A nurse is caring for a client with systemic lupus erythematosus (SLE) who is experiencing a flare-up. Which nursing intervention should be the priority?
1Implement energy conservation techniques and schedule activities during peak energy periods✓ 정답
2Apply cold compresses to inflamed joints for 15 minutes every 3 hours
3Encourage brief sun exposure to improve vitamin D synthesis
4Recommend low-impact exercise to maintain joint mobility
해설
Energy conservation is the priority for SLE flare-ups to manage fatigue and reduce immune stress. Other options are contraindicated: heat may worsen inflammation, sun exposure can trigger flares, and high-impact exercise increases joint stress.
Clinical Judgment
This question assesses the nurse's prioritization in managing an SLE patient's acute flare-up. The key is to connect the "flare-up" situation with the presented symptoms (joint pain, fatigue, butterfly rash) to identify the problem that is most debilitating and poses the most immediate risk. During a flare-up, the immune system is overactive, causing systemic inflammation and fatigue. In this context, Fatigue is not just a symptom; it is a major factor that impairs daily function, hinders recovery, and where excessive activity can trigger further exacerbation. Therefore, conserving energy and preventing exhaustion becomes the top priority in flare-up management.
Memory Tip:
Remember: Prioritize Pacing in Flares. The core nursing care during an SLE flare-up is Rest and Energy conservation.
KR vs US:
In Korea, there is a tendency to give general advice like 'get plenty of rest' for managing fatigue in SLE patients. In contrast, the US NGN/CJMM emphasizes systematically teaching Energy Conservation Techniques and analyzing the patient's daily activities to establish an individualized activity-rest plan. This is an approach focused on enhancing the patient's self-management abilities.
임상 시나리오
Clinical Practice Guide
Management of SLE patients during exacerbation:
1. Fatigue management: Educate on energy conservation techniques (task simplification, scheduling rest, using assistive devices).
2. Pain management: Hot compresses are contraindicated. Apply cold packs to inflamed joints to reduce swelling and pain.
3. Skin care: Ultraviolet (UV) light is a major trigger for SLE exacerbations. Explain photosensitivity and emphasize the essential use of sunscreen (SPF 30 or higher) and wearing hats and long-sleeved clothing.
4. Exercise: During exacerbations, avoid high-intensity exercise and recommend low-impact exercise (aquatic exercise, stretching) that places less stress on the joints.
Caution:
The key pitfalls in SLE questions are "Heat vs. Cold" and "Sun exposure". Cold compresses are the standard for inflammatory joint pain, and choices that recommend sun exposure for SLE patients are almost always incorrect.
핵심 개념
Systemic Lupus Erythematosus — A chronic autoimmune disease affecting multiple organs and systems. The immune system attacks the body's own tissues, causing widespread inflammation.
Flare-up (Acute Exacerbation) — A period when symptoms suddenly worsen or become active in a chronic disease. In SLE, fatigue, joint pain, rash, etc. worsen.
Energy Conservation Techniques — Strategies for managing fatigue by efficiently using limited energy. Includes work planning, incorporating rest, and prioritizing activities.
Butterfly Rash (Malar Rash) — Representative skin symptom of SLE. A butterfly-shaped erythematous rash across the nose and cheeks. Triggered or worsened by ultraviolet light.
Photosensitivity — Abnormal sensitivity reaction to sunlight or artificial ultraviolet light. Common in SLE patients, and can cause skin rash or worsening of systemic symptoms.