SYSTEMATIZATION OF NURSING CARE FOR PREGNANT WOMEN DIAGNOSED WITH BULLOUS SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

INTRODUCTION: Systemic Lupus Erythematosus (SLE) is a chronic, multisystem inflammatory disease of unknown cause and autoimmune nature, characterized by the presence of several autoantibodies. It evolves with polymorphic clinical manifestations, with periods of exacerbations and remissions. Of not fully understood etiology, the development of the disease is linked to genetic predisposition and environmental factors, such as ultraviolet light and some medications. It has a predilection for females, especially affecting women of reproductive age, with a ratio of nine women to every man (1). Bullous Systemic Lupus Erythematosus (BLE) is a rare subtype of Systemic Lupus Erythematosus (SLE) in which during the progression of the disease there will be the appearance of blisters on the skin, often associated with identified lesions and additional complications (2). Its occurrence during pregnancy is particularly important as it directly or indirectly impacts maternal and perinatal health, with high risks of fetal loss, premature birth, fetal growth restriction and hypertension. Although advances in diagnosis and treatment have improved outcomes, lupus is still associated with high morbidity. Lupus activity during pregnancy and in the six months preceding it, a history of lupus nephropathy, high blood pressure, and positivity for antiphospholipid antibodies are the main factors associated with unfavorable outcomes (3). Nursing Care Systematization (NCS) is a structured and interrelated process that aims to organize nursing care practices, providing individualized and safe care for the patient. In the context of pregnant women with systemic lupus erythematosus, NCS becomes essential for the implementation of effective and safe care, since SLE is a chronic and complex disease that requires constant monitoring and specific actions. NCS allows the operationalization of the Nursing Process (NP), which involves nursing assessment, diagnosis, planning, implementation, and nursing evolution, providing continuous care adapted to the needs of the pregnant woman. Furthermore, it contributes to improving the quality of care, since each stage of the process is carried out based on the specific needs of the pregnant woman and the consequences resulting from lupus. When applied in acute or clinical contexts, NCS also ensures that the care provided is continuous, resilient and adjusted to changes in the patient's health status (4). Furthermore, improving the standards of preconception and gestational care for women with lupus should be one of the primary objectives of obstetric monitoring. The adoption of a specific care protocol for these women is essential to ensure that this objective is achieved (3). OBJECTIVE: To describe the application of the Systematization of Nursing Care (NCS) in the care of pregnant women with bullous systemic lupus erythematosus. MATERIAL AND METHODS: This is a descriptive experience report, resulting from an extracurricular internship in a maternity hospital, on the systematization of nursing care for pregnant women diagnosed with bullous lupus erythematosus, in the region of Belém-PA, in the year 2024. Nursing care began with welcoming the pregnant woman, followed by admission, which included a complete interview (socioeconomic data, personal history, family history, obstetric history and medications in use), evaluation of the pregnant woman's booklet and vaccination card, cephalopodal physical examination, obstetric evaluation (uterine dynamics, fetal heartbeat and uterine height), verification of vital signs, nursing prescriptions and care guidelines. The daily routine includes interdisciplinary care, involving a physician, occupational therapist, psychologist, and nursing staff (nurse and nursing technicians), with the nurse being responsible for managing care, due to 24-hour care. The nursing staff at the monitoring and evaluation center cleaned and applied simple dressings to the skin lesions present, and more complex dressings were performed by the wound outpatient clinic team at the public health institution. Skin lesions were assessed daily and described in the nursing care plan in the electronic medical record. The pregnant woman received guidance on body hygiene care and the appropriate use of oral and topical medications. The nursing staff developed inclusion activities at the center, through health education, for this client to interact with other pregnant women. Due to the lack of knowledge about this autoimmune disease, the other pregnant women were afraid of approaching and making contact. Recreational activities were carried out at the center, such as movie time, and art therapy activities were also carried out with painting and creating drawings, developing the skills motor skills and providing well-being. Thus, the systematization and nursing care was established beyond just disease care, it also occurred through health education and important interaction between women, providing discussions on topics that can be considered controversial. RESULTS: The experience allowed a broad view of nursing care, considering all the needs of pregnant women, presented throughout their stay. Skin lesions were healed due to care that included cleaning and dressing, and the inclusion of the outpatient team was essential for this healing process of more complex lesions, which provided an improvement in self-esteem. The daily recording of the pregnant woman's conditions in the electronic medical record allowed greater interaction of the multidisciplinary team, establishing a comprehensive line of care and the insertion of the care plan by health professionals. The execution of inclusion activities promoted an exchange of knowledge on various subjects, clarified doubts about care during pregnancy, created bonds and brought pregnant women closer together, making the environment more welcoming and familiar. Nursing guidelines provided better body care, involving the pregnant woman throughout the process, and also scheduled medications and procedures related to their appropriate use. Art therapy was essential in nursing care, bringing the professional closer to the pregnant woman, creating trust in the care and bonding until the moment of preparation for childbirth. It was also considered a therapeutic activity that improves motor skills and provides distraction of the mind. The experience allowed a humanized view of nursing care during pregnancy, contributing to the training process through decision-making, autonomy and inclusion in the care process. In addition, the experience provided knowledge about the practice of nursing, through care management, seeking alternatives that could improve the client's condition. CONCLUSION: Care for pregnant women with bullous systemic lupus erythematosus requires a personalized approach that is attentive to clinical and emotional complications. The application of the Nursing Care Systematization (NCS) ensures continuous and effective monitoring, minimizing the risks of fetal loss and premature birth. Furthermore, it is essential to offer emotional and psychological support to the pregnant woman, promoting comprehensive care that guarantees her physical and mental health. Efficient communication between the nursing team is also crucial to monitor the progress of the pregnancy and adapt the care plan according to the pregnant woman's needs. With this approach, it is possible to improve perinatal outcomes and provide a safer pregnancy for mother and baby.