Introduction
The nursing diagnosis is a result of an appropriate assessment of the patient’s symptoms, medical and family history. In the given case study, a thirty-five-year-old female called Mary suffers from a rash that appeared on her face one week ago after camping and hiking. The purpose of this paper is to suggest two presumptive nursing analyses and provide an adequate teaching and nursing care plan.
According to the described symptoms, the patient might have a risk for alteration in comfort related to joint pain or peripheral nerve inflammation or dysfunction related to systemic lupus erythematosus as evidenced by fatigue and rash on her cheeks and nose. Some researchers state that systemic lupus erythematosus is an autoimmune disease which is characterized by the increased level of serum autoantibodies that can fluctuate according to disease activeness (Tipton et al., 2015). The autoimmune diseases are characterized by an inappropriate response of the immune system against body’s cells, organs, and tissues. The patient’s mother suffers from another autoimmune disease such as rheumatoid arthritis.
Presumptive nursing diagnosis with teaching and nursing care plan
Teaching plan for this diagnosis includes basic hand hygiene to reduce skin infections related to skin damage. The patient should also be advised to decrease sun influence on the skin by wearing a hat or caring an umbrella in the sunny days. The information on using specific medications such as hydroxychloroquine to reduce rash should be given to the patient. This disease is incurable, and the patient will have to change some of her habits to achieve relief. Nursing care plan for systemic lupus erythematosus includes steroid creams used for her rash, corticosteroids to decrease the immune response, and the drugs for reduction of skin problems.
The patient might also have a risk of infection related to the inadequate primary defenses (broken skin) as evidenced by the fever and painful lesions. It is noted that “skin infections are among the most commonly reported infections causing hospitalization in SLE, while bacteremia and sepsis, often complicated by organ failure, are leading causes of in-hospital mortality” (Tektonidou, Wang, Dasgupta, & Ward, 2015, p. 1078). Skin infections are characterized by increased temperature and respiratory infections. The patient claims that she has a sore mouth and her temperature is 100.3 degrees by Fahrenheit scale.
Teaching plan for this diagnosis might include education on asepsis for wound care and dressing changes and importance of basic hygiene rules maintaining. The patient should be encouraged to intake food which is rich in proteins and a lot of fluid. The wounds on skin should be protected by a surgical mask. It is important not to contact with people who have a cold or some infections.
The patient’s family should be also educated to keep to certain hygienic rules such as covering face during sneezing or coughing to minimize the risk of infections for a patient. It is believed that the risk of infections for such patients is increased when they utilize immunosuppressive medications. Thus, all the necessary precautions should be taken to minimize infections. Nursing care plan for skin infections includes antibiotic treatment in case of infections. It is crucial to complete a full antibiotic course even if the disease symptoms disappear or improve.
Conclusion
The given paper dealt with the case study which involved the patient with a severe skin rash on her face. The possible diagnoses of this rash were defined as systemic lupus erythematosus complicated with skin infection evidenced by painful and itching lesions. The appropriate teaching and nursing care plans were identified for each of the presumptive nursing diagnosis.
References
Tektonidou, M. G., Wang, Z., Dasgupta, A., & Ward, M. M. (2015). Burden of serious infections in adults with systemic lupus erythematosus: A national population‐based study, 1996–2011. Arthritis Care & Research, 67(8), 1078-1085.
Tipton, C. M., Fucile, C. F., Darce, J., Chida, A., Ichikawa, T., Gregoretti, I.,… Mehr, R. (2015). Diversity, cellular origin and autoreactivity of antibody-secreting cell population expansions in acute systemic lupus erythematosus. Nature Immunology, 16(7), 755.