory
processes.
5. Cardiovascular System
 Overview: Comprises the heart and blood vessels, responsible for circulating blood throughout the body.
 Physiology in SLE:
 Chronic inflammation can lead to accelerated atherosclerosis and increased risk of myocarditis, pericarditis, and
thromboembolic events.
 Inflammation affects endothelial function, promoting vascular changes and increasing cardiovascular disease risk in
SLE patients.
6. Pulmonary System
 Anatomy: Includes the lungs and airways, responsible for gas exchange.
 Physiology in SLE:
 Inflammation in the pleura can lead to pleuritis, resulting in chest pain and difficulty breathing.
 Lupus pneumonitis may develop, causing inflammation of lung tissue and potentially leading to pulmonary
hypertension.
7. Nervous System
 Anatomy: Comprises the central nervous system (CNS) and peripheral nervous system (PNS).
 Physiology in SLE:
 Autoimmune processes can affect the CNS, leading to symptoms like seizures, cognitive dysfunction, and psychosis.
 Inflammation and autoantibody production may damage neurons and blood vessels in the brain.
8. Hematologic System
  Overview: Involves blood cells, including red blood cells (RBCs), white blood cells (WBCs), and platelets.
 Physiology in SLE:
 Hematologic complications include anemia, thrombocytopenia, and leukopenia due to immune-mediated
destruction of blood cells.
 Autoantibodies may target RBCs, leading to hemolytic anemia.
9. Endocrine System
 Anatomy: Comprises glands that secrete hormones, including the thyroid, adrenal glands, and pancreas.
 Physiology in SLE:
 SLE can affect hormonal regulation, leading to thyroid dysfunction or adrenal insufficiency, particularly in patients on
long-term corticosteroids.

D. DRUG ANALYSIS

Name of the Indication Mechanism of Side Effects Contraindication Nursing

Drug Action Responsibilities

Generic Name: Treatment of: Inhibits CNS: headache, Before:

Ibuprofen Mild to prostaglandin dizziness, Hypersensitivity to the -Educate patient
moderate pain, synthesis Drowsiness Drug. Active peptic about the drug
Brand Name: Fever, ulcer; hypersensitivity. and its purpose
Advil inflammatory EENT: Neonates with -Educate patient
disorders amblyopia, congenital heart and significant
including blurred vision, disease, suspected others about the
Dose: 200 mg or rheumatoid tinnitus necrotising possible side
1 capsule arthritis enterocolitis and effects
(including CV: HF, active bleeding -Assess patient
Frequency: juvenile) and myocardial (parenteral). for allergies
q4h to q6h osteoarthritis, infarction,
dysmenorrhea stroke, During:
Route: PO arrythmias, -Administer orally,
edema, with food or after
Drug Class: hypertension meals
Therapeutic: -Do not exceed
antipyretics, F and E: prescribed
antirheumatics, hyperkalemia Dosage
nonopioid
analgesics, GI: GI bleeding, After:
nonsteroidal hepatitis, -Advise patient
anti- constipation, and significant
inflammatory nausea, others to give
Agents vomiting, medication
abdominal exactly as
Pharmacologic: Discomfort directed and not
nonopioid give more than
analgesics GU: cystitis, the recommended
hematuria, renal amount
Failure -Advise patient
and significant
Derm: rash, other to report if
toxic epidermal any side effects
necrolysis, occur
exfoliative
Dermatitis

Hemat: anemia,
prolonged
bleeding time

Misc: allergic
reactions
including
anaphylaxis

Name of the Indication Mechanism of Side Effects Contraindication Nursing

Drug Action Responsibilities

Generic Name: For the Unknown Do not require Hypersensitivity to -Do not confuse
Hydroxychloroqui treatment of medical attention: 4-aminoquinoline hydroxychloroquin
ne chronic discoid Diarrhea, Headache, derivatives e with
lupus Nausea, Stomach hydrochlorothiazid
Brand Name: erythematosus pain, Vomiting e or hydroxyurea.
Plaquenil and systemic -PO: Administer
lupus with milk or meals
erythematosus, Requires medical to minimize GI
Dose: malaria, malaria attention: Allergic distress.
200-400 mg prophylaxis, reactions, Aplastic -Tablets may be
rheumatoid anemia, Change in crushed and
Frequency: vision, Heart rhythm placed inside
Once a day, arthritis changes, Infection, empty capsules for
divided into 1 or 2 Low blood sugar, patients with
doses Muscle injury, difficulty
unusual bruising swallowing.
Route: -Contents of
PO capsules may also
be mixed with a
Drug Class: teaspoonful of jam,
Antimalarial jelly, or Jell-O prior
quinolines, Antirh to administration.
eumatics -Malaria
Prophylaxis: Hydro
xychloroquine
therapy should be
started 2 wk prior
to potential
exposure and
continued for 4–6
wk after leaving the
malarious area.

