Systemic Lupus Erythematosus (SLE) is a complex disease that can affect many body systems. “Lupus is a chronic inflammatory autoimmune disease that can affect many parts of your body, including your skin, joints, kidneys, blood cells, heart and lungs” (Mayo Clinic, 2004, p.1). The diagnosis of Lupus evokes many questions and concerns in the patient. Educating patients is a major responsibility of nurses; therefore, the nurse should be knowledgeable in answering these questions. The nurse should be knowledgeable in answering these questions as educating patients is a major responsibility of nurses. Each patient is different; therefore, the education method should be individualized. You must take into consideration the patient’s motivation to learn and also the patient’s learning style.
Motivation (or readiness) to learn must be determined in the early stages of developing a teaching plan. The more motivated the patient is to learn, the more cooperative and attentive they will be during the implementation of the teaching plan. Patients who participate in their own care are more likely to retain the information presented to them. When assessing the motivation of the patient, consider if the patient has asked questions about his or her condition. Asking questions shows that the patient has a desire or motivation to learn more about his or her condition. Does the patient appear interested in learning more about his or her disease? Has the patient accepted the diagnosis or is he or she in denial?
In developing a teaching plan, you must also consider the needs of the patient. What does the patient already know about the disease? What areas need further exploring?
You can identify a patient’s needs by being attentive to the questions they ask about the disease. The nurse can also ask some open ended questions to determine the patient’s current knowledge base. The nurse could ask the patient what having the disease means to him or her. The patient could be questioned regarding his or her expectations of the treatments available. The patient’s age should also be considered as this will affect the method used in presenting the educational material. With young patients, the parents should be included in the teaching plan. With older patients, you should consider hearing and visual deficits when presenting material. Handouts could require larger print. The patient’s learning style will also influence how you proceed with your teaching plan. Visual learners are likely to benefit from more handouts, pictures, and diagrams. With auditory learners, you should consider using more lecture and discussion techniques. You must also consider whether teaching should be done in a group environment or on a one-on-one basis. The patient’s cultural background will affect how he or she responds to health care. Many cultures believe only in herbal remedies. This is important to note as it will directly affect the plan of care. Other cultures are not vocal about their problems, complaints, and concerns. These patients require specific questions to obtain information.
Lupus is most prevalent in women ages 15 to 45 and affects Blacks, Hispanics, Asians, and Native Americans more often than whites (Mayo Clinic, 2004, p.1). For this reason, patients included in these categories should be considered the target group when developing an educational or teaching plan. The plan should be geared towards the lifestyles of these patients.
There are numerous important aspects of SLE that need to be discussed with the patient. Discussion allows the patient to be involved and ask questions as they arise. Face-to-face interaction allows you to assess nonverbal cues from the patient. Lupus “causes the immune system to attack the body’s own tissue and organs” (Lupus Foundation of America, 2001, p.1). Lupus can go through periods of remission in which symptoms are not present. Symptoms of Lupus vary widely depending on the body system or systems being affected. Symptoms could include achy joints, frequent fevers of over 100 degrees, arthritis or swollen joints, extreme or prolonged fatigue, skin rashes, anemia, kidney problems, pleurisy, sun or light sensitivity, hair loss, seizures, and mouth or nose ulcers (Lupus Foundation of America, 2001, p.2). A butterfly-shaped rash across the nose and cheeks is considered the cardinal sign of Lupus. An estimated fifty percent of SLE cases result in a major organ being affected (Lupus Foundation of America, 2001, p.2). Emphasize to the patient that Lupus is not infectious. Due to the numerous systems that could be affected by SLE, providing the patient with a handout as reinforcement of information covered could be helpful. This handout could include a picture of the body with the symptoms that could be experienced written next to the particular body part involved. Handouts also provide a resource to assist the patient with finding answers to future questions.
Patients should be aware of factors that can trigger Lupus episodes. Such factors include “infections, antibiotics, ultraviolet light, extreme stress, certain drugs, and hormones” (Lupus Foundation of America, 2001, p.3). Lifestyle modifications should be implemented accordingly. Preventive measures should also be taken and include
“influenza and pneumococcal vaccination, TB screening, and patient education regarding the dangers of ultraviolet light, a prudent diet, and exercise” (Belmont, 1998, p.1). Because the symptoms of Lupus often mimic those of other conditions, Lupus is difficult to diagnose. Diagnosis is usually made by evaluating the person’s entire medical history, performing a physical exam, and by performing laboratory tests (Lupus Foundation of America, 2001, p.3). There is no single test to determine Lupus.
Although there is no cure for Lupus, treatment can minimize symptoms, reduce inflammation, and maintain normal body functions (Lupus Foundation of America, 2001, p.3). Treatment is aimed at the specific needs and symptoms of the patient. Medication usage is often determined by the organ or organs involved and by the severity of the disease. Medications commonly used to treat SLE include nonsteroidal anti- inflammatory drugs (NSAIDs), acetaminophen, corticosteroids, antimalarials, and immunomodulating drugs (Lupus Foundation of America, 2001, p.3). The patient should be instructed on the possible side effects of these medications. Side effects from these medications can be numerous. For example, side effects from the use of NSAIDs include headache, tinnitus, abdominal pain and cramping, constipation, diarrhea, and fluid retention (Karch, 2001, p.50). Over dosage of acetaminophen can result in liver damage (Karch, 2004, p.66). Corticosteroids have been known to cause insomnia, peptic ulcers, hyperglycemia, and edema (Karch, 2004, p.280). Use of immunomodulating drugs could result in immunosuppression, hepatotoxicity, pancreatitis, and reversible alopecia (Karch, 2004, p.344). Ongoing medical evaluation will be required. The patient should be provided with the name and phone number of his or her health care provider and also the hospital used by the provider. “With current methods of therapy 80-90% of people with non-organ threatening lupus can look forward to a normal lifespan” (Lupus Foundation of America, 2001, p.3).
Both the disease process of Lupus and also the medications used in treatment place the patient at increased risk of developing infections: therefore, the patient should be able to identify signs and symptoms of infection. It is imperative that the patient identify these symptoms so that early treatment can be implemented. Signs and symptoms of infection include fever, chills, productive cough, and increased warmth and redness at an incision or open wound site. Untreated infections can result in serious complications for patients with SLE.
In order to effectively teach a patient about Lupus, a combination of teaching methods must be utilized. The teaching plan must be individualized for each patient, and the patient must be motivated to learn. “To effectively care for a lupus patient, the nurse or other health professional needs an up-to-date knowledge and understanding of the disease, its manifestations, and its changing and often unpredictable course” (NIAMS, 2001, p.1).
References
Belmont, H. (1998). Lupus clinical overview. Retrieved January 4, 2005, from http://cerebel.com/lupus/overview.htm Karch, A. (2004). 2004 Lippincott’s nursing drug guide. Philadelphia, PA: Lippincott, Williams, & Wilkins.
Lupus Foundation of America. (2001). Lupus fact sheet. Retrieved January 5, 2005, from http://www.lupus.org/education/factsheet.html
Mayo Clinic. (2004). Lupus. Retrieved January 5, 2005, from http://www.mayoclinic.com/invoke.cfm?id=DS00115
National Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS). (2001). Lupus: A health care guide for nurses and other health professionals. Retrieved January 4, 2005, from http://www.niams.nih.gov/hi/topics/lupus/lupusguide/chp4.htm