# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=540852  
> language: ko  
> subject: Adult Health

## 문제

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?

## 보기

1. Implement energy conservation techniques and schedule activities during peak energy periods **✔ 정답**
2. Apply cold compresses to inflamed joints for 15 minutes every 3 hours
3. Encourage brief sun exposure to improve vitamin D synthesis
4. Recommend low-impact exercise to maintain joint mobility

**정답: 1**

## 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.

## 심화 해설

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: **P**rioritize **P**acing in **F**lares. The core nursing care during an SLE flare-up is **R**est and **E**nergy 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.

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