Name of the Indication Mechanism of Side Effects Contraindication Nursing

Drug Action Responsibilities

Generic Name: For Renal Azathioprine is Do not require History of treatment with Assessment
Azathioprine Transplant, an imidazolyl medical attention: alkylating agents (e.g.
-History: Allergy to
Rheumatoid derivative of nausea, diarrhea, chlorambucil,
azathioprine;
Brand Name: Arthritis,Crohn's mercaptopurin stomach pain, hair cyclophosphamide)
rheumatoid
Azasan Disease - e which inhibits loss; or skin rash.
arthritis patients
Acute, RNA and DNA
 previously treated
Dose: Crohn's synthesis, and
Requires medical with alkylating
1 to 3 mg/kg Disease - antagonises
attention: agents; pregnancy
actual body Maintenance, purine
or male partners of
weight Chronic syntheis. It signs of infection women trying to
(ABW)/day Inflammatory interferes with (fever, chills, become pregnant;
Demyelinating cellular weakness, flu lactation
Frequency: Polyradiculoneu metabolism by symptoms, sore -Physical: T; skin
Once a day ropathy, inhibiting throat, cough, pain or color, lesions; liver
Atopic coenzyme burning when you evaluation, bowel
Route: Dermatitis, functioning and urinate); severe sounds; LFTs,
PO, IV Sarcoidosis, formation; may nausea, vomiting, or renal function
Ulcerative also ihibit diarrhea; easy tests, CBC
Drug Class: Colitis, mitosis bruising, unusual
Antirheumatics, Uveitis, bleeding; rapid Interventions
Other Multiple heartbeats, shortness
immunosuppress Sclerosis, of breath; pale skin, -Give drug IV if
ants Systemic Lupus cold hands and feet; oral administration
Erythematosus, or dark urine, is not possible;
Chronic Active jaundice (yellowing of switch to oral route
Hepatitis, the skin or eyes). as soon as
Takayasu's possible.
Arteritis  -Administer in
divided daily doses
or with food if GI
upset occurs.
-BLACK BOX
WARNING: Monito
r blood counts
regularly; severe
hematologic
effects may
require the
discontinuation of
therapy; increases
risk of neoplasia.

Teaching points
-Take drug in
divided doses with
food if GI upset
occurs.
-Avoid infections;
avoid crowds or
people who have
infections. Notify
your physician at
once if you are
injured.
 -Notify your health
care provider if you
think you are
pregnant or wish to
become pregnant,
or if you are a man
whose sexual
partner wishes to
become pregnant.
You may
experience these
side effects:
Nausea, vomiting
(take drug in
divided doses or
with food),
diarrhea, rash.
-Report unusual
bleeding or
bruising, fever,
sore throat, mouth
sores, signs of
infection,
abdominal pain,
severe diarrhea,
darkened urine or
pale stools, severe
nausea and
vomiting.

Surgical Management of Systemic Lupus Erythematosus

Surgery is generally not a primary treatment for SLE itself but may be required for complications arising from the disease or its treatment.

1. Renal Surgery

 Indications: In cases of severe lupus nephritis or complications such as severe scarring or obstruction.
 Examples:

 Kidney Biopsy: To assess the extent of kidney damage and guide treatment.
 Dialysis: In end-stage renal disease due to lupus nephritis, hemodialysis or peritoneal dialysis may be required.
 Kidney Transplant: For patients with irreversible kidney damage due to lupus nephritis.

2. Orthopedic Surgery

 Indications: For joint damage due to arthritis, such as joint replacement surgery.
 Examples:

 Total Joint Replacement: In cases of severe joint pain and dysfunction due to SLE-related arthritis.

3. Cardiac Surgery

 Indications: For patients with significant heart involvement (e.g., pericarditis, valve disease).
 Examples:

 Pericardial Window: To relieve symptoms of constrictive pericarditis or to drain fluid in cases of recurrent pericardial
effusion.
 Valve Repair/Replacement: For severe valvular disease secondary to SLE.

4. Neurological Interventions

 Indications: For complications affecting the central nervous system.

