Running head: CARE PLAN FOR SLE 1
Care Plan for Systemic Lupus Erythematosus
1. Patient status- Patricia Doyle is clinically sick but does not require emergency department
management because she does not have severe thrombocytopenia or rapid progress of
glomerulonephritis (Yildirim-Toruner & Diamond, 2011). However, she requires prompt
treatment to avoid serious complications such as systemic vasculitis, severe neurological
impairment, diffuse alveolar hemorrhage, profound thrombocytopenia and a rapidly progressive
glomerulonephritis (Bartels, 2013).
2. Nursing Interventions
The treatment of systemic lupus erythematosus is highly dependent on disease severity
and the presenting signs and symptoms (Askanase, Shum, & Mitnick, 2012). Nonetheless, the
mainstay drug for managing SLE on a long-term basis is hydroxychloroquine although it gets
preserved for severe manifestations of the disease (Ahmadpoor, P.; Dalili, N.; Rostami, 2014).
Mild and moderate forms of SLE get managed by the use of low-potency immunosuppression
agents, NSAIDs or a short course of corticosteroids. Involvement of the vital organs such as the
central nervous system and kidney is considered severe forms of the SLE (Bertsias George et al.,
2012). Therefore, Patricia Doyle is suffering from severe SLE due to the presence of proteinuria,
pitting edema and hematuria which are signs of renal damage.
Lupus nephritis management is by use of immunosuppressive agents and glucocorticoids
to prevent its progression to end-stage renal disease. However, patients with Level I and Level II
lupus nephritis do not the use of immunosuppressive medications. Besides, those with
proteinuria of more than 500mg per day should receive ACE inhibitors or ARBs drugs to reduce
protein loss and decrease the progression of the disease (Koutsokeras & Healy, 2014). Patricia
, CARE PLAN FOR SLE 2
Doyle has not gotten to the severe forms of lupus nephritis, and thus, glucocorticoids and
hydroxychloroquine are enough to manage her condition (Lisnevskaia, Murphy, & Isenberg,
2014). Specifically, her treatment will include:
• 0.5mg of intravenous methylprednisolone administered slowly for over one hour daily for
three days.
• 400mg hydroxychloroquine tablet administered as a STAT dose then followed by a
maintenance dose of 200mg once per day until symptoms get relieved.
Hydroxychloroquine can cause side effects such as headaches, dizziness, nausea and
vomiting, leukopenia, thrombocytopenia and aplastic anemia. Besides, methylprednisolone can
cause several adverse effects such as adrenal suppression, emotional instability, and glucose
intolerance among others. Therefore, the patient should be informed and monitored for these side
effects to avoid other complications and promote compliance.
3. Referrals- SLE can cause several complications in essentially all the organs in the body.
Hence, several consultations are required to prevent these early complications. A rheumatologist
is needed to rule out rheumatoid arthritis in the course of treatment. An infectious disease
specialist is needed for immediate assessment and management of infections because the
treatment of SLE gets associated with immunosuppression. A neurologist is necessary to manage
involvement of the CNS while a cardiologist to take care of cardiac complications. Other
specialists who are beneficial for consultations include pulmonologists, nephrologists,
gastroenterologists, hematologist and a dermatologist to manage the complications in the
particular organs and tissues (Bartels, 2013).
4. Laboratory tests- the accurate identification of SLE get based on the clinical findings and
appropriate laboratory results. The standard laboratory tests for diagnosing SLE include a
complete blood count with its differentials, urinalysis with microscopy and serum creatinine.
Care Plan for Systemic Lupus Erythematosus
1. Patient status- Patricia Doyle is clinically sick but does not require emergency department
management because she does not have severe thrombocytopenia or rapid progress of
glomerulonephritis (Yildirim-Toruner & Diamond, 2011). However, she requires prompt
treatment to avoid serious complications such as systemic vasculitis, severe neurological
impairment, diffuse alveolar hemorrhage, profound thrombocytopenia and a rapidly progressive
glomerulonephritis (Bartels, 2013).
2. Nursing Interventions
The treatment of systemic lupus erythematosus is highly dependent on disease severity
and the presenting signs and symptoms (Askanase, Shum, & Mitnick, 2012). Nonetheless, the
mainstay drug for managing SLE on a long-term basis is hydroxychloroquine although it gets
preserved for severe manifestations of the disease (Ahmadpoor, P.; Dalili, N.; Rostami, 2014).
Mild and moderate forms of SLE get managed by the use of low-potency immunosuppression
agents, NSAIDs or a short course of corticosteroids. Involvement of the vital organs such as the
central nervous system and kidney is considered severe forms of the SLE (Bertsias George et al.,
2012). Therefore, Patricia Doyle is suffering from severe SLE due to the presence of proteinuria,
pitting edema and hematuria which are signs of renal damage.
Lupus nephritis management is by use of immunosuppressive agents and glucocorticoids
to prevent its progression to end-stage renal disease. However, patients with Level I and Level II
lupus nephritis do not the use of immunosuppressive medications. Besides, those with
proteinuria of more than 500mg per day should receive ACE inhibitors or ARBs drugs to reduce
protein loss and decrease the progression of the disease (Koutsokeras & Healy, 2014). Patricia
, CARE PLAN FOR SLE 2
Doyle has not gotten to the severe forms of lupus nephritis, and thus, glucocorticoids and
hydroxychloroquine are enough to manage her condition (Lisnevskaia, Murphy, & Isenberg,
2014). Specifically, her treatment will include:
• 0.5mg of intravenous methylprednisolone administered slowly for over one hour daily for
three days.
• 400mg hydroxychloroquine tablet administered as a STAT dose then followed by a
maintenance dose of 200mg once per day until symptoms get relieved.
Hydroxychloroquine can cause side effects such as headaches, dizziness, nausea and
vomiting, leukopenia, thrombocytopenia and aplastic anemia. Besides, methylprednisolone can
cause several adverse effects such as adrenal suppression, emotional instability, and glucose
intolerance among others. Therefore, the patient should be informed and monitored for these side
effects to avoid other complications and promote compliance.
3. Referrals- SLE can cause several complications in essentially all the organs in the body.
Hence, several consultations are required to prevent these early complications. A rheumatologist
is needed to rule out rheumatoid arthritis in the course of treatment. An infectious disease
specialist is needed for immediate assessment and management of infections because the
treatment of SLE gets associated with immunosuppression. A neurologist is necessary to manage
involvement of the CNS while a cardiologist to take care of cardiac complications. Other
specialists who are beneficial for consultations include pulmonologists, nephrologists,
gastroenterologists, hematologist and a dermatologist to manage the complications in the
particular organs and tissues (Bartels, 2013).
4. Laboratory tests- the accurate identification of SLE get based on the clinical findings and
appropriate laboratory results. The standard laboratory tests for diagnosing SLE include a
complete blood count with its differentials, urinalysis with microscopy and serum creatinine.
