SYSTEMIC LOPUS ERYTHEMATOSUS

lupus is an autoimmune disease characterized by acute and chronic inflammation of various tissues of the body. Autoimmune diseases are illnesses that occur when the body's tissues are attacked by its own immune system. Connective tissue and fibrin deposits collect in blood vessels on collagen fibers and on organs. The deposits lead to necrosis and inflammation in the blood vessels, lymph nodes, gastrointestinal tract, and pleura. Statistics: 100 per 100,000 persons Occurs 10x more frequently in women than in men Approximately 3x more frequent in African-American populations than in Caucasians (Ruddy, et.al 2001) PATIENTS PROFILE: Name: Alegado, Shenne Age: 9 years old Sex: Female Address: Moag, Guadalupe Car-car City Name of Hospital:VSMMC Date of Admission: 3-7-11 Ward and Bed no: WARD XII, bed 27 Case no: 230402 Chief Complaint: fever, rash Medical Dx: TC: SLE vs. Steven Johnsons Syndrome Developmental Task: Erikson: Industry VS. Inferiority Developing social, physical, and learning skills Havighurst: 1. 1. Learning physical skills necessary for ordinary games. 2. Building wholesome attitudes toward oneself as a growing organism 3. Learning to get along with age-mates 4. Learning an appropriate masculine or feminine social role 5. 5. Developing fundamental skills in reading, writing, and calculating 6. Developing concepts necessary for everyday living. 7. Developing conscience, morality, and a scale of values

8. Achieving personal independence 9. Developing attitudes toward social institutions

groups

and

HEALTH ASSESSMENT: 1. HISTORY OF PRESENT ILLNESS: 2 weeks PTA, noted onset of fever (undocumented) associated with cough and erythematous rash on forehead. Self-medicated with paracetamol which afforded temporary relief of fever. No consultation done. 1 week PTA, fever persisted and erythematous rash also noted at maxillary area. Sought consultation at a private M.D. Given Terbutaline 5ml 3x a day, Cefaclor 250/7ml 3x a a day and Foartin 10mg 1 tab once a day, with good compliance. 5 days PTA, above condition persisted with associated joint pains. Prompted consultation at Carcar DH. Given Cefuroxime 50mg tab 1 tab 2x a day. 2. Functional Health Patterns 2.1 Health Perception and Health maintenance: Client states that health is the absence of disease and can be maintained through proper nutrition. 2.2 Nutrition and Metabolism : on DAT with AP 2.3 Elimination : PTA, client evacuates a brown, formed stool once a day, and voids 3-5x a day. Urine is clear and yellow. Upon admission, she hasnt eliminated yet. 2.4 Activity and Exercise: PTA, client spends most of her time in school, studying and playing with her friends. Upon admission, client stays most of the time lying in bed, weak. 2.5 Cognition and Perception: Client is conscious and coherent. 2.6 Sleep and Rest: PTA, client sleeps for 8-10 hours a day with afternoon naps. Upon admission, client experiences a disturbed sleep pattern. 2.7. Sexuality and Reproduction: Client is a female, with no history or past experiences with sexual intercourse.

2.8 Self-perception and self-concept: Not answered. 2.9 Roles and relationship: Client relates well with support persons but with limited interaction to other people. 2.10 Stress Tolerance and Coping: Copes up stress through rest and sleep 2.11 Values and Belief: Client is a R. Catholic. She believes in God, Angels and Demons. 3. Physical Examination: 3.1 General Survey: Received patient on bed, awake, conscious, coherent, with HL @ L arm, appears thin, weak and unwashed. 3.2. Skin, Hair and Neck Skin is brown with erythematous butterfly rashes on face, chest and subscapular area. Skin is Dry, warm to touch. Hair is long, unkept and dry. Nails are pinkish with <2sec CRT. 3.3 Head, Neck and Cervival Lymph Nodes Head is round, (-) masses, 1 palpable cervical lymph node noted on both sides of the neck and 1 palpable lymph node noted on both axillae 3.4 Mouth, Nose and Sinus (+)mouth sores, (-)nasal congestion, nontender sinuses 3.5 Eye and Ear Eyes are pale white, (-) discharges, pink conjunctivae 3.6 Thoracic and Lungs (-)chest indrawing, (-)rales, (-)wheeze 3.7 Cardiovascular (-) heart murmur 3.8 Breast (-)masses, lumps and nodules 3.9 Abdomen Flat, soft, non-distended 3.10 Genitourinary Female genitalia, no discharges noted 3.11. Musculoskeletal