 Examples:

 Surgical Interventions: In cases of seizures or vascular complications like stroke, interventions may include the
removal of lesions or vascular repairs.

Multidisciplinary Approach

Managing SLE often requires a multidisciplinary team, including:

 Rheumatologists: Specialize in autoimmune diseases.

 Nephrologists: Focus on kidney-related issues.
 Dermatologists: Address skin manifestations.
 Psychiatrists/Psychologists: Help manage mental health issues.
  Dietitians: Assist with nutritional guidance.

Monitoring and Follow-Up

Regular monitoring of disease activity, medication side effects, and organ function is essential. This includes:

 Routine blood tests (CBC, liver function, kidney function, complement levels).
 Urinalysis for kidney involvement.
 Imaging studies if necessary to assess organ involvement.

E. NURSING CARE PLAN

Nursing Care Plan #1
Assessment Diagnosis Planning Intervention Evaluation

Subjcetive: Acute Pain related to Short Term: Independent: Short Term Evaluation (STE)
-Patient reports joint inflammatory joint process -The patient will report -Use a -The patient will report a reduction
pain in hands and as evidenced by patient a decrease in pain level standardized pain in pain level to 3 or below on a
knees, describing it reports of joint pain, limited to 4/10 or lower within scale (0-10) to pain scale of 0-10 within 48 hours.
as "throbbing" and ROM, swelling, and warmth 24 hours of evaluate pain -The patient will demonstrate a
"constant," with a in the affected joints. intervention. intensity and slight increase in joint range of
pain level of 8/10. -The patient will location. motion within 3 days, as evidenced
-Pain is worse in the demonstrate the use of -Reassess pain by improved ability to perform daily
morning and after at least two after activities.
physical activity. non-pharmacological interventions to
-Patient reports pain relief techniques determine
difficulty with daily (e.g., heat/cold effectiveness. Long Term Evaluation (LTE)
activities, such as application, relaxation -Encourage the -The patient will maintain a pain
dressing and techniques) within 48 patient to rest level of 3 or below over the course
walking, due to pain hours. and avoid of 2 weeks to 1 month, with
activities that minimal reliance on high-dose
Long Term: exacerbate joint analgesics.
Objective: -The patient will pain. -The patient will regain functional
-Patient exhibits maintain a manageable -Suggest using range of motion in affected joints
visible signs of joint pain level (4/10 or pillows or within 1-2 months, allowing for the
swelling and lower) by discharge. cushions to resumption of most daily activities
tenderness. -The patient will support joints with minimal discomfort.
-Limited range of participate in activities during rest.
motion noted in of daily living (ADLs) -Teach the
affected joints. with minimal discomfort patient relaxation
-Grimacing and by the time of techniques (e.g.,
guarding behavior discharge. deep breathing,
during movement or guided imagery)
physical assessment to manage pain
of joints perception.
-Increased warmth -Encourage the
and erythema use of warm
(redness) around the compresses on
inflamed joints inflamed joints to
(particularly hands reduce stiffness
and knees). and discomfort.
-Teach and
encourage
gentle,
low-impact ROM
exercises to
maintain joint
flexibility and
prevent stiffness.

Dependent:
-Administer
nonsteroidal
anti-inflammatory
drugs (NSAIDs)
like ibuprofen or
naproxen as
prescribed to
reduce
inflammation and
pain.
-Administer
corticosteroids
(e.g., prednisone)
as ordered for
severe joint
inflammation.
-Monitor for side
effects (e.g.,
gastrointestinal
upset, increased
 blood sugar, fluid
retention) from
prolonged use of
NSAIDs or
corticosteroids.
-Evaluate the
patient’s
response to pain
medications and
report to the
healthcare
provider if
adjustments are
needed.

Collaborative:
-Refer the patient
to a physical
therapist for the
development of
an individualized
exercise program
that focuses on
joint mobility and
pain reduction.
-Work with the
therapist to teach
the patient proper
techniques for
safe joint
movement and
muscle
strengthening
exercises.
-Collaborate with
the pharmacist to
ensure optimal
medication
dosing and to
discuss
alternatives if the
patient
experiences side
effects from
current
medications
-Work with the
rheumatologist to
monitor disease
activity and
adjust
medications or
treatment plans
as needed.
-Discuss the
possibility of
initiating
disease-modifyin
g antirheumatic
drugs (DMARDs)
or biologic agents
if pain and
inflammation
persist despite
current
treatments.

