West Visayas State University

COLLEGE OF NURSING
La Paz, Iloilo City

Vision: WVSU as One of the Top 10 Universities in Southeast Asia by 2015

Mission: To produce globally competitive lifelong learners
Core Values: Service, Harmony, Excellence

LESSON PLAN: SYSTEMIC LUPUS ERYTHEMATOSUS

I. Topic: Systemic Lupus Erythematosus

II. Specific Objectives:

After 45 minutes of lecture-discussion, the level IV students will be able to:

Knowledge:

1. describe Systemic Lupus Erythematosus (S.L.E) comprehensively.

2. identify at least 2 etiologic factors contributing to the development of the disease.
3. trace correctly the pathophysiology of S.L.E. using a schematic diagram.
4. identify correctly the clinical manifestations of S.L.E.
5. name at least 3 complications of S.L.E.
6. enumerate at least 3 diagnostic procedures in SLE.
7. explain the medical management for SLE.
8. formulate at least 3 nursing diagnoses for patients with SLE with at least 3 nursing interventions for diagnosis.

Attitude:

1. demonstrate appreciation of the vital role of nurses in caring patients with S.L.E.
2. show appreciation of the importance of maintaining a normal immune system.
III. Content of Lecture:

A. Systemic Lupus Erythematosus

1. Definition
2. Etiologic Factors
a. Genetics
b. Environmental factors
c. Hormones
3. Pathophysiology
a. Schematic Diagram
4. Clinical Manifestations
a. Musculoskeletal
b. Cutaneous
c. Renal
d. Nervous System
e. Pulmonary
f. Cardiac
g. Hematologic
h. Gastrointestinal
i. Ocular
5. Complications
a. End Stage Renal Disease
b. Organic Brain Syndrome
c. Strokes
d. Myocardial Infarction
e. Acute Lupus Hemaphagocyte Syndrome
6. Diagnostic Tests
a. Antinuclear antibody (ANA) test
b. Complete Blood Count (CBC)
c. Erythrocyte Sedimentation Rate (ESR)
d. ANA- antinuclear antibody test
e. Urinalysis
f. Creatinine Clearance Analysis
g. C3 complement assay
h. GFR Scan
i. Anti-cardiolipin Antibody (IgG) & (IgM)
j. Xray
7. Medical Management
 a. Nonsteroidal anti-inflammatory drugs (NSAIDs
b. Corticosteroids
c. Immunosuppressive medications (Cytotoxic drugs)
d. Antimalarial agents
e. Antibiotic

8. Nursing Management
a. Nursing diagnoses
b. Nursing interventions

III. Methodologies:
Lecture-discussion
Powerpoint Presentation

IV. Requirements:
Attendance
Class Participation

V. Teaching Strategy:
Lecture-discussion

VI. Materials:
Microsoft PowerPoint Presentation
Handouts

VII. Evaluation:
Quiz/Post-Test 100%

VIII. References:

 Porth, C.M. (2002). Pathophysiology Concepts of Altered Healt States. 6 th Ed. Lippincott Williams & Wilkins.
 McFadden, E.R. Jr. (2005). Harrison’s Principles of Internal Medicine. 16 th Ed.
 Author Unknown (2008) Asthma. Retrieved February 13, 2009, from [Link]

Prepared by:
JENNIFER G. PINUELA
Student Lecturer

Noted:

Approved:

MERLINE S. POSECION, Ed.D.

Dean/Preceptor, Teaching and Supervision

West Visayas State University

COLLEGE OF NURSING
La Paz, Iloilo City

Vision: WVSU as One of the Top 10 Universities in Southeast Asia by 2015

Mission: To produce globally competitive lifelong learners
Core Values: Service, Harmony, Excellence

TIME CONTENT TEACHER ACTIVITY STUDENT ACTIVITY REFERENCES

ALLOTED
1 minute I. Introduction of self and topic to be discussed. Introduces self to the students and Recognizes the teacher’s
explains her purpose in discussing presence and understands the
the lesson. purpose of the student
teacher.
2 minutes II. Introduction to the topic States the objectives and contents Gain insights on what is Course Syllabus
a. Specific Objectives of the lecture. Informs the expected from the lecture as
b. Content of Lecture students what to expect during the well as how it will proceed.
 c. Basis for evaluation lecture and that an evaluation test
will be given afterwards.
5 minutes III. Motivational Activity Instructs and demonstrates on Participates actively with the
HATHA YOGA… some yoga exercises with the use yoga demonstration. Execute
of proper deep breathing and breathing exercises properly
body posture. while maintaining correct
posture.
Briefly explains what Hatha Yoga
is and its benefits and relates the
activity to the topic which will be
discussed.

Uses acoustic yoga sound to

soothe the atmosphere.

