Ch 88 Sytemic Lupus Erythematous

Question 1

What is SLE

Answer 1

It is an autoimmune disorder in which atypical immune response results in chronic inflammation and destruction of healthy tissue.

Question 2

What can trigger autoimmune disorders

Answer 2

In autoimmune disorders small antigens may bond with healthy tissue. The body then produces antibodies that attack healthy tissue… This may be triggered by toxins, meds, bacteria, mad or viruses.

Question 3

Is there a cure for autoimmune disorders

Answer 3

No

Question 4

Name other autoimmune disorders

Answer 4

Rheumatoid arthritis
Vasculitis
Multiple sclerosis
Scleroderma ( including Raynaud's phenomenon)
Psoriasis

Question 5

Occurrence of auto immune disorders increases with what

Answer 5

Age

Question 6

What is SLE characterized by

Answer 6

Periods of exacerbations and remissions

Question 7

SLE can be classified into what 2 groups

Answer 7

Discoid SLE- primarily affects the skin; characterized by butterfly rash on the nose and cheeks, generally self limiting

systemic SLE- affects the connective tissues of multiple organs systems and can lead to multiple organ failure

Question 8

What causes medication induced SLE

Answer 8

Procainamide
Hydralazine
Isoniazid

Question 9

What are risk factors for SLE

Answer 9

Female between the ages of 20-40
African American, Asian, or Native American descent
The incidence of SLE declines in woman following menopause. It remains steady on men.

Question 10

What is subjective data of SLE

Answer 10

Fatigue/ malaise
Alopecia
Blurred vision 
Pleuritic pain
Anorexia/ weight loss
Depression
Joint pain, swelling, tenderness

Question 11

What is objective assessment data of SLE

Answer 11

Fever( a major symptom of exacerbation)
Anemia
Lymphadenopathy
Pericarditis ( presence of a cardiac friction rub or pleural friction rub)
Raynaud’s phenomenon ( arteriolar vasospasm in response to cold/ stress)
Butterfly rash on face

Question 12

What are lab tests to diagnose SLE

Answer 12

+ ANA titer ( antibody produced against ones own DNA)
Anti - DNA + ( not specific to SLE but in the majority of ppl)
Anti sm +
Anti- RO (SSA) +
Anti - LA ( SSB) +
Anti - RNP +
Anti- phospholipids (AP) +
Serum complement C3,C4 decreased
BUN & Cr increased with renal involvement
Urinalysis + for protein and RBC ( renal involvement)
CBC- pantocytopenia

Question 13

What are systemic manifestations of SLE

Answer 13

HTN and edema & urine output indicate renal compromise
Diminished breath sounds indicate pleural effusion
Tachycardia and shape insipiratory chest pain indicate pericarditis
Rubor, pallor and cyanosis of hands, feet indicate vaculitits/ vasospasm, Raynaud’s phenomenon
Arthalgias, myalgias and polyarthritis indicate joint and connective tissue involvement
Changes in mental status indicates neurological involvement
Nutritional status

Question 14

What are medications for SLE

Answer 14

1. NSAIDS- used to reduce inflammation and arthritic pain
   ( NSAIDS are contraindicated in renal compromise / monitor for drug induced hepatitis)
2. Corticosteroids { prednisone, deltasone}( monitor for fluid retention, HTN, and renal dysfunction)
3. Immunosuppressant agents { methotrexate, azathioprine}
4. Anti malarial { hydroxychloroquine , Plaquenil}

Question 15

Why are corticosteroids used to treat SLE

Answer 15

It is used as an immunosuppressant and to reduce inflammation

Question 16

Why are anti malarial drugs used to treat SLE

Answer 16

They are used for the suppression of synovitis, fever and fatigue

Question 17

What is a recommended teaching of the use of corticosteroids

Answer 17

Do not stop taking steroids or decrease dose abruptly

Question 18

What is recommended teaching of immunosuppressant agents such as methotrexate and azathioprine

Answer 18

Monitor for toxic effects ( bone marrow suppression, increased liver enzymes)

Question 19

What are nursing considerations of anti malarial medications

Answer 19

Encourage frequent eye exams

Question 20

What is client education care after discharge instructions

Answer 20

Avoid UV and sun exposure ( use sunscreen when outdoors)
Use mild protein shampoo and avoid harsh hair treatments
Use steroid creams for skin rash
Report peripheral and peri orbital edema promptly
Report evidence of infection related to immunosuppression

Question 21

What are complications of SLE

Answer 21

Lupus nephritis
Clients whose SLE is unable to b managed with immunosuppressants and corticosteroids may experience renal failure secondary to glomerulonephritis… THIS IS A MAJOR CAUSE OF DEATH AND A RENAL TRANSPLANT MAY BE NECESSARY

Question 22

What is pericarditis and myocarditis

Answer 22

Inflammation of the the heart, it’s vessels and the surrounding sac can occur secondary to SLE
( monitor for chest pain, fatigue, arrhythmias and fever)

Question 23

For a client with suspected systemic SLE, what are anticipated lab findings?

Answer 23

+ ANA
^ urine protein due to renal involvement
decreased C3,C4
^ BUN

Question 24

For a client prescribed prednisone, what should be included in the teaching

Answer 24

Prednisone causes fluid retention which results in weight gain
Because of the weight gain, abdominal striae may appear in the abdomen

Moon fancies ( rounding of the face due to accumulation of fatty tissue) is an adverse effect of this medication