Nursing Care Plan #2

Assessment Diagnosis Planning Intervention Evaluation

Subjcetive: Risk for Impaired Gas Short Term: Independent: Short Term Evaluation (STE)
-Patient reports Exchange Related to Pleural -The patient will -Monitor -The patient will maintain an
sharp chest pain, Involvement maintain an oxygen respiratory rate, oxygen saturation level of 95% or
particularly when (Pleuritis)secondary to SLE, saturation level of at depth, and effort. above within 24 hours, as
taking deep breaths leading to pain and shallow least 95% within 48 -Note any use of monitored by pulse oximetry.
or coughing. breathing. hours. accessory -The patient will report reduced
-Patient complains of -The patient will muscles or signs pleuritic chest pain and
shortness of breath demonstrate an of distress (e.g., demonstrate less shallow
and fatigue improved breathing nasal flaring, breathing within 48 hours.
pattern, with a cyanosis).
respiratory rate of -Document Long Term Evaluation (LTE)
Objective: 16-20 breaths/min and changes in -The patient will demonstrate
-Auscultation reveals less shallow breathing breath sounds normal, unlabored breathing
diminished breath within 24 hours. (e.g., crackles, patterns within 1-2 weeks, with
sounds, especially in diminished minimal or no pleuritic pain
the lower lung fields. Long Term: sounds) using affecting breathing.
-Respiratory rate: 28 -The patient will auscultation. -The patient will remain free of
breaths/min experience improved -Monitor complications related to impaired
(tachypnea). gas exchange, respiratory rate, gas exchange (e.g., respiratory
-Oxygen saturation: evidenced by clear lung depth, and effort. failure or pneumonia) within 2-4
92% on room air. sounds, normal -Note any use of week
-Shallow, rapid respiratory rate, and accessory
breathing pattern adequate oxygenation muscles or signs
noted during (SpO2 ≥ 95%) within of distress (e.g.,
physical 1-2 weeks. nasal flaring,
examination. -The patient will cyanosis).
-Chest X-ray shows verbalize and -Document
pleural effusion. demonstrate effective changes in
use of pain breath sounds
management strategies (e.g., crackles,
to allow for deeper, less diminished
painful breathing within sounds) using
1 week. auscultation.
Encourage the
patient to sit in a
semi-Fowler’s or
high-Fowler’s
position to
promote lung
expansion and
improve
oxygenation.
-Reposition the
patient frequently
to enhance
alveolar
ventilation and
reduce the risk of
atelectasis.
-Instruct the
patient in using
deep breathing
and incentive
spirometry every
1-2 hours to
prevent
atelectasis and
improve lung
function.
-Educate the
patient on
splinting their
chest (using a
pillow) while
performing
breathing
exercises to
reduce pleuritic
pain.
-Use pulse
oximetry to
monitor oxygen
saturation levels
regularly. Ensure
oxygen levels
stay above 92%,
and alert the
healthcare
provider if levels
drop significantly.

Dependent:
-Administer pain
medications as
prescribed (e.g.,
NSAIDs, opioids)
to reduce pleuritic
pain and
encourage deep
breathing.
-Administer
corticosteroids to
reduce pleural
inflammation, as
prescribed.
-Administer
supplemental
oxygen if
indicated by low
SpO2 (oxygen
saturation) or
respiratory
distress.
-Assist in the
preparation and
education of the
patient for
ordered
diagnostic tests
such as a chest
X-ray or CT scan
to assess the
degree of pleural
involvement and
lung function.
-Prepare the
patient for a
potential
thoracentesis if
pleural effusion is
suspected.

Collaborative:-
Work with the
respiratory
therapist to
initiate and
monitor the use
of incentive
spirometry and
provide guidance
on respiratory
treatments (e.g.,
nebulizer
treatments if
needed).
-Facilitate the use
of specialized
breathing
techniques or
devices to
maximize lung
function and
oxygenation.
-Report abnormal
respiratory
findings and seek
further medical
management
such as
adjustments in
medication or the
need for
advanced
interventions
(e.g.,
thoracentesis or
pleural drainage).
-Discuss with the
healthcare
provider the
possibility of
titrating oxygen
therapy based on
SpO2 levels and
patient tolerance.
-Coordinate with
physical therapy
to engage the
 patient in
exercises that
promote lung
expansion and
improve overall
conditioning,
while taking care
to avoid fatigue.