IV. Lecture Proper  Porth, C.M.

(2002).
1 minute A. SYSTEMIC LUPUS ERYTHEMATOSUS Pathophysiolo
gy Concepts
 Systemic: affects organs and tissue throughout the body. Presents a video clip about a Interactive listening. of Altered
 Lupus: Latin for “wolf” which refers to the rash that extends patient with SLE. Active participation on the Healt States.
across the bridge of the nose and upper cheekbones. lecture discussion. 6th Ed.
 Erythematosus: Greek word for red which is the color of the Gives an overview of the Answer questions raised by Lippincott
rash. definition of systemic lupus the teacher. Williams &
erythematosus. Wilkins.
 is an autoimmune disease in which organs, tissues, and cells  McFadden,
undergo damage mediated by tissue-binding autoantibodies Comprehensive lecture- E.R. Jr.
and immune complexes. discussion on the topic systemic (2005).
 chronic multisystem inflammatory disease that typically lupus erythematosus: presenting Harrison’s
affects the joints, serous membranes (pleura, pericardium), its definition, its various etiologic Principles of
and renal, hematologic, and neurologic systems. factors contributing to the Internal
development of the disease; Medicine. 16th
3 minutes B. ETIOLOGIC FACTORS tracing correctly the Ed.
pathophysiology of SLE;  Dirksen, S.R.,
UNKNOWN, but scientists predict that its cause is likely a identifying the clinical [Link]., (2004).
combination of genetic, environmental, and hormonal factors. manifestations involved; Medical
distinguishing the complications, Surgical
1. Genetics—no single “lupus gene” has yet been identified. and describing the diagnostic tests Nursing.3rd
Instead, multiple genes appear to influence a person’s chance of requested to support the diagnosis edition.
 developing lupus when triggered by environmental factors. of SLE. United States
 the most important genes are located in the Human of Ameirca:
Leukocyte Antigen region on chromosome 6, where Utilizes powerpoint presentation Elsevier
mutations may occur randomly or may be inherited. for the visual aides. Science
(USA), Inc.
2. Environmental factors
a. Medications (such as some antidepressants and antibiotics)
—causes reversible condition that usually occurs in patients
being treated for long-term illness; symptoms generally
disappear once the patient is taken off the medication that
triggered the episode.
b. extreme stress—weakens immune system
c. exposure to UV radiation—increases apoptosis in
keratinocytes and other cells or by altering DNA and
intracellular proteins to make them allergenic
d. Infections—stimulate responses (antibodies and activated T
lymphocytes) that cross-react with self or responses that, as
they mature, develop the ability to recognize self can
promote autoimmune responses that lead to SLE.

3. Hormones
-- occurs after the onset of menarche, with the use of oral
contraceptives, and during and after pregnancy because of increase
in the level of estrogen.
--estradiol binds to receptors on T and B lymphocytes, increasing
activation and survival of those cells, thus favoring prolonged
responses.

 some researchers have found that women with silicone gel-

filled breast implants have produces antibodies of their own
collagen.

5 minutes C. PATHOPHYSIOLOGY Uses a schematic diagram in

tracing the disease process.
Schematic diagram Uses laser pointer to emphasize
each step in the diagram.

7 minutes D. CLINICAL MANIFESTATIONS

Shows pictures of the different
  “great imitator” clinical manifestations of SLE.

Common initial and chronic complaints: Fever, malaise, joint

pains, myalgias, fatigue, weight loss

1. MUSCULOSKELETAL MANIFESTATIONS
 Lupus arthritis—non-erosive; 90% of patients
 <10% develop deformities of the hands and feet: swan-neck,
ulnar deviation and subluxation

 Polyarthralgia and morning stiffness—usually in small

joints of the hand, wrist and knees.
 diffuse swelling
 muscle weakness

2. CUTANEOUS MANIFESTATIONS
 Lupus dermatitits:
a. Discoid lupus erythematosus (DLE)—roughly circular, with
slightly raised, scaly, hyperpigmented erythematous rims and
depigmented, atrophic centers
b. Systemic rash—photosensitive, slightly raised erythema,
occasionally scaly on the face (cheeks and nose—the classic
“butterfly” rash); 50% of patients
c. Subacute cutaneous lupus erythematosus (SCLE)—scaly red
patches or attacks of circular red-rimmed lesions
 alopecia
 mouth, nasal and vaginal ulcers
 panniculitis or lupus profundus

3. RENAL MANIFESTATIONS
 Membranous glomerulonephritis—histological hallmark of
SLE; 50% of patients
 painless hematuria
 Proteinuria

4. NERVOUS SYSTEM MANIFESTATIONS

 seizures
 psychosis—can be the dominant manifestation; occurs in the
first weeks of glucocorticoid therapy
  cognitive dysfunction
 headache
 myelopathy

5. PULMONARY MANIFESTATIONS

 Pleuritis with or without Pleural effusion

 Tachypnea
 Cough
 Pneumonitis

6. CARDIAC MANIFESTATIONS
 Arrythmias
 Pericarditis
 myocarditis
 endocarditis(Libman-Sacks endocarditis)—non-infective

7. HEMATOLOGIC MANIFESTATIONS
 Anemia
 Leukopenia
 Thrombocytopenia

8. GASTROINTESTINAL MANIFESTATIONS
 Nausea and vomiting
 Diarrhea
 Vasculitis involving the intestines

9. OCULAR MANIFESTATIONS
 nonspecific conjunctivitis
 retinal vasculitis
 optic neuritis

E. COMPLICATIONS

1. End Stage Renal Disease

2. Organic Brain Syndrome—from deposition of immune
complexes within the brain tissue
3. Strokes
4. Myocardial Infarction
 5. Acute Lupus Hemaphagocyte Syndrome—rare blood
complication which is characterized by fever and a sudden
drop in blood cells and platelets

4 minutes F. DIAGNOSTIC PROCEDURES

Purposes: (1) to establish or rule out diagnosis, (2) to follow the

course of the disease, (3) to identify adverse effects of therapies.

1. Antinuclear antibody (ANA) test—a positive test for the

presence of these antibodies—produced by the immune
system—indicates a stimulated immune system.
2. Complete Blood Count (CBC)—measures the number of red
blood cells, white blood cells and platelets. Results may
indicate anemia.
3. Erythrocyte Sedimentation Rate (ESR)—determines at
which red blood cells settle at the bottom of a tube in an
hour. a faster than normal rate may indicate a systemic
disease, such as lupus.
4 minutes 4. ANA- antinuclear antibody test
-the higher the titer, the greater the degree of inflammation
-1:256 is positive; 1:32 is negative
5. Urinalysis—indicates organ involvement; may show an
increased protein level or red blood cells in the urine.
6. Creatinine Clearance Analysis- for determination of any
progression of renal disease
7. C3 complement assay test to examine total level of serum
complement (a group of proteins to be consumed in immune
reactions
-dec. in SLE
8. GFR Scan- determine the amount of kidney nvolvement
in SLE
9. Anti-cardiolipin Antibody (IgG) & (IgM)
-Associated with thromboembolic mplications
– Associated with mild-to-moderate PTT elevations
10. Xray- to determine if there are enlargement of heart, plaural
effusion, etc.
3 minutes G. MEDICAL MANAGEMENT

1. Nonsteroidal anti-inflammatory drugs (NSAIDs)—reduce

inflammation and pain in muscles, joints and other tissues.
exs: Aspirin, Ibuprofen (Motrin), Naproxen (Naprosyn)
2. Corticosteroids—more potent than NSAIDs an drestoring
function when the disease is active.
• Longterm use: increase risk of osteoporosis, cataracts,
diabetes, etc.
-daily calcium supplements are recommended
3. Immunosuppressive medications (Cytotoxic drugs)—used to treat
patients with a more severe manifestations of SLE with damage
to internal organs esp. nephritis.
exs. Methotrexate (Rheumatrex), Cyclophosphamide
(Cellcept),Cyclosporine (Sandimmune)
4. Antimalarial agents—used to treat polyarthritis and cutaneous
manifestations.
ex. Hydroxychloroquine (Plaquenil)
Longterm use: risk for glaucoma
(have an eye examination every 3-6 months)
5. Antibiotic- in treatment of ordinary & opportunistic infections

2 minutes H. POSSIBLE NURSING DIAGNOSES

• Pain r/t widespread inflammation process affecting

connective tissues
• Fatigue r/t increased energy requirements (chronic
inflammation)
• Alteration in body image
• Impaired skin/tissue integrity r/t chronic inflammation,
edema formation
• Infection
• Ineffective individual coping evidenced by fear of death

5 minutes I. NURSING MANAGEMENT

1. Protection from the sun

(To avoid photosensitivity reactions and disease flares
 -use sunscreen with UVA and UVB protection of at least
SPF 15.
-wear protective clothing, such as wide-brimmed hats and
long sleeves, when outside during the day.)
2. Compliance with medications and follow-up appointments
3. Complications involving organs should be treated by a physician
4. Patient should follow easy pattern of living, as free as possible
from stress and extremes.
Encourage to maintain a healthy active lifestyle.
5. To lessen fatigue, get at least 9 hours of sleep at [Link] the
day, take half-hour rest between periods of activity
6. Get a well-balanced diet
7. Exercise regularly but avoid jarring movements that stress joints
8. Do relaxation, meditation & deep breathing exercise
9. Encourage the patient to share feelings
[Link] family to verbalize their feelings about the illness
11. Provide spiritual support as requested.
Recommend spiritual artwork, music or reading materials
12. Alternate therapies such as leisure arts (art, literature, dance or
music)
13. Utilize resources and support
system

3 minutes V. Summary Reviews the salient points Recall salient points on the
discussed about systemic lupus topic discussed, may ask
erythematosus. Also, all questions questions for clarifications of
and clarifications of the students certain parts which are not
will be answered adequately. well understood.
10 minutes VI. Post-Test (20 items) Conducts an evaluative test based Answers the written test
on the topic previously discussed. quietly, honestly and
This is to assess the participant’s correctly.
learning and as well as their
attentiveness on the duration of
the lecture.
50minutes