Cutaneous Lupus Erythematosus: Nursing Care Plan Essay Example

Presumptive Nursing Diagnosis

The accuracy of diagnosis is dependent on various factors. Subjective and objective assessments assist in acquiring the information about the patient’s condition (Rosdalh & Kwalski, 2008). In the context of the presented case, the presumptive nursing diagnosis is Cutaneous Lupus Erythematosus. This autoimmune disease has a special set of symptoms such as rash, fatigue, fever, and shallow oral ulcers (Kuhn, Lehmann, & Ruzicka, 2005). Nonetheless, the rationale for the chosen diagnosis will be presented with the help of subjective and objective assessments.

As for the evaluation of patient’s health and social background, it could be said that there are several factors, which can contribute to the development of Cutaneous Lupus Erythematosus. Her medical record does not portray any recent chronical diseases and illnesses while tonsillectomy was present at the age of nine. In turn, she has never been hospitalized previously. Moreover, the information about her parents does not offer any reasoning for any chronical diseases. A combination of these factors indicates no possibility of the chronical illness as a potential diagnosis.

Sequentially, the physical examination supports the presumptive diagnosis. As it was mentioned earlier, the primary symptoms of Cutaneous Lupus Erythematosus are rash (focused on the face), fatigue, and the unreasonable rise in temperature (Kuhn et al., 2005). The examination of the patient revealed the similar symptoms. To support the initial hypothesis, Mary has rash erythematous plaques on her cheeks and nose, shallow ulcers in the mucosa and complains about fatigue (BP 112/62 mm Hg) and fever (100.3 F). At the same time, a high reaction to sun and pains in muscles underline the reasoning for the preliminary diagnosis. In the end, it could be said that both objective and subjective evaluation emphasize that the possibility of Cutaneous Lupus Erythematosus as a presumptive diagnosis.

Teaching and Nursing Care Plan on This Case

Increasing awareness of the patient and providing information about his/her medical condition is critical in the first place. In this case, initially, one has to pay attention to patient’s learning style by making observations and having a conversation (Bastable, 2016). Based on the findings, written, oral, or visual presentation will be conducted to deliver the information about the disease to the patient. General facts about Cutaneous Lupus Erythematosus will be provided with the assistance of the commonly accepted language. Thus, the medical terms have to be avoided. Meanwhile, particular attention has to be paid to the treatment of the disease, as the patient has to be prepared for challenges and be optimistic about the outcomes of the medical intervention.

Speaking of the nursing care plan, the first step is to conduct another examination to determine the nature of the rash in more details. Blood testing will help see any changes in the percentage of leukocytes and ANA (American Skin Association, 2016). The next step is to reveal whether any internal organs are affected by the disease. MRI scanning can be used to disclose the existence of any abnormalities. Based on the assessments performed previously, it will be possible to prescribe suitable medications such as corticosteroid creams to treat the skin lesions and oral drugs including methotrexate and azathioprine (American Skin Association, 2016). At the same time, the patient will be asked to apply sunscreen creams before going outdoors and avoid sunlight (American Skin Association, 2016). The second appointment will be scheduled within a week to check the progress of the interventions.


American Skin Association. (2016). Cutaneous Lupus Erythematosus. Web.

Bastable, S. (2016). Essentials of patient education. Burlington, MA: Jones & Bartlett Learning.

Kuhn, A., Lehmann, P., & Ruzicka, T. (2005). Cutaneous Lupus Erythematosus. Dusseldorf, Germany: Springer.

Rosdalh, C., & Kwalski, M. (2008). Textbook of basis nursing. New York, NY: Wolters Kluwer Health.

Professional Development And Nursing Education


The nursing profession is the largest part of the health care personnel. Today, it comprises about 3 million members. Working directly with patients, nurses play a major role in helping to understand the objectives of the 2010 Affordable Care Act and improving the health care system of the United States of America (Institute of Medicine, 2011). To understand the impact of the 2010 IOM report on the overall future of nursing, its influence on nursing education, practice, and the nurse’s role as a leader has to be considered.

