Ch. 17 Flashcards
systemic lupus erythematosus (SLE)
- chronic, progressive, inflammatory connective tissue disorder
- can cause major body organs/systems to fail
- spontaneous remissions and exacerbations
- autoimmune process
- autoimmune complexes tend to be attracted to glomeruli of the kidneys
- often some degree of kidney involvement
- F > M higher risk
- younger F (25-55 years(?))
lupus clinical manifestations/sx
- skin involvement: butterfly rash on nose
- polyarthritis
- osteonecrosis
- muscle atrophy
- fever and fatigue
- renal involvement
- pleural effusions
- pericarditits
- raynaud’s
- neuro manifestation: seizures (not common)
- serositis: inflammation of serous membranes: pericardial sac, lining of the lungs
psychosocial assessment of lupus
can be devestating
younger females with rash, feeling fatigued
- not wanting to go out and socialize
lupus assessment: labs
- skin biopsy (to confirm dx)
- immunologic-based lab tests
- CBC (pancytopenia: low RBC, WBC, plt counts)
- body system function
- renal function tests: BUN, Creatinine
lupus patient problems
- Persistent pain due to chronic inflammation and hypoxia from vasculitis-related reduced perfusion in many tissues and organs
- Fatigue due to chronic inflammation and hypoxia from vasculitis-related reduced perfusion in many tissues and organs, especially during flares
- Potential for loss of tissue integrity and organ failure with progression of the disorder and increased Inflammation and/or vasculitis
- Potential for decreased self-esteem due to changes in body image from disorder progression or drug therapy
lupus: management
Managing persistent pain
Managing fatigue
Preventing organ failure and reducing SLE activity periods (want to exercise but also rest)
Enhancing self-esteem
lupus drug therapy
**CORNERSTONE RX: oral corticosteroids: PO prednisone daily
Topical cortisone drugs
hydroxychloroquine: immune system* watch infection
Tylenol or NSAIDs
Chronic steroid therapy
Immunosuppressive agents
New drugs in clinical trials
- Lupozor
- Belimumab (Benlysta)
lupus: outcomes
- Understand the basis of the disorder and its management
- Accept the life-style changes needed to protect herself or himself to prevent complications (STAY OUT OF SUN/UV LIGHT)
- Be an active partner in the prescribed long-term SLE management plan
- Have pain levels reduced to the extent that she or he can participate in job-related, family, and social activities to a degree acceptable to her or him
- Have reduced number and severity of flares and longer periods of remission with low SLE activity
- Remain free from infection (more from s/e of meds)
- Express a positive perception of herself or himself
scleroderma: systemic sclerosis
Chronic, inflammatory, autoimmune connective tissue disease
younger women, 25-55 years
Not always progressive
Hardening of the skin
system wide disease
scleroderma classfications
Diffuse cutaneous
Limited cutaneous
crest syndrome
CREST
calcinosis: calcium deposits in skin (painful)
raynaud’s: vasospasm to extremities (fingers/toes)
esophageal dysmotility: not good GI motility, reflux-type sx
sclerodactyly: hardening of skin and hands
telangiectasia: spider veins due to dilation of capillary veins
hands and forearm edema with bilateral carpal tunnel syndrome usually first symptoms to occur
scleroderma clinical manifestations/ sx
- arthralgia: joint aches/stiffness
- renal and cardiac system involvement: BUN, Creatinine, BP
- problems with GI tract: motility issues
- lung involvement: fibrosis (hardening of tissues) in the lungs
“sausage fingers”
scleroderma interventions
- drug therapy: corticosteroids: prednisone on daily basis; immune modulators
- skin protective measures
- identify early organ involvement
- comfort
- GI management: for GERD-like sx
- mobility: to reduce inflammation
lyme disease
caused by spirochete borrelia burgdorferi, resulting from bite of infected deer tick
- stages I, II, III
- chronic complications- arthralgias, fatigue, memory/thinking problems
- sometimes first and only s/sx is arthritis
lyme disease rash
bull’s eye rash
