Running head: EXACERBATION OF LUPUS

Exacerbation of Lupus
Stephanie Williams
Humber College NURS 252
Wendy Chow
March 11, 2015

EXACERBATION OF LUPUS

Systemic lupus erythematosus is a genetic systemic autoimmune disease, where the

bodies immune system attacks healthy tissue, which causes inflammation. There is no cure for
SLE, however symptom control treatment includes the use of corticosteroids and
immunosuppressants. In the presented case study the patient is experiencing a lupus flare up,
refuses to take any fluids and food, presents with a flat affect as well as refusal to participate in
self-care. Vital signs include T 37.8 C and P 118. As a pathophysiological priority for this patient
I have chosen exacerbation of systemic lupus pathway over the psychosocial pathway of poor
self-concept.
As a chosen pathophysiological priority I have chosen exacerbation of systemic lupus
over poor self-concept because it needs immediate attention due to the fact that lupus can be
fatal. It affects multiple body systems, but usually targets the skin, muscle, lungs, heart, nervous
tissue, and kidneys (Lewis, 2014, p. 1905). The complications that arise from this include fever,
weight loss, fatigue, and joint pain (Lewis, 2014, p. 1905). In the musculoskeletal system
extreme joint pain, swelling, and deviation of joints occur making these patients at higher risk of
bone loss and fracture (Lewis, 2014, p. 1905). In the nervous system the complications can occur
such as severe headaches, stroke, depression, and psychosis. In 15% of patients focal seizures
occur, but can be controlled by corticosteroid and anti-seizure medication (Lewis, 2014, p.
1906). Usually with lupus flare-ups comes increased temperature, which is a contributory factor
to seizure activity. Unlike the psychosocial approach regarding poor self-concept, exacerbation
of systemic lupus clearly is the priority for the patient due to numerous life-threatening
manifestations and high risk factors that need to be addressed before further attention is brought
to the psychosocial pathway.
The clinical manifestations and complications of exacerbation of systemic lupus 3

EXACERBATION OF LUPUS

priority areas I have chosen are patient at risk for dehydration related to fluid and electrolyte
imbalance, potential for seizure activity related to untreated fevers, and potential for viral or
bacterial infection related to compromised immune system due to both corticosteroid and
immunosuppressive drug use. Dehydration arises based on the fact that the patient is refusing to
take any fluids. In patients with SLE fluid intake is important because it enables natural body
processes to continue to work effectively. Because of increased temperature fluid is often lost
and needs to be replenished and can serve as a way to decrease fever. With exacerbation of lupus,
inflammation in the brain can occur, which in turn can cause seizures especially in adults and
children (Yamaya, 2009). Untreated or fevers unable to break can also trigger seizure activity
(Yamaya, 2009). According to Lewis (2014), some families carry a predisposition to seizure
disorders in the form of an inherently low threshold to seizure-producing stimuli, such as trauma,
disease, and high fever (p. 1707). The use of immunosuppressants in lupus is very important,
but may pose complications such as susceptibility to other illnesses (Lewis, 2014, p. 1906).
Contraction of infection in lupus patients will further complicate the patients stability and may
be fatal.
To combat the risk for dehydration related to fluid and electrolyte imbalance the
following nursing interventions can be put in place; advocating for the admitted patient to have
ringers lactate administered because it most closely replicates serum. Encouraging the patient to
aim for 2L of liquids within a two to four hour period. Educating the patient on the importance of
discontinuing the use of alcohol in their diet to prevent dehydration. "Concentrations of 12 to 14
percent alcohol, such as liquor and wine, do contribute to dehydration by increasing urine
output (Hail, 2014). Educating the patient on the importance of hydration before, after, and
during exercise using water and energy drinks as part of the patients daily routine in the hospital

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and incorporated in discharge planning is important because excessive diaphoresis causes fluid
loss and in turn fluids need to be replenished. Exercise in lupus patients has many benefits, but
hydration status should be closely monitored. Lastly, working within the inter-professional team
especially with the dietitian to implement a low-sodium diet to combat dehydration.
Interventions to help with potential for seizure activity include the use of anti-pyretic
drugs such as Tylenol, which lowers temperature by targeting the control center in the
hypothalamus; to be taken every four hours to combat fever like symptoms (Lewis, 2014, p.
260). One of the first signs of a lupus flare-up is a fever so implementation/educating the patient
on the importance of avoiding things that may trigger flare-ups such as sun exposure and
smoking (Lewis, 2014, p. 1909). During exacerbation recommendation to be proactive by
wearing lose fitted clothing to decrease temperature is helpful. ESR and CRP levels are not
diagnostic of SLE but may be used to monitor disease activity and effectiveness of therapy
(Lewis, 2014, p. 1907). Regular blood tests should be taken for early detection of other illnesses
that may occur and/or to monitor disease activity. Establishing the patients baseline temperature
is important because every patient is different and everyones normal temperature could be
different. Educating the patient on the importance of corticosteroid use to prevent inflammation
in the brain, which helps to prevent seizures in lupus patients.
Potential for viral or bacterial infection related to a compromised immune system due to
both corticosteroid and immunosuppressive drug use by implementing that patient eats a healthy
balanced meal full of nutrients recommended by the dietitian in order to give their immune
system a boost. Fatigue is a great obstacle in lupus patients, therefore getting a full nine hours of
sleep each night is very important and can be achieved by incorporating a regular sleep schedule.
Educating the patient on the importance of practicing proper hand washing and hygiene as it can

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prevent transmission of viruses and bacteria in those who have weak immune systems. Educating
the patients so they have control and the knowledge about prescribed antibiotics such as
sulfonamides, which can cause flare-ups due to increase in sun sensitivity and lowering of blood
counts (Cohen, 1996). Infectious control is a great resource and preventative measure in further
complicating or spreading disease. Working with infectious control and their protocol for
immunocompromised patients to prevent visitors from transmitting outside illnesses to the
patient.
Close monitoring is needed to decrease drug toxicity and other adverse effects. SLE is a
multi-organ autoimmune disease that affects over 50,000 Canadians. Although, there are many
interventions for exacerbation of systemic lupus it is important for patients to know that even
with strong dedication to the treatments flare-ups can still occur due to the nature of the
unpredictable disease. All in all, the priority for this patient is the pathophysiological
exacerbation of systemic lupus due to the numerous risk factors and manifestations that can be
fatal to the patient if left untreated.

EXACERBATION OF LUPUS
References
Cohen P, Gardner FH. Sulfonamide Reactions in Systemic Lupus Erythematosus. JAMA.
1966;197(10):817-819. doi:10.1001/jama.1966.03110100125037.

Hail, M. (2014, August). Hydrate well for health: Quench your body's thirst with appropriate
amounts and types of beverages every day. Environmental Nutrition, 37(8), 4. Retrieved
from http://go.galegroup.com.rap.ocls.ca/ps/i.do?id=GALE
%7CA376635404&v=2.1&u=humber&it=r&p=AONE&sw=w&asid=7035a5dd61fa14fd
b8ddb076d7bc68d3
Lewis, S. L. (2014). Medical-Surgical Nursing in Canada, 3rd Edition. [VitalSource Bookshelf
version]. Retrieved from http://pageburstls.elsevier.com/books/978-1-926648-705/id/B9781926648705000795_s0380
Yamaya, M., Yoshida, M., Yamasaki, M., Kubo, H., Furukawa, K., & Arai, H. (2009). Seizure
and pneumonia in an elderly patient with systemic lupus erythematosus. Journal Of The
American Geriatrics Society, 57(9), 1709-1711. doi:10.1111/j.1532-5415.2009.02386.x

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