The Impact of the IOM Report on Nursing Education

Over the past century, the health challenges in the United States of America have increased significantly. The nation’s healthcare needs have increased accordingly. According to the Institute of Medicine (2011) “How nurses were educated during the 20th century are no longer adequate for dealing with the realities of health care in the 21st century”. Nursing education specialized in acute care instead of public health and primary care. It had to be revised and updated to comply with today’s needs of the patients, modern science, and technology achievements (Institute of Medicine, 2011).

To develop a more educated workforce, severe changes in the education of nurses are required, including the education before and after receiving the nursing license. The license should serve as a way to continue learning and getting to higher degree programs. There are several programs such as LPN-to-BSN, AND-to-BSN, AND-to-MSN designed for the transition between undergraduate and graduate programs (Institute of Medicine, 2011).

Today, in the United States of America, one of the issues that continue to interrupt the nurses’ workforce is high turnover rates. It can be fixed by paying more attention to the newly graduated nurses’ transition from education to practice. Nurse residency programs can help newly graduated nurses to transit into practice by giving them knowledge and skills. Also, these programs develop the necessary leadership skills (Institute of Medicine, 2011).

The Impact of the IOM on Nursing Practice

Changing of health care system requires a reconsidering of healthcare workers, including nurses. Being trained and educated to provide a lot of medical services, today, nurses are ready to meet the needs of providing patient-centered care, delivering more primary care, and delivering care in the community as opposed to acute care (Institute of Medicine, 2011). Today’s nurses work with a full variety of health care services. Sometimes nurses provide services that are usually considered to be a physicians’ work, but with additional social and medical care.

One of the major advantages of primary care nursing is that the patient builds trust in his or her nurse. This type of nursing has proved to be beneficial for the fast recovery of patients and building a nurse-client relationship (Dunphy et al., 2015). Nowadays, among other services nurses provide, they manage possible medical errors, decrease the spread of infections, and help patients to move on to home treatment. Despite this fact, most states continue to limit the nursing practice (Institute of Medicine, 2011).

Today, primary care in the United States of America is ready to have more implementation than it has now. Nurses should be allowed to practice using all of their education, skills, and competence. The outdated health care services should be replaced by modern ones, in which nurses should play a meaningful role. This will lead to the improvement of a health care system in general.

The Impact of the IOM Report on the Nurse’s Role as a Leader

To transform the health care system, leadership from nurses is necessary at every level of the health care system. Nurses should begin to learn leadership skills as early as it is possible. They should be given the most relevant knowledge and practical skills to get ready for their nursing practice.

To become leaders, nurses should cope with policy. They have to become a part of the policy and have a voice in health care decisions. Nurses must make changes using their leadership knowledge to improve the quality of patient care. Nurses must learn the leadership principles to create partnerships that will help to develop the quality of health care services (Bleich, 2011).


To understand the impact of the 2010 IOM report on the overall future of nursing, its influence on nursing education, practice, and the nurse’s role as a leader has to be considered. Over the past 100 years, the health care needs in the United States of America have increased significantly. To make nurses ready to challenge the current issues of health care, their educational program must be changed. Nurses should be given more theoretical and practical knowledge on the transition from education to work. Having a wide range of skills, nurses should be given a chance to use it to improve the health care system. To increase the quality of patient centered-care, nurses must be allowed to become leaders, and to make decisions on changes in the health care system.


Bleich, M. R. (2011). IOM report; The future of nursing: Leading change, advancing health: Milestones and challenges in expanding nursing science. Research in nursing & health, 34(3), 169-170.

Dunphy, L. M., Winland-Brown, J., Porter, B., & Thomas, D. (2015). Primary Care: Art and Science of Advanced Practice Nursing. Philadelphia, PA: FA Davis.

