Based on the symptoms, it is possible to assume that the patient has lupus. Lupus is an autoimmune, inflammatory disorder. It progresses as a result of impairments in the immune system when it starts to treat the body cells as foreign and try to destroy them (Maidhof & Hilas, 2012). Because of this, allergic reactions appear. The etiology of the disease remains unclear, but it is considered that genetic, hormonal, immunological, and environmental factors take part in the development of lupus altogether (Maidhof & Hilas, 2012). However, in the case of Mary, her condition was likely aggravated by the environmental factors.

Female gender and the age from 15 to 50 years are the primary risk factors for lupus (Nichols, 2016). Since the patient is a young woman, she may be predisposed to the development of the disease. Another important factor contributing to the progression of illness is the exposure to ultraviolet (UV) light. According to Barbhaiya and Costenbader (2014), UV radiation is an important immunomodulatory component in lupus development. Since the patient reports the aggravation of the symptoms after being outdoors, and since the rash first appeared when she was hiking, Mary is likely UV light-sensitive, and the exposure to excess UV radiation exacerbated the development of the pre-existing disease.

Teaching and Nursing Care Plan
Lupus is associated with the following problems: increased risk of infections in urinary and respiratory tracts, skin infections, cardiovascular disease, changes in weight, kidney disorders, adverse impacts on central nervous system, nutrition problems, as well as impaired functionality due to fatigue and other difficulties (U.S. National Institutes of Health, 2017). Based on this, the major intervention goals will include the minimization of fatigue, emergence of lesions, incidence of infections, and discomfort; the maintenance of weight; and the reduction of risks for the alteration of mental status in the patient.

First of all, it is important to alleviate discomfort associated with the dermatological lupus manifestations (itchy and painful rash) and reduce the appearance of lesions. Mary should be informed about UV light-protective practices and behaviors including the regular use of sunscreen with a high level of SPF. She should also be educated about other risk factors which may contribute to the aggravation of her condition, e.g., medication, smoking, etc.

In order to minimize fatigue, the patient should be encouraged to design an energy-conserving plan for her daily activities and normalize the time of sleep (U.S. National Institutes of Health, 2017). It can also be recommended to intervene Mary’s dietary habits and encourage the engagement in moderate physical activities as they may help her to become more energetic.

It is essential to educate the patient on how to identify the comorbid conditions and symptoms promptly. For instance, it is suggested to teach patients to monitor their temperature throughout the lupus flares and recognize the symptoms of urinary and respiratory infections (U.S. National Institutes of Health, 2017). For instance, sore throat is one of the primary symptoms of respiratory infections. It means that Mary is at risk of severe inflammation development. For this reason, it can be useful to check her current immunization status and inform the patient about existing options for the minimization of infections. However, in this case, it is also critical to provide the information on medicines which can potentially induce lupus flares.

Lastly, since the disease may cause some psychological, cognitive, and mental changes, the nurse should instruct Mary on possible coping mechanisms and provide information about available sources of support. A greater level of family members’ involvement should be encouraged as the sufficient psychological and emotional support is vital for positive patient outcomes.