Avoid direct exposure to sunlight to reduce the
chance of exacerbation.
Behavior modification to prevent exacerbations and
to reduce symptoms.
Joint protection and energy conservation.
Close follow-up for evaluation of
cardiac, neurologic, renal, and other body systems.
Referral to specialists for systemic manifestations.
Obtain clinical history, review systems, and perform
physical examination for characteristic findings.
Assess for signs and symptoms of infection and
other side effects to medications.
Assess patient's and family's ability to cope with
impact of prolonged disease.
Fatigue related to chronic inflammation and altered
immunity as evidenced by lack of energy inability to
maintain usual routine
Acute pain related to inflammatory process and
inadequate comfort measures as evidenced by
complaints of joint pain lack of relief from pain
relieving measures ,reduction of activity to avoid
exacerbation of pain
Impaired skin integrity related to photosensitivity
,skin rash ,and alopecia as evidenced by rash
anywhere on body butterfly rash on face hairless
areas of ulceration on fingertips, complaints of
urticaria and photosensitivity
Knowledge deficit related to lack of exposure to and
unfamiliarity with information resources as
evidenced by questions about SLE
misinterpretation of information and inaccurate
follow -through of instruction
NURSING INTERVENTIONS REDUCING PAIN
Administer and teach self-administration of
use of hot or cold applications, relaxation
INCREASING CONTROL OVER DISEASE
Instruct patient to avoid factors that may exacerbate
Avoid exposure to sunlight and ultraviolet light.
Use sunscreen with sun protection factor (SPF)of 15 or
greater. Avoid prolonged sun exposure.
Wear protective, lightweight clothing, long sleeves, hats.
Avoid use of tanning beds.
Avoid exposure to drugs and chemicals.
Avoid exposure to hair spray
Avoid exposure to hair-coloring agents.
Teach self-administration of pharmacologic agents to
reduce disease activity.
Encourage good nutrition, sleep
habits, exercise, rest, and relaxation to improve general
health and to help prevent infection.
Encourage ventilation of feelings, counseling, or
referrals to social work, occupational therapy, as
MAINTAINING SKIN AND MUCOUS MEMBRANE
Apply topical corticosteroids to skin lesions as
Suggest alternative hairstyles, scarves, and wigs to
cover significant areas of alopecia.
Encourage good oral hygiene and inspect mouth for
Avoid hot or spicy foods that may irritate oral ulcers.
Apply topical agents or analgesics to reduce pain
to promote eating.
Advise patient that fatigue level will fluctuate with
Encourage patient to modify schedule to include
several rest periods during the day, pace activity
and exercise according to body's tolerance, use
energy conservation techniques in daily activities.
Teach relaxation techniques, such as deep
breathing, progressive muscle relaxation, and
imagery to reduce emotional stress that causes
PRESERVING URINARY ELIMINATION
Assist with monitoring of urinary status as indicated
by degree of renal involvement.
Monitor intake and output and urine specific gravity.
Measure urine protein, micro albumin, or obtain24-
hour creatinine clearance, as ordered.
Check test results of serum blood urea nitrogen
(BUN) and creatinine.
PATIENT EDUCATION AND HEALTH
Stress that close follow-up is mandatory, even in
times of remission, to detect early progression of
organ involvement and to alter drug therapy.
Advise on the use of special cosmetics to cover
skin lesions.Advise about reproduction.
Avoid pregnancy during time of severe disease
Immunomodulators may have teratogenic effects.
Use of some drugs for treatment of SLE can result
Uric acid is the major end product of purine
catabolism and is primarily excreted by the kidneys
hyperuricemia may be result of of increased purine
synthesis decreased renal excretion or both, Gout
results from an overabundant accumulation and
subsequent deposition of uric acid in the body.
CLINICAL MANIFESTATIONS ACUTE GOUTY
Generally affects one joint—often first
Other joints can be affected, such as ankle, knee;
upper extremities are less commonly involved.
Pain, warmth, erythema, and swelling of tissue
surrounding the affected joint.
Fever may occur.
Onset of symptoms is sudden; intensity is severe.
Duration of symptoms is self-limiting; lasts
approxi-mately 3 to 10 days without treatment
CHRONIC TOPHACEOUS GOUT
Occurs if acute gout is inadequately treated or if it
Characterized by development of tophi or deposits
of uric acid in and around joints, cartilage, and soft
Arthritis is more prolonged in nature with discrete
attacks less common.
Caused by hyperuricemia (persistent elevation of
uric acid in the blood).
Kidney stones are composed of uric acid.
Deposition of uric acid in kidney tissue.
Synovial fluid analysis.
Identification of monosodium urate crystals under
Synovial WBC count can range from 2,000 to
Culture of synovial fluid to rule out infection.
24-hour urine for uric acid to determine
overproduction of uric acid versus under excretion.
X-rays of affected joints show changes consistent
with diagnosis of gout.
NSAIDs—for acute attacks to relieve pain and
Colchicines—for prevention of acute attacks and
Oral at onset of an attack, taken hourly until pain
relief or first signs of toxicity (nausea, vomiting
Intra-articular if attack confined to one joint.
Oral—in short tapering course if other treatments
are contraindicated or if attack involves many joints.
Uricosuric drugs, such as probenecid
(Benamid), inter-fere with
tubular reabsorption of uric acid.
Allopurinol (Zyloprim)—interferes with conversion of
hypoxanthine and xanthine to uric acid.
Avoidance of obesity.
Avoidance of alcohol.
Low-purine diet gives only a minor decrease in
serum uric acid levels.
Obtain history for factors predisposing to gout.
Perform physical examination.
Inspect involved joint.
Observe for tophi:
a) Pinna of ear.
b) Olecranon bursa
c) Achilles tendon.
Assess pain and pain relief pattern if attack is acute
NURSING INTERVENTIONS RELIEVING PAIN
Administer and teach self-administration of pain
relieving medications as prescribed.
Encourage adequate fluid intake to assist with
excretion of uric acid and to decrease likelihood of
Instruct patient to take prescribed medications
consis-tently because interruptions in therapy can
precipitate acute attacks.
Elevate and protect affected joint during acute
Assist with activities of daily living.
Encourage exercise and maintenance of routine
activity in chronic gout, except during acute attacks.
Protect draining tophi by covering and applying
anti-biotic ointment as needed.
Instruct patient and family about nature of disease.
Encourage to avoid alcohol.
Avoid rapid weight loss by fasting or crash
Avoid medications known to increase uric acid
Advise prompt treatment of acute attack
Instruct in signs and symptoms of allopurinol
Review foods containing purine