Nursing Care Plan #3

Assessment Diagnosis Planning Intervention Evaluation

Subjcetive: Fatigue Related to Short Term: Independent: Short Term Evaluation (STE)
-Patient reports Persistent inflammatory The patient will report a -Regularly -The patient will report a subjective
feeling tired and response, anemia, and decrease in fatigue evaluate the improvement in energy levels
exhausted, even tissue damage due to levels and demonstrate patient's fatigue within 48 hours.
after minimal activity. ongoing SLE activity. increased energy for using a -The patient will experience
-Patient states, "I basic activities within standardized improved sleep quality as
feel drained all the 3-5 days. scale (e.g., evidenced by a report of at least 6
time, and I can't do -The patient will identify Fatigue Severity hours of restful sleep per night
what I used to." and implement at least Scale) to within 72 hours.
-Patient reports two understand its
difficulty in energy-conservation impact on daily Long Term Evaluation (LTE)
performing activities techniques within 24 activities. -The patient will be able to engage
of daily living (ADLs) hours. -Document in regular activities (e.g., work,
such as bathing, findings to help hobbies, exercise) without
dressing, and Long Term: identify patterns significant fatigue.
walking short -The patient will or triggers. -The patient will maintain a journal
distances. demonstrate improved -Advise the documenting daily energy levels
tolerance for physical patient to and activities, showing
activity and be able to alternate periods improvement over time
Objective: participate in ADLs with of activity with The patient will achieve normal
-Hemoglobin: 9.2 minimal fatigue within rest to prevent hemoglobin levels and stable
g/dL (indicating 2-4 weeks. overexertion. inflammatory markers (e.g., ESR,
anemia). -The patient will -Create a daily CRP) within 1-2 months.
-Pale conjunctivae maintain stable activity schedule
and mucous hemoglobin levels and that incorporates
membranes noted reduced inflammatory short rest breaks.
on examination. markers within 4-6 -Teach the
-The patient requires weeks, reflecting patient
frequent rest periods reduced disease energy-saving
during physical activity. techniques such
assessment or as prioritizing
ambulation. tasks, using
-Low activity adaptive
tolerance observed equipment, and
during mobility delegating
exercises (e.g., early responsibilities.
fatigue during short -Encourage the
walks). patient to engage
in light physical
activity as
tolerated to
improve overall
stamina.·
-Advise the
patient to
consume a
balanced diet rich
in iron, protein,
and vitamins to
help combat
anemia and
support energy
levels.
-Suggest small,
frequent meals
instead of large
ones to minimize
fatigue after
eating.

Dependent:
-Administer iron
supplements,
erythropoietin-sti
mulating agents,
or other
medications as
prescribed to
address anemia
and improve
energy levels.
-Monitor the
patient for
potential side
effects and
effectiveness of
medications.
-Regularly check
complete blood
counts (CBC)
and iron studies
to evaluate
hemoglobin
levels and
identify any
changes that may
contribute to
fatigue.
-Collaborate with
the healthcare
provider for
adjustments to
the treatment
plan based on lab
results.
-If severe anemia
is present, assist
in preparing the
patient for blood
transfusions as
ordered,
monitoring for
any transfusion
reactions.

Collaborative:
-Collaborate with a
dietitian to
develop an
individualized
nutrition plan
focused on
managing anemia
and enhancing
energy levels.
=Educate the
patient about food
choices that
support overall
health and energy.
-Refer the patient
to physical therapy
for tailored
exercise programs
that focus on
gradually
improving strength
and endurance
-Involve
occupational
therapy to assess
the patient's daily
activities and
provide adaptive
strategies or
equipment to
reduce fatigue
during ADLs.
-Work with the
healthcare team to
ensure regular
follow-up
appointments for
 monitoring SLE
activity, treatment
response, and
overall health.
-Encourage the
patient to discuss
any new symptoms
or concerns during
these visits to
adapt the care
plan as necessary.

E. NURSING THEORY

Jean Watson's Theory of Human Caring is highly applicable to nursing care for patients with Systemic Lupus Erythematosus (SLE).
This theory emphasizes the importance of caring relationships and the holistic approach to patient care, recognizing that emotional and
spiritual support are just as crucial as physical treatment. Watson's model encourages nurses to create a caring environment that fosters
healing, promotes patient dignity, and enhances well-being. For SLE patients, who often face chronic pain, fatigue, and emotional
distress, applying Watson’s principles can help nurses provide compassionate care, establish meaningful connections, and empower
patients to actively participate in their health management, ultimately improving their quality of life.