Butterfly Rash On The Skin By Lupus

Systemic lupus erythematosus (SLE), is an autoimmune disease that affects the connective tissue of the body. This disease doesn’t always show signs and symptoms. It will have occasional exacerbations here and there, but in worst cases the signs and symptoms and exacerbations can be deliberating. In this passage some of the things that will be discussed are the prominent butterfly rash across the nose and on the cheeks. Nutrition will also be discussed, and this will be the effects that vitamin D can do for someone with SLE. This will also include some client education, medical management and treatment and some of the laboratory test for this disease.

Pathophysiology

“Systemic lupus erythematosus is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail” (Ignatavicius, Workman, & Rebar, 2018) (p.326). Many live with this disease. Some experience the exacerbations more often than other. These exacerbations may also lead to a more serious point of the disease process. As stated by Iggy, the ANA cause the body to primarily attack itself leading to inflammation, damage, and destruction to the organs in the body and usually appears during at ages 20 to 40 years old. SLE tends to lead to death from kidney failure, cardiac and central nervous system involvement according to Iggy p. 326.

Risk Factors

The risk factors of SLE according to ATI’s RN Adult Medical Surgical Nursing book are:

1. Women between the ages of 20 and 40
2. African American, Asian, and Native American
3. Diagnosis in older women may be delayed due to the manifestation mimicking other disorders or associated with the aging process.

These risk factors are very broad but should be taken into consideration if any manifestation occur that are similar to SLE. It is a serious disease and should be treated as soon as diagnosed to slow the disease process down and try and prevent early major organ failure or death.

Clinical Manifestation

A study about the symptoms of SLE from the journal article titled, Early symptoms of systemic lupus erythematosus (SLE) recalled by 339 SLE patients, showed that 81.7 percent of the patients had joint pain as an early symptom of SLE. Some more common manifestation stated in Iggy p. 326 are the butterfly rash, nephritis, pericarditis, Raynaud’s phenomenon, pleural effusion, pneumonia, CNS involvement, abdominal pain, myositis, fever, fatigue, anorexia, weight loss, generalized weakness, and vasculitis. These may all not appear in a person with lupus. They may not also have them all the time. Like stated above, these manifestations can occur during exacerbation or remission of the disease. I’ve seen an exacerbation of lupus that came along suddenly. My youth pastor was fine one week and the next he was in the hospital for what seemed like forever. He was eventually moved from a hospital to a rehab facility where he was expected to get better because his exacerbations and the manifestations that occur with lupus where not as prominent like they were when he arrived at the hospital. Unfortunately, the disease had gotten the best of him. He was one of those that had the frequent pneumonia and the infamous butterfly rash. These manifestations can occur anytime and at random.

Complications

The more serious manifestations are lupus nephritis pericarditis, and myocarditis according to ATI’s Adult Medical Surgical Nursing book. These complications can potentially lead to death which, of course, is the more serious complication. Some complications associated with the treatment with immunosuppressants are bone marrow suppression, and increased liver enzymes, and a complication with NSAIDS can be hepatis. With the treatment of this disease the medications can cause liver damage so keeping a close eye on the liver is just as important as keeping an eye on the kidneys and heart, remembering that SLE can lead to organ failure.

Standards of Practice

Medical management and pharmacological treatment of SLE is usually done with immunosuppressant drugs, NSAIDS, corticosteroids, and antimalarial drugs. These drugs treat the progression and the symptoms like joint inflammation. The medical management that could help these patients are recommendations to support groups, physical therapy to help the patient move easier with the joint inflammation and occupational therapy. The provider may not diagnose the disease right away since the signs and symptoms aren’t that noticeable at the beginning stages of the disease, some may become progressively ill before they are diagnosed. “The cause of SLE is unknown, but is believed to be a defect in immunological mechanism…” (Silvestri, 2017) (p. 970). Some lab tests that can help diagnose this disease are an immunological test, BUN and creatinine, urinalysis, and a CBC. The immunological is what is mainly used to diagnose SLE. The urinalysis, BUN, and creatine can tell the provider if there is any kind of kidney involvement. Nutritional considerations for SLE are anorexia, limiting salt intake, and consuming or replacing vitamin D. As stated in the ATI Adult Medical Surgical Nursing book, providing small frequent meals can help for a patient with anorexia. It also states that limiting salt intake will help with fluid retention. Since a patient with SLE gets fatigued easily it may be recommended that they consume or replace their vitamin D intake to help with said fatigue. Vitamin D can also increase the immunity of someone on these immunosuppressant drugs, “…a recent randomized, placebo-controlled trial found that vitamin D supplementation (50,000 IU/week) significantly reduced disease activity…” (Nguyen, Bryant, & O'Neill, 2018) (p. 2007). A diet plan for someone SLE may differ from day to day depending on how the patient feels. They could be anorexia so offering the small frequent meals may need to be loaded with protein only if the patient doesn’t have any sort of damage or disease to the kidneys. Doing so could help with the weight loss and with the fatigue and generalized weakness they may be experiencing.

Standards of Care

Some priority nursing actions for a patient with SLE could include recommendations to a SLE support group. Making the patient feel comfortable and letting them be independent as mush as possible. This will help the patient feel like they can still do things for themselves and not focus to much on their disease. Make sure the client is moving in bed and isn’t getting any type of bedsores, also check for skin tears as some may have fragile skin or rashes. A big nursing action is administering the medications to this patient. Another nursing actions is watching and assessing for signs of any organ involvement as stated in the Saunders NCLEX-RN book. Some client education for someone with SLE are report any signs of infection as this could lead to serious illness due to the patient being immunosuppressed, use mild soaps and shampoos (this will help keep the rashes caused by SLE limited to appearing during exacerbations) and lastly avoid crowds because the immunosuppressants taken for this disease as stated in ATI Adult Medical Surgical Nursing book.

References

1. Henry, N. E., McMIcheal, M., Johnson, J., DiStasi, A., Ball, B. S., Holman, H. C., . . . Lemon, T. (2016). RN Adult Medical Surgical Nursing. ATI nursing education.
2. Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). Medical-Surgical Nursing: Concepts for Interprofesstional Collaberative Care. St. Louis: Elsevier.
3. Leuchten, N., Milke, B., Winkler-Rohlfing, B., Daikh, D., Dörner, T., Johnson, S., & Aringer, M. (2018). Early symptoms of SLE recalled by 339 SLE patients. Lupus, 1432.
4. Nguyen, M., Bryant, K., & O'Neill, S. (2018). Vitamin D in SLE: a role in pathogenesis and fatigue? A review of the literature. Lupus, 2007.
5. Silvestri, L. A. (2017). Saunders Comprehensive Review for the NCLEX-RN Examination. St. Louis: Elsevier.