Systemic Lupus Erythematosus Flashcards
SLE potential causes
Genetic with 1st degree family members
women (estrogen)
stress
exposure to toxins, sunlight, UV lights
40 Different medications
What are the top 3 meds causing lupus?
Procainamide (Pronestal)
Hydralazine (Apresaline)
Quinine
Isoniazid(from video)
Describe Lupus in 4 words
Multisystem inflammatory autoimmune disease
-affects multiple organs but knowingly causes reddening of the skin
Pathology of Lupus
susceptibility genes pt is triggered by an environmental factor (sunburn)
cell DNA becomes damaged and undergoes apoptosis and dies
the DNA from the nucleus is exposed and causes the susp. genes to attack forming nuclear antigens and unable to clear the dead cells out
Antibodies are formed for the nuclear antigens
The antigen-antibodies complex form and enter the bloodstream
they attach to the bloodstream and organs causing inflammation
Complement system with enzymes allowing for fluid to enter cells and continue cell deaths
When antibodies attach to WBC, RBC, and phospholipids and caused phagocytosis this is called?
Type 2 Hypersensitivity
What month is Lupus month?
May
When tissues become damaged as a result of the antibody-antigen complexes it is called?
Type 3 Hypersensitivity
What are the different classifications of Lupus?
SLE - most common
Discoid - limited to skin upper - round rashes
Drug-induced
Neonatal Lupus
Risk factors of SLE
unpredictable alternating remissions and worsening
Women 20-40
AA, Asian, Hispanics, and Native Americans more than Caucasians
unexpected flares
The severity of SLE is
extremely variable
- range from disorder to rapidly progressive
SLE most commonly affects what systems
skin
kidneys
muscles
lungs
heart
nervous tissue
What are the biggest complications of SLE
pneumonia
sepsis
kidney failure
What are the skin conditions of SLE?
alopecia
Butterly malar rash
rash with sunlight exposure
discoid erythema
palmar erythema
mucosal ulcers (oral and pharyngeal)
What are the neuro conditions of SLE?
stroke
seizures
peripheral neuropathy
psychosis
cog. impaired (disordered, disoriented, and memory deficit)
What are the psychiatric conditions of SLE?
depression
anxiety
What are the cardiopulmonary conditions of SLE?
inflammation of all heart parts (endo, myo, and peri)
Dyspnea and cough
dysrhythmias
pleural effusion (pleurisy)
pneumonitis
Raynaud’s phenomenon
SLE dysrhythmias are caused by what
fibrosis of the SA and AV nodes
SLE pericarditis can develop into
endocarditis (out to in)
What are the urinary conditions of SLE?
glomerulonephritis
hematuria
proteinuria
Lupus nephritis
Renal samples need to be assessed every
3-6 months
Proteinuria
the filter is damaged and larger molecules (protein) get through and out of the urine
Lupus nephritis
Kidney disease caused by lupus may get worse over time and lead to kidney failure
- from the complexes being excreted
Hypercoagulability
antiphospholipid state
more prone to clots
DVT
hepatic vein thrombosis
stroke
lifelong therapy
SLE can lead to what severe renal problem?
end-stage renal disease (75%)
What are the blood conditions of SLE?
anemia
leukopenia
lymphadenopathy
splenomegaly
thrombocytopenia
blood clotting problems at the ends of fingers turn red and purple
What tx is used for anticoagulant therapy?
aspirin
Plavix
comadin
What are the GI conditions of SLE?
abdominal pain
dysphagia
N/V/D
What are the musculoskeletal conditions of SLE?
Polyarthralgia with morning stiffness no limitation
arthritis (swan-neck, ulnar deviation, subluxation with hyperlaxity)
myositis (muscle pain)
synovitis
SLE has an ______________ risk of bone loss and fx.
increased
What are the reproductive conditions of SLE?
menstrual abnormalities
What are the systemic conditions (c/o) of SLE?
low-grade fever
wt loss expected
rash
arthralgia (joint pain)
extreme fatigue
in a women of child bearing age
Why is SLE a systemic illness?
antibodies stick to various areas causing inflammation and damage to multiple organs
Raynaud’s phenomenon
T/F: SLE is more susceptible for infection.
True
Why are SLE pts more susceptible to infections?
defects in the ability to phagocytize invading bacteria
deficiency antibody production
immunosuppressive therapy from anti-inflammatory or steroids
Diagnosis for SLE
Anti-DNA 50%
Anti-Smith antibodies 30-40% always dx
ANA 97%
CRP and ESR increased
What tests are monitored for treatment response?
CRP
ESR
increased
SLE is primarily diagnosed on criteria r/t
pt hx
physical exam
lab findings
T/F: There is no one test to dx SLE.
True
only a process of elimination
If treatment works in a SLE pt, the CRP and ESR do what
decrease
If at least _____ of the criteria on SOAP BRAIN MD is present at the present time or at some time in the past, this is a strong criterion of lupus.
4
Mnemonic for SLE Dx criteria
SOAP BRAIN MD
What are the SLE Dx criteria?
Serositis (pleuritis, pericarditis)
Oral ulcers
Arthritis - 2+ joints
Photosensitivity
Blood disorder (low blood, WBCs, etc)
Renal disorders (protein or casts in urine)
ANA + 97%
Immunologic disorder (anti-DNA, Sm, or + antiphospholipid)
Neurologic disorder (seizure/psychosis)
Malar rash (butterfly)
Discoid rash
Serositits
inflammation of the lining around the lungs (pleuritis) or inflammation of the lining around the heart that causes chest pain which is worse with deep breathing (pericarditis)
Photosensitivity
a reaction to sun or light that causes a skin rash to appear or get worse
Malar rash
a rash over the cheeks and nose, often in the shape of a butterfly
Discoid Rash
rash that appears as red, raised, disk-shaped patches
-chronic and can scar
Most common problems with SLE
cues
persistent pain overall
chronic inflammation
- rash low skin integrity
fatigue
possible loss of tissue integrity
self-esteem low body image
Major classes of drug therapies
NSAIDs
Antimalarial/antirheumatic
Immunosuppressives (combined)
Corticosteroids (short during flares)
Anticoagulants
RA and SLE drugs are
similar in treatments
Antimalarial/Antirheumatic Drugs
hydroxychloroquine (Plaquenil) – 1st used
Hydroxychloroquine (Plaquenil) Uses
Discoid Lupus/SLE
RA
Malaria
Hydroxychloroquine (Plaquenil) Prevents/Reduces
Reduces the amount of autoantibodies
Reduces pain & inflammation
Prevent lupus flares
Prevent blood clots
Prevent organ damage
Hydroxychloroquine (Plaquenil)
monitor and assessments
Monitor CBC, LFT, glucose
Assess low TENDON REFLEX, rash
Retinopathy, hepatotoxicity, infection
How long does Hydroxychloroquine (Plaquenil) take to become effective?
1-3 months
Hydroxychloroquine (Plaquenil) side effects
Hepatotoxic
Dysrrhytmia (skipping