NURSING CARE MANAGEMENT

1. Patient education is started at diagnosis and continued at every

opportunity, repetition is good.
2. Family members are encouraged to call with questions and concerns.
3. Patients are advised to write down their questions so they are prepared
during the appointment.
4. Adolescent development, with heightened concerns about body image
and looking different, should be considered.
5. The nurse should be open about this; skin care, cosmetics, and
unobtrusive moisturizers with sunscreen and sun block should be
discussed.
6. Weight gain is an emotional issue, and it must be approached honestly
with a workable plan for family dietary changes and realistic exercise
program.
7. Prevention of infection includes hand washing (especially at school) and
pre procedure antibiotic coverage for routine events such as dental
cleaning.
8. To compensate for the side effects of same drugs such as corticosteroid,
teenagers will often go on fad or starvation diets.
9. School attendance may decrease because of loss of self esteem,
depression, feelings of inadequacy, or poor academic performance.
10. Adolescent need to understand what the function of each drug is, how
each drug helps to manage the disease, and what effect missing does
may have on their health.
11. Perform a thorough is systemic physical assessment, inspecting skin for
erythematosus rashes and cutaneous erythematosus plaques with an
adherent scale on scalp, face, or neck.
12. Note areas for hyperpigmentation or depigmentation, depending on the
phase and type of the disease and question patient about skin changes,
specifically about sensitivity to sunlight or artificial ultraviolet light.
13. Inspect scalp for alopecia and examine mouth and throat for ulcerations;
provide appropriate oral care.
14. Observe for edema and hematuria, indicative of renal involvement.
15. Direct neurologic assessment and identifying and describing central
nervous system involvement.
16. Question family members regarding behavioral changes, neuroses or
psychoses.
17. Assess knowledge of disease process and self management.
18. Assess patients perception of and methods of coping with fatigue, body
image changes, and other problems caused by disease. Assist patient to
develop effective coping strategies.
MEDICAL MANAGEMENT/ THERAPEUTIC

1. Corticosteroid are used topically for cutaneous manifestations.

• Have been the mainstay of SLE therapy
• Generally a dosage sufficient to control symptoms is prescribed and
then the dosage is tapered to the lowest level possible to achieve an
acceptable balance between disease activity steroid side effects.
2. Nonsteroidal anti inflammatory drugs (NSAIDs) are used with
corticosteroid to minimize corticosteroid requirements.
• Nurses need to instruct patient to take NSAIDs with food to help
prevent G.I side effects.
• Cyclophosphamide, a potent immunosuppressive agent, used in
combination with corticosteroids, is effective in treating proliferative
lupus nephritis and neuropsychiatric lupus. A detailed
cyclophosphamide education session should be held for patient
and family at which potential benefits and risks, including infertility
and future malignancy, are clearly stated.
3. immunosuppressive agents are generally reserved for the most serious
forms of SLE.
4. In addition to medication, treatment includes general measures such as
patient and family education, rest and exercise, proper diet, sun avoidance
and social support.
• Families also want to hear about the impact of SLE on growth and
development, childbearing, schooling and vocation.
• Diet, exercise and rest are the daily elements under direct patient
control.
• There is no specific SLE diet, but a balanced diet has does not
exceed caloric expenditure is essential for maintaining appropriate
weight on corticosteroid therapy.
• Given the frequency of photosensitive rash, the dangers of
excessive ultraviolet light exposure (including exposure to
uncovered fluorescent lights) needs to be stressed.
• One rule useful to share with the adolescent who may be
surrounded by peers who regularly seek out sun exposure is the
“slip, slop, slap” rule; slip on a shirt, slop on sunscreen and slap on
a hat before going in the sun.
• Social support from family, friends, teachers, counselors, and
professional social workers and therapist can help the child and
family through difficult times and promote adaptation to an illness
that is not going to go way.