 Extremeties are warm. Joint pain noted on upper exteremeties. 3.12 Neurologic Awake, conscious, coherent, cooperative (+) corneal reflex, (-)facial asymmetry, (+) gag reflex, (-)nystagmus, (-)nuchal rigidity, (-)babinski, (-)ankle clonus 4. Diagnostic and Laboratory Test Immunology Report Patients name: Alegado, Shanne Canape Requesting Doctor: Walk-in Res.no.: 110022642950 Request no.: LABRO2466701 Room no.: OPD Date/Time Rendered: 03-07-11/19:33:00 Date/Time Received: 03-07-11/19:33 Clinical Chemistry Test Normal Result Unit range >Creatinine 0.60-1.10 0.73 Mg/dl >Bun 7.00-18.68 11.89 Mg/dl Date & Time Requested 03/08/11- 7:39 A.M Date Performed 03/08/11-1:39 P.M Complete blood Result count >WBC count 15.20 >Hemoglobin 119 >Hematocrit 0.37 >MCV 73.00 >MCH 23.40 >RBC Count 5.07 >MCHC 321 >RDW 19.10 >MPV 7.60 >Platelet count 506.00 DIFFERENT COUNT: >Neutrophil 60.00 >Lymphocyte 31.90 >Monocyte 6.30 >Eosinophil 1.00 >Basophil 0.80 >Stab 0 >Atypical 0 Unit 10^9/L g/L L/L +L pg 10^12/L g/L +L +L 10^g/L % % % % % % % Reference 10-26 135-195 0.44-0.64 100-112 30-38 100-600 320-360 11-16 6-11 200-400 40-74 19-48 3-9 0-7 0-2 -

>Metamyelocytes 0 >Myelocytes 0 >Blast 0 Complete Blood Result Count >WBC Count 3.10 >Hemoglobin 89 >Hematocrit 0.28 >MCV 79.00 >MCH 25.60 >RBC Count 3.47 >MCHC 323 >ROW 15.80 >MPV 7.80 >Platelet Count 275.00 DIFFERENT COUNT: >Neutrophil 59.90 >Lymphocyte 24.60 >Monocyte 12.80 >Eosinophil 1.50 >Basophil 1.20 >Stab 0 >Atypical 0 lymphocyte >Metamyelocytes 0 >Myelocytes 0 >Blast 0

% % % Unit 10^g/L g/L L/L Fl Pg 10^12/L g/L Fl Fl 10^g/L % % % % % % % % % %

Reference 4.5-13.5 115-145 0.37-0.45 77-91 24-30 4.00-5.40 320-360 11-16 6-11 200-400 40-74 19-48 3-9 0-7 0-2 -

Date & Time Requested 03/08/11- 7:39 A.M Date Performed 03/08/11-1:39 P.M Test Result Reference Unit >ANA(immunePositive NEGATIVE fluorescence) (+3) at 1:320 dilution >Anti-DS Positive NEGATIVE DNA(immune(+2) fluorescence Blood Typing >Blood type O >RH Positive (+) >Sedementation 130 mm/hr 0-2

ANATOMY AND PATHOPHYSIOLOGY: 1.Anatomy

 Systemiccan affect tissues and cells throughout the body Autoimmune Disorder- self-antigens stimulate unwanted destruction Lupus- an autoimmune disease where the body's immune system becomes hyperactive and attacks normal, healthy tissue. This results in symptoms such as inflammation, swelling, and damage to joints, skin, kidneys, blood, the heart, and lungs. Erythematous -. Of or relating to or characterized by erythema, which is the redness of skin as caused by dilation orcongestion of capillary. SYSTEM INTERACTIONS SYSTEM INTEGUMENTARY THE EFFECT OF SLE ON OTHER SYSTEMS