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.

North Miami Community Health Assessment


The community selected for this assignment was North Miami, a large community that is in a relatively good condition; however, it included some of the problematic areas. This review is focused on the primary characteristics of the community in terms of socio-economic dynamics, living conditions, and health-related issues. North Miami is a densely populated suburban city in Miami-Dade County, Florida.

Community Vitality

The community appeared rather vital. The streets were moderately busy with a lot of people outside. In the day time, most of the residents of 30 and 40 years of age were walking in a purposeful manner as if to or from work, driving cars or riding public transportation. In the evening, the streets were less busy, and the people outside were 20 to 30 years of age predominantly. They were walking in groups of 4 or more people. Populations of all ages were seen, the most common age being 30 and older. Two ethnicities seemed to dominate the community – Hispanic (or Latino) and white. Mainly, people appeared healthy and were dressed well. Older people were accompanied by their spouses or younger relatives. Also, the percentage of overweight residents was rather high – about 25%.

Indicators of Social and Economic Conditions

Most buildings in the area were the small one-family houses, the vast majority of which was in good state. However, there were areas in the poorer state with deteriorating multifamily buildings and decaying public areas. Buses were the most common mode of public transportation. Bus stops were majorly in good conditions; however, some lacked shares and benches. There are many small businesses in the areas many of which announced having vacancies.

Homeless people were visible in the poorer districts. Most of there were men gathered in groups of 3-4. Also, at night, there were large groups of young males walking together (5-10 people). The area is suburban with some urban districts. There are not farms nearby; the major businesses are the larger manufacturing organizations and factories. No political posters were observed or any visible interest towards politics. However, there were billboards related to health education (smoking and its impact on children and safe sex specifically).

Health Resources

Several hospitals and medical centers were noticed in the area. They specialized in geriatrics, pediatrics, and emergency care. Also, several dentist offices and a dental clinic were found providing services to all groups of the population. Some of the bigger facilities were located in the center of the area. Some newer organizations were placed at the edge of the community. Access to them was complicated. Several relatively large nursing homes were seen that could accommodate about 20 people. Additionally, multiple pharmacies were noticed all around the area. However, the size of the community’s population points at an increased need for health care services. It is likely that some parts of the community are underserved and have limited access to care.

In the poorer districts of the community, it was possible to notice multiple heavily littered areas where there could be sanitary concerns such as pests; however, no actual stray animals were visible. Also, there is a risk of air and noise pollution due to the active traffic. Overcrowded and decaying housing and public buildings could only be found in the poorer parts of the community. The rest of it seemed to be well-managed and maintained in good condition. The streets were well-lit in the evening, and the traffic lights were in place. The roads were safe without any hazardous curves and sections.

Recreational centers and playgrounds for children were noticed in different parts of the area; also, there are two large parks in the territory of North Miami. The food was sold in the streets quite often, and in many cases, there were no sitting areas around.

Social Functioning

Many families were seen in the parks. In the poorer areas mostly women with young children were observed, no couples. One group of adult women and men was seen to clean up, paint, and fix children’s playground. In the areas with one-family houses, the neighbors were seen speaking to one another in groups or sitting together and resting.

In poorer areas there were signs of juvenile delinquency such as adolescents in the streets on schooldays and the defiled walls of public facilities.

Attitude toward Health and Health Care

Several wellness centers and herbal shops were found in the area. There was also one poster of an individual calling herself a healer. The health resources are used actively. One poster of a seminar concerning alcohol and drug addictions was observed near a hospital.

Vulnerable Population

The most vulnerable group are the residents of the low-income areas who were underserved and facing limited access to health care. The areas where this population dwells are also littered and could have pests.


The assessed area is economically divided into higher and lower income communities, both of which are numerous. The latter is underserved in regard to health care and is facing environmental challenges related to health (pollution, litter, deteriorating buildings, and limited access to health care)

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