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A 20-year old female presents with chief complaint of fatigue, anxiety, and heart palpitations. She has recently given birth to her second child, a daughter. Initial recommendation from her follow up appointment is to rest. The patient’s symptoms worsen and then gradually resolve. Over the next year she has increased fatigue and headaches. She also starts to complain of joint pain in her ankles, knees, elbows, wrists, and fingers. Rest and over-the-counter pain medication relieve her symptoms, but it is difficult for her to find time for much rest due to the responsibilities of caring for a family and working full-time. The winter brings a new intolerance to low temperatures. She states her hands and feet becoming painful and discolored when she is exposed to cold. Her extremities became painful, stiff, and altered in color when exposed to cold temperatures. She also develops a butterfly rash.

DX: systemic lupus erythematosus.

Rx: prednisone and hydroxychloroquine

You are providing the patient with education on her new diagnosis. Create a patient teaching plan that covers the following questions.

1. What is lupus?

2. What key lifestyle changes will the patient need to address to manage her condition?

3. What are the important teaching points for her medications?

4. What are the recommendations to manage her symptoms, to avoid flare-ups, and to monitor her condition?

5. What symptoms, if they occur, should she report immediately to her provider and why?

Immune System: Systemic Lupus Erythematous

ADULTH Health 2 Teaching Team

1

2

STRESS!

3

Fatigue

4

5

Diagnostic Labs

6

A in “brain” = ANA

I = other Immunologic labs

dsDNA

Serum complements (C3, C4)

Cutaneous Manifestations of SLE

Oral ulcers

Photosensitivity

Malar rash

Discoid rash

7

8

Other Manifestations in SLE

9

Arthritis = A in SOAP

Blood

Anemia

Thrombocytopenia

Leukopenia OR leukocytosis

Neurologic

Psychosis

Seizures

Complications of SLE

Serositis

Pericarditis and myocarditis

Renal involvement

Medications for SLE

NSAIDs

corticosteroids

methotrexate

hydroxychloroquine

10

Prevent infection

Reduce stress

Don’t smoke

11

Exemplar (This is an example of a finished work)

Lupus Patient Education Activity

A 20-year old female presents with chief complaint of fatigue, anxiety, and heart palpitations. She has recently given birth to her second child, a daughter. Initial recommendation from her follow up appointment is to rest. The patient’s symptoms worsen and then gradually resolve. Over the next year she has increased fatigue and headaches. She also starts to complain of joint pain in her ankles, knees, elbows, wrists, and fingers. Rest and over-the-counter pain medication relieve her symptoms, but it is difficult for her to find time for much rest due to the responsibilities of caring for a family and working full-time. The winter brings a new intolerance to low temperatures. She states her hands and feet becoming painful and discolored when she is exposed to cold. Her extremities became painful, stiff, and altered in color when exposed to cold temperatures. She also develops a butterfly rash.

DX: systemic lupus erythematosus.

Rx: prednisone and hydroxychloroquine

You are providing the patient with education on her new diagnosis. Create a patient teaching plan that covers the following questions.

1. What is lupus?

SLE is an inflammatory, autoimmune disorder that affects nearly every organ in the body. SLE starts with the body’s immune system inaccurately recognizing one or more components of the cell’s nucleus as foreign, seeing it as an antigen. The immune system starts to develop antibodies to the nuclear antigen. 

1. What key lifestyle changes will the patient need to address to manage her condition?

Patient needs to monitor level of stress as it can affect physical health; The patient needs to avoid and manage these situations. Patient also needs to take medication as prescribed to reduce inflammation and symptoms such as fatigue.

1. What are the important teaching points for her medications?

Prednisone is used for immunosuppression and to reduce inflammation. Client education should include: Do not stop taking steroids abruptly. Gradually taper the dosage as prescribed.

Hydroxychloroquine is used for suppression of synovitis, fever, and fatigue, and decreases the risk of developing skin lesions from the absorption of ultraviolet light from sun exposure. Client education should include: Encouragement of frequent eye examinations.

1. What are the recommendations to manage her symptoms, to avoid flare-ups, and to monitor her condition?

1. Use steroid creams for skin rash.

1. Try to avoid stress and illness.

1. Take medications as prescribed.

1. Report evidence of infection related to immunosuppression.

1. Avoid crowds and individuals who are sick, because illness can precipitate an exacerbation.

1. Understand the risks of pregnancy with lupus and treatment medications.

1. Cleanse skin with mild soap and inspect for open areas and rashes daily.

1. Apply lotion to dry skin.

1. Avoid applying drying agents to skin, such as powder or rubbing alcohol.

1. Pat skin dry rather than rubbing.

1. Report chest pain to provider.

1. What symptoms, if they occur, should she report immediately to her provider and why?

Report chest pain to the provider. Patients may present with substernal chest pain that is aggravated by movement or inspiration. Other cardiac symptoms may involve myocarditis, hypertension, cardiac dysrhythmias, and valvular incompetence. Women with SLE are at risk for early-onset atherosclerosis, making them at risk to suffer myocardial infarction or stroke.