Systemic lupus erythematosus

Question 1

What is SLE also referred to?

Answer 1

The look good feel bad disease

Question 2

What is lupus?

Answer 2

Autoimmune multisystem inflammatory disease

Question 3

Is Lupus more common in men or women?

Answer 3

Women (10 X more likely)

20 - 40 years old

Question 4

Course of lupus?

Answer 4

Chronic, unpredictable remissions and exacerbations

Question 5

Where does lupus typically affect?

Answer 5

Skin
Joints
Serous membranes (pleura, Pericardium)
Renal, hematologic, neurologic systems

Question 6

Lupus: clinical manifestations

Answer 6

Joint pain (90%) - earliest symptom of lupus. Polyarthralgia with morning stiffness may precede other symptoms by years.

• Pain and stiffness tends to move from one body part to another
• Doesn’t usually affect both sides of the body the same way
• Typical joins = fingers, wrists, knees
• Joints may be swollen and warm

Question 7

More Lupus clinical manifestations

Answer 7

Photosensitivity (rash occurs after exposure)
Butterfly Rash (50%) - after being in the sun; lasts a couple of days. Does return.
Lupus Nephritis (40%) - Within 5 years of Dx
Anemia/ Thrombocytopenia/ mild leukopenia (Pancytopenia)
Unexplained fever
Extreme fatigue (debilitating)
Raynaud Phenomena
Unusual hair loss
Edema in legs and around eyes
Ulcers of mouth and nose
Pleurisy and pericarditis

Question 8

Nervous system cues related to Lupus

Answer 8

Difficulty concentrating
confusion
depression
Headache
seizures
Lupus cerebritis (brain inflammation)

Question 9

What is the most common area of skin affected my lupus

Answer 9

Head

Question 10

Lupus arthritis can cause?

Answer 10

Disfiguration of the fingers (swan neck)

Question 11

Lupus diagnosis

Answer 11

Based on distinct criteria revealed through patient history, physical exam and lab findings

No one test is diagnostic for SLE

Question 12

What is the most specific lab for SLE?

Answer 12

Anti-DNA

Question 13

What does the ESR and CRP look like for a Lupus pt?

Answer 13

Increased

Question 14

What does the serum compliment look like?

Answer 14

Decreased

Question 15

What does the CBC look like?

Answer 15

Pancytopenia

Question 16

What does the urinalysis look like?

Answer 16

Proteinuria, hematuria, and blood cell casts

Question 17

Lupus - Possible nursing problems

Answer 17

Fatigue
Impaired skin integrity (skin rash)
Impaired comfort or pain
Body image disturbance
Ineffective coping
Deficient knowledge
Ineffective self health management
Risk for infection
Risk for bleeding
Ineffective role performance

Question 18

Is Lupus drug therapy individualized?

Answer 18

Yes depending on predominant symptoms and organ involvement

Question 19

Drug therapy for Lupus

Answer 19

Hydroxychloroquine - Nearly all patients

• Mild - With or without NSAIDS and or short term glucocorticoids
• Moderate - Short term therapy of 5-15 mg of prednisone daily
• Severe/ life threatening - Intensive immunosuppressants (methotrexate) and high dose steroids to halt tissue injury

Question 20

What is the cornerstone of treatment for SLE?

Answer 20

Hydroxychloroquine

Question 21

Lupus: collaborative care

Answer 21

Chronic and unpredictable = challenge for patient/family

Question 22

Collaborative care: Care during exacerbations directed toward

Answer 22

Fever
joint inflammation
Limitation of movement
Location/degree of discomfort
Fatigue
Monitor adverse effects of steroid therapy
Monitor neuro status

Question 23

Patient teaching

Answer 23

Avoid triggers:
UV light
Abruptly stopping drug therapy
avoid infections

Psychosocial issues r/t 
Pain and fatigue
chronicity
Pregnancy/ sexual counseling
Body image disturbances