SKELETAL MUSCULAR NERVOUS

ENDOCRINE

INTERACTIONS Skin lesions frequently occur and are made worst by exposure of the sun. There are three forms: (1) an inflammation redness, which can take the form a butterfly rash, which extends from the bridge of the nose to the cheeks; (2) small, localizd, pimplelike eruptions accomjpanied by scaling the skin; and (3) areas of atrophied, depigmented skin with borders of increased pigmentation. Diffuse thinning of the hair results to hair loss. Arthritis, tendonitis, and death of bone tissue can occur Destruction of the muscle tissue and muscular weakness can occur Memory loss, intellectual deterioration, disorientation, psychosis, relative depression, headache, seizures, nausea, and loss of appetite can occur. Stroke is a major cause of dysfunction and death. Cranial nerve involvement in the facial muscle weakness, drooping of the eyelid, and double vision. Central nervous system lesion can cause paralysis. Sex hormones may play a major role in SLE because 90% of the cases occur in females, and females with SLE will have decreased levels of androgens. Inflammation of the pericardium

CARDIOVASCULAR

RESPIRATORY

DIGESTIVE

URINARY

(Pericarditis) with chest pain can develop. Damage to heart vessels, inflammation of the cardiac tissue, tachycardia, arrhythmias, angina, and myocardial infection can occur. Hemolytic anemia can occur and leucopenia can be present. Antiphospholipid antibody syndrome, through an unknown mechanism, increases coagulation and thrombus formation, which increases the risk for stroke and heart attack. Chest pain caused by inflammation of pleural membranes: fever, shortness of breath, and hypoxemia caused by inflammation of the lungs; alveolar hemorrhage can develop. Ulcers develop in the oral cavity and pharynx. Abdominal pain and vomiting are common, bout no cause can be found. Inflammation of the pancreas and occasionally enlargement of the liver and minor abnormalities in liver function can occur. Renal lesions and glomerulonephritis can result in progressive failure of kidney function. Excess proteins are lost in the urine, resulting in lower than normal blood proteins, which can produce edema.

2. PATHOPHYSIOLOGY OF SYSTEMIC LUPUS ERYTHEMATOUSUS PREDISPOSING FACTO Age, gender, heredity, race, hormones, history PRECIPITATING FACTOR Environment, drugs, infection, lifestyle

ETIOLOGY UNKNOWN

Disturbed immune regulation

Exaggerated production of antibodies

Result from abnormal suppressor T-cell function

Immune complex deposition and tissue damage

Inflammation stimulates antigens Stimulates additional antibodies

Cycle repeats

SIGNS AND SYMPTOMS

MANIFESTATION SYSTEMIC LUPUS ERYTHEMATOSUS Present

PATIENTS

INTERPRETATION -Due to the inflammatory response -Attacked the nervous system -Attacked the upper portion of digestive tract -Attacked skeletal tissue death of bone tissue can occur -Attacked nervous system Attacked nervous system -Affected the integumentary system; appearance of skin lesions -Caused by chest pain in the inflammation of pleural membranes

Low-grade fever

Photosensitivity Present Mouth ulcers Joint pain Present Present

Fatigue

Present

Loss of appetite Present Butterfly rash Present

Pleural effusion Not seen

3. SIGNS AND SYMPTOMS MEDICAL MANAGEMENT: Cefuroxime 750g IVTT q 8

 Paracetamol

250g/7.5cc q 6

NURSING CARE PLAN: Nursing Diagnosis: Fatigue r/t poor oxygenation of body tissues secondary to decreased red blood cells Subjective cues: -kapoy akong lawas, as verbalized by patient. Objective cues: -lying on bed, awake, conscious and coherent, with HL on left arm, weak and drowsy -compromised concentration -irritable -erythematous rash noted on face - V/S taken as follows: T=38.1, P=136bpm, R=26 cpm

Laboratory findings: CBC RESULT REFERENCE Hgb 89 g/L 115- 145 Hct 0.28 0.31- 0.45 RBC 3.47 4.00- 5.40 - Decreased Hemoglobin and Hematocrit level - Decreased RBC count Scientific Basis: Systemic Lupus Erythematosus is characterized by the formation of autoantibodies and immune complexes. Autoantibodies against red blood cells can lead to decreased RBC count. Poor tissue perfusion then results from this decrease in RBC, therefore leading to an overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level, this is known as fatigue. Short-term objective: After 6 hrs of nursing interventions, client will: K- will gain knowledge on fatigue management S- demonstrate willingness to cooperate with nursing interventions. A- show a positive attitude with nursing care given. Long-term goal: After 2-3 days of nursing caring care, client will: - Report improved sense of energy - Perform ADLs @ level of ability - Participate in treatment program

Nursing Interventions: Independent 1. Review medication regimen/ use. Rationale: certain medications are known to cause and or exacerbate fatigue. 2. Monitor V/S. Rationale: to provide baseline data and evaluate fluid status and cardiopulmonary response to activity.

3. Determine presence/ degree of sleep disturbances. Rationale: fatigue can be a consequence and or exacerbated by sleep deprivation 4. Accept reality of clients reports of fatigue and do not underestimate effect on clients quality of life. Rationale: Clients with SLE are prone to more frequent/ severe fatigue following minimal energy expenditure and require longer recovery period than usual.

5. Establish realistic activity goals with client and encourage forward movement. Rationale: Enhances commitment to promoting optimal outcomes. 6. Plan interventions to allow adequate rest periods. Rationale: to promote comfort and maximize participation. 7. Encourage use of assistive devices. Rationale: to extend active time/ conserve energy for other tasks. 8. Avoid/ limit exposure to temperature and humidity extremes. Rationale: To promote comfort. Excessive heat can negatively impact energy level. 9. Provide diversional activities. Rationale: to refocus energy and diminish feelings of unhappiness and sluggishness 10. Teach patient on importance of eating nutritious food and on eating adequately, teach about the complications of not eating on time. Rationale: To provide health education on adequate nutrition and promote energy. DEPENDENT/ COLLABORATIVE: 1. Provide supplemental O2 inhalation, as ordered.

Rationale: To provide adequate O2 supply. Decreased RBC reduces O2 available for cellular uptake and contributes to fatigue. Nursing Diagnosis: Acute pain r/t joint inflammation secondary to present disease condition (SLE) Subjective cues: Sakit ilihok akong kamot, as verbalized by the patient.

Objective cues: -lying on bed, awake, conscious, coherent with HL on left arm -butterfly rash noted on face -pain scale of 6/10 (0 as no pain, 10 as severe pain) -2 wks PTA, patient noted a pricking pain on the joints of her left arm; pain persisted for 2 wks; it is aggravated by movement and position changes and is alleviated by bed rest and analgesic Scientific Basis: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect virtually any organ system, including the musculoskeletal system. Arthralgia and arthritis are among the most commonly occurring early symptoms. All persons with the disease complain of joint pain at some point during the course of the disease. Short-term objective: After 6 hrs of nursing interventions, client will: K- verbalize understanding on pain management S- demonstrate willingness to participate with nursing interventions A- show positive attitude toward nursing care Long-term goal: After 2-3 days of nursing interventions, client will: - Follow prescribed pharmacological regimen - Report pain is relieved/ controlled Nursing Interventions: Independent 1.Obtain pain assessment. Reassess each time pain is reported. Rationale: to rule out worsening of underlying condition/ devt of complications. 2. Accept clients description of pain. Rationale: to assess type of pain

3. Observe non-verbal cues/ pain behaviors. Rationale: to further assess status as observations may/ may not be congruent with verbal reports. 4. Monitor skin color/ temperature & V/S. Rationale: To determine client status, these findings are usually altered in acute pain. 5. Note when pain occurs (e.g. movement) Rationale: To minimize aggravating factors and prevent pain sensation 6. Provide comfort measure. Rationale: To promote non-pharmacological pain management. 7. Instruct/ encourage use of relaxation techniques. Rationale: to help alleviate pain 8. Instruct client to report pain as soon as it begins. Rationale: timely intervention is more likely to be successful in alleviating pain 9. Encourage adequate rest periods. Rationale: to prevent fatigue and promote comfort. 10. Inform patient of prognosis of pain sensation. Rationale: To minimize anxiety. Nursing Diagnosis: Altered thermoregulation: Hyperthermia r/t inflammatory process Subjective Cues: Init akong paminaw, as verbalized by the pt. Objective cues: - T= 38.1 P= , P=136bpm, R=26 cpm - Appears weak - Flushed face, skin warm to touch Scientific Basis: process of _____ Fever results as an inflammatory

After 6 hrs of nursing interventions, client will: K- verbalize understanding on fever management S- demonstrate willingness to participate with nursing interventions A- show positive attitude toward nursing care Long-term goal: After 1-2 days of nursing interventions, client will: - Follow prescribed pharmacological regimen - Clients temperature will decrease to 36.5- 37.5 degrees Celsius from a temp of 38.1.

Nursing Interventions: 1. Monitor V/S. Rationale: to provide baseline data 2. Monitor fluctuations of temperature. Rationale: to assess patients status 3. Provide tepid sponge bath. Rationale: to dissipate heat through convection. 4. Encourage patient to increase fluid intake. Rationale: to prevent dehydration. 5. Provide adequate nutrition. Rationale: To provide needed energy. 6. Provide cool, circulating air. Rationale: to dissipate heat through evaporation and enhance comfort. 7. Provide loose, comfortable clothing. Rationale: to promote comfort. 8. Provide additional blanket when the client feels cold and remove blanket when the client feels warm. Rationale: Nursing Diagnosis: Altered thermoregulation: Hyperthermia r/t inflammatory process Subjective Cues: Init akong paminaw, as verbalized by the pt. Objective cues: - T= 38.1 P= , P=136bpm, R=26 cpm - Appears weak - Flushed face, skin warm to touch Scientific Basis: Fever results process of the disease condition. as an inflammatory

After 6 hrs of nursing interventions, client will: K- verbalize understanding on fever management S- demonstrate willingness to participate with nursing interventions A- show positive attitude toward nursing care Long-term goal: After 1-2 days of nursing interventions, client will: - Follow prescribed pharmacological regimen - Clients temperature will decrease to 36.5- 37.5 degrees Celsius from a temp of 38.1.

Nursing Interventions:

1. Monitor V/S. Rationale: to provide baseline data 2. Monitor fluctuations of temperature. Rationale: to assess patients status 3. Provide tepid sponge bath. Rationale: to dissipate heat through conduction. 4. Encourage patient to increase fluid intake. Rationale: to prevent dehydration. 5. Provide adequate nutrition. Rationale: To provide needed energy. 6. Provide cool, circulating air. Rationale: to dissipate heat through evaporation and enhance comfort. 7. Provide loose, comfortable clothing. Rationale: to promote comfort. 8. Provide additional blanket when the client feels cold and remove blanket when the client feels warm. Rationale: to prevent increase in body heat. 9. Maintain bedrest/ provide adequate rest periods. Rationale: to reduce metabolic demands and oxygen consumption. 10. Provide a quiet environment conducive to rest and recovery. COLLABORATIVE/ DEPENDENT: 1. Provide supplemental oxygen. To offset increased oxygen demands and consumption. 2. Administer replacement fluids and electrolytes. To support circulating volume and tissue perfusion. 3. Administer analgesic, as prescribed. To reduce fever.

Drug Study: Name of Drug Generic name: Cefuroxime Trade Name: Ceftin Patients Dose: 750mg IVTT q6 Maximum Dose: 750mg Minimum Dose: 200mg Classification Generic Classification: Cephalosporin Functional Classification:

Antibiotics Mechanism of action: Bacterial: Inhibits synthesis causing cell death. of bacterial cell wall,

Patients Indication: Prophylactic management against infection. Contraindication: Contraindicated with allergy to cephalosporins or penicillins. Use cautiously with renal failure, lactation, pregnancy. Adverse reaction: CNS: headache, dizziness, lethargy, paresthesias GI: nausea, vomiting, diarrhea, anorexia, flatulence, abdominal pain, hepatotoxicity. GU: Nephrotoxicity HEMATOLOGIC: bone marrow depression HYPERSENSITIVITY: rash, anaphylaxis Nsg. Responsibilities: Monitor patients vital signs Assess for hepatic and renal impairment Hypersensitivity for Cephalosporin or Penicillins Discontinue if hypersensitivity reaction occurs. Take a full course of the therapy even if patient feels better

Store solution in the refrigerator. Shake well before each use. Inform patient/SO that patient may experience side effects: stomach upset or diarrhea. Report any severe diarrhea, difficulty breathing Evaluate drug effectiveness Name of Drug: Generic name: Paracetamol Trade Name: Biogesic Patients Dose: 250mg/7.5cc q 6 Maximum Dose: 500mg Minimum Dose:

250mg Classification Generic Classification: non opioid Functional Classification: Antipyretic, analgesic Mechanism of action: Reduce fever by direct action on hypothalamus heatregulating center with consequent peripheral vasodilation, sweating, and dissipation of heat. Patients Indication: Fever reduction. Temporary relief of mild pain. Generally as substitute for aspirin when the latter is not tolerated or is contraindicated. Contraindication: Hypersensitivity to acetaminophen or phenacetin; use with alcohol. Adverse reaction: CNS: headache, CV: chest pain, dyspnea GI: hepatotoxicity. GU: acute renal failure, renal tubular necrosis HEMATOLOGIC: bone marrow depression HYPERSENSITIVITY: rash Nsg. Responsibilities: Monitor patients vital signs Assess for Hypersensitivity of acetaminophen Discontinue drug if hypersensitivity occurs Give drugs with food if GI upset occurs Do not exceed the recommended dosage.

Give drug only for complaints indicated. Report rash, unusual bleeeding or bruising, yellowing of skin or eyes, changes in voiding patterns. DISCHARGE PLAN: HEALTH TEACHINGS: STRESS MANAGEMENT 1.AMPLE TIME FOR REST AND SLEEP 2. ENCOURAGE PATIENT TO EXPRESS HIS HER FEELINGS RELATED TO HIS ILLNESS

3.PROVIDE EMOTIONAL SUPPORT 4.PROMOTE RELAXATION ACTIVIES 5. ENCOURAGE PATIENT TO SPEND TIME WITH SUPPORT SYSTEM 6. HAVE AN OPEN COMMUNICATION 7. PROVIDE SPIRITUAL SUPPORT TO CLIENT MAINTANING SKIN INTEGRITY 1.MAINTAINING ORAL CARE 2.APPLYING SUNSCREEN MAY BE NECESSARY FOR SENSITIVITY TO SUNLIGHT AND UV RAYS 3.MAINTAIN PROPER HYGIENE 4.MAY USE ARTIFICIAL HAIR OR WIGS IF ALOPECIA OCCURS SEIZURE Seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.THIS CAN CAUSE SERIOUS PHYSICAL INJURY TO PATIENT WITH SLE NEVER LEAVE PATIENT WITHOUT SUPERVISION HYPERTENSION Pulmonary hypertension with pathological changes similar to those observed in primary pulmonary hypertension occurs in patients with systemic lupus erythematosus (SLE) poprostenol was effective for the treatment of pulmonary hypertension in this small group of patients with SLE. Further evaluation of epoprostenol therapy for patients with SLE and other diseases associated with pulmonary hypertension is warranted. DISCHARGE PLAN: Medication Instruct significant others to let patient comply the taken home medication prescribed by the physician. Do not take any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers. Instruct S.O to give the medicine to the child as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. Follow-up visit information: Discuss to the S.O about the importance for people

with lupus to see a caregiver regularly. Regular checkups may help your caregiver catch serious problems early. Instruct S.O to ask your caregiver how many times a year you should have a check-up. Activity and home care: ADVISE FAMILY/ S.O that the child needs: Rest: Get plenty of rest, especially during a flare of lupus symptoms. Rest is one of the most important things you can do to decrease your symptoms. Exercise: Try to exercise when your lupus symptoms are mild. Exercise strengthens muscles and makes joints move more easily. It can also keep your heart and lungs healthy, and help you have more energy. Avoid sunlight: Sunlight can make your lupus symptoms worse. Use sunscreen with a sun-protection factor (SPF) of 15 or more. Put it on your skin before you go outside. Put more on every two hours when you are out in the sun. If you are swimming, put more on each time you get out of the water. If you burn easily, wear loose thin shirts with long sleeves, pants, a hat, and shoes while outside. Try to stay out of the sun when it is at its brightest, usually between 10 a.m. and 3 p.m. Heat: Use heat to decrease pain or swelling in your joints. Use a heating pad (turned on low), a hot water bottle, or sit in a warm water bath. Do this for 20 minutes out of every hour, for as long as you need it. Do not sleep on the heating pad or hot water bottle. This can cause a bad burn. Ice: Use ice to decrease joint pain or swelling. Put the ice in a plastic bag and cover it with a towel. Place this over the injured area for 20 minutes out of every hour, for as long as you need it. Do not put the ice pack directly on the skin because you can get frostbite. Diet: o Eat a healthy variety of foods every day. Your diet should include fruits, vegetables, breads, dairy products, and protein (meat, fish, or beans). Eating healthy foods may help you feel better and have more energy. o Ask your caregiver if you should be on a special diet. You may be told to eat foods that are "hearthealthy." These foods are low in fat and

cholesterol. Special cookbooks can make it easier to plan low fat meals. Ask your caregiver for more information if you need to be on a special diet. o Do not drink alcohol. Alcohol can damage your brain, heart, and liver. Almost every part of your body can be harmed by alcohol. Drinking alcohol can also make your lupus worse. CONTACT A CAREGIVER IF the childs having: a fever (increased body temperature). new symptoms that you are worried about. questions or concerns about lupus or your lupus medicine. new trouble breathing while resting. a flare of lupus symptoms. a bad headache. You feel like you are starting to get an illness or infection. any problems urinating. bleeding from your nose or gums, or blood in your urine, BM, or vomit (throw up). notice that you are bruising more than usual. SEEK CARE IMMEDIATELY IF the child is having: any bleeding that cannot be controlled, including bleeding from your rectum (rear-end) or vomiting blood. bad abdominal (belly) pain. confused or less alert. faint (pass out) or feel like fainting. feel dizzy, have numbness or weakness of your face or limbs, or have trouble seeing or speaking. have a seizure (convulsion). new, sudden vision changes. SPIRITUAL Advised family to continue believing and praying in God. BIBLIOGRAPHY Nurses Pocket Guide, 12th Ed., Doenges pp. 351- 356; 586-891; 439- 444 Lippincotts Nursing Drug Guide, 2010. Karch pp. 7172; 258- 260 Maternal & Child Health Nursing, 6th Ed. Pilliteri. Pp. 530- 531

UNIVERSITY OF SOUTHERN PHILLIPINES FOUNDATION Salinas Drive, Lahug, Cebu City

A Case Study of a Pediatric Patient Who Manifested Signs and Symptoms Of Systemic Lupus Erythematosus

Presented to Ms. Lydia Auriel Yburan, R.N. College of Nursing

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Submitted By: Group I Capalla, Carlo Angelo Cunanan, Rosemarie Delos Reyes, Jibson Franz Fetiluna, Maricel A. Lim, Hannah Mae

Obien, Sheena Pepito, Hannah Jill Quirol, Mark Nichole Santos, Ma. Hespher Blaise Tumulak, Anna Jorel Veloria, Carlisle Joan