Lupus Flashcards
Lupus
Multisystem inflammatory autoimmune disease
Causes of lupus
Genetic influence
Hormones
Enviromental factors
Certain medications
Classifications
Systemic lupus erythematous
Discoidlupuslimited toskin
Drug induced lupus
Neonatal lupus
Discoid lupus
Round coin shape rashes
Limited to skin
Tend to be more to upper body
Risk factors
Women20-40 (child bearing yrs)
More common in African Americans, Asian Americans, Hispanics, native Americans than in whites
1 trigger of lupus
Sunlight
Other triggers of lupus
Ultraviolet light
Stress
Exposure to chemicals
Top 3 meds that cause lupus
Procainamide
Hydralazine
Quinidine
Flare ups are predictable t/f
False
Severity of SLE
Is extremely variable
Effects skin
Kidneys
Muscles
Lungs
Heart
Nervous tissue
3 main things SLE effects
Cardiopulmonary , neurologic, urinary
Cardiopulmonary s/s
Endocarditis
Myocarditis
Pericarditis
Pleural effusion
Pneumonitis
Raynaud’s phenomenon
Other s/s ofSLE
Fever of unknown origin, achy , extreme fatigue, weight loss, arthralgia
Integumentary problems SLE
Malar “butter fly “rash
Rash with sunlight exposure
Oral /nasopharyngeal ulcers
Discoid lesions
Musculoskeletal probs
Polyarthralgia with morning stiffness
Arthritis
Swan neck fingers
Ulcer deviation
Subluxation with hyperlaxity of joints
Increase risk of bone loss and fracture
Muscle pain
Cardiopulmonary s/s2
Dyspnea
Cough
Pleurisy
Raynauds
Dysrhythmias(fibrosis of SA &AV nodes)
Pericarditis
What do we get from pt every 3-6 month
A renal sample everytime they go to the doctor
Filter is damaged
And larger proteins molecules get through
Glomerulonephritis
And lupus nephritis
Also watch hypercoagability
Hyper-coagulability
Micro clots
Can effect vision and kidneys
After 2nd year of being diagnosed
Most pt may have kidney damage
If scarring and permanent damage pt can go into ESRD
Nervous system problems
Seizures
Peripheral neuropathy
Congnitive dysfunction
Psychiatric - depression and anxiety
Hematologic probs
Formation of antibodies against blood cells
Anemia
Leukopenia
Thrombocytopenia
Coagulation disorders
Anticoagulation therapy
Aspirin , plavix
SLE are typically
Immunocompromised
Effect of immunosuppressive effect of anti inflammatory drugs
ESR &&& CRP
monitor for treatment
Usually elevated , easy test and very inexpensive will be ran on a regular basis to see how pt is reacting to treatment
SLE is primarily diagnosed
Primarily on criteria relating to pt history , physical examination and laboratory findings
SLE diagnostic criteria
“Soap brain MD”
Serositis(pleuritis, pericarditis)
Oral ulcers
arthritis
Photosensitivity
Blood disorder
Renal disorder
Ana +
Immunologic disorder
Neurologic disorder
Malar rash
Discoid rash
If pt has 4/11 on criteria soap brain md
Then it is highly likely they have lupus
Most common problems with SLE
Persistent pain(joints and muscles)
Chronic inflammation
Fatigue
Possible loss of tissue integrity (from rashes)
Self esteem decreased r/t body image
+Ana
Anti nuclear antibodies
Antimalarial drug/lupus
Hydroxychloroquine
First drug of choice
Most of the RA drugs can be used to treat lupus but not all of them t/f
True
NSAIDS for lupus
For arthralgia feelings
Immunosuppressive drugs can also be combined with what to treat lupus
Hydroxychloroquine
Corticosteroids for lupus
In short intervals used only in flare ups
What are all drugs that a lupus can be on
NSAIDS
Hydroxychloroquine
Immunosuppressive
Corticosteroids
Anticoagulant
Uses for hydroxychloroquine
Discoid lupus or SLE
RA
Malaria
What does hydroxychloroquine do?
Reduce antibodies , reduce pain and inflammation
, prevent lupus flares and prevent organ damage
Side effects of hydroxychloroquine
Hepatotoxicity
Dysrhythmias (heart feels like skips a beat)
Retinal damage
education for hydroxychloroquine
Eye exam every 6 months
Call HCP -fever bleeding bruising vision changes
(Will effect clotting ability)
What is the goal when treating lupus
Prevent exacerbation
How can we prevent exacerbation?
Maintain good nutrition
Avoid exposure to infections
Teach client about medications
Avoid sunlight exposure
CallHCP before taking immunizations
Avoid pregnancy
What kind of immunizations can lupus pt take
Not live vaccines
Flu, pneumonia
How can we monitor for adequate tissue perfusion?
Assess for impaired peripheral perfusion- are they developing s/s of neuropathy , color changes , vision changes etc
Prevent injury to extremities
Monitor for fluid retention(perfusion to kidneys)
Effective pain control
Encourage rest between activity
Nsaids for arthritic pain
Ice, heat, elevation
Corticosteroids (flare up )
How can we monitor renal function in lupus
Monitor for edema, HTN , hematuria & UO \
BUN & creatine
Monitor for utis& glomerulonephritis
Assess for excess fluid volume
(Daily weight)
What can we do when lupus starts showing s/s of CNS involvement (headache, inappropriate speech, difficulty concentration, memory loss)
Assess for mood change
Encourage use of support groups& other resources
Lupus flares
Acute care
May quickly become very ill
Encourage pt to keep logs
What worked, what didnt
What do we observe for in acute care
Fever pattern
Joint inflammation
Limitation of motion(monitor changes of ROM)
Location and degree of discomfort
Fatigue
Acute care nursing implantation
Monitor weight & I&O
Collect 24 hour urine sample
Assess neurologic status
Visual problems
, headaches
Seizures
Personality changes memory loss
Explain nature of disease
Provide emotional support
Pregnancy and lupus
Councel against pregnancy
Be vigilant on BC
If they want a baby OB and specialist need to communicate
Some meds may impact placenta and blood vessels of placcenta
What happens during pregnancy and lupus
Sometimes people are better and sometimes flare ups are worse
Miscarriage is a high risk and so is still born
What can happen in post pardon pt ?
Flare ups
How can I evaluate?
Use energy conservation techniques
Lifestyle changes
Adherence to medication
Avoid /delay organ dysfunction
Maintain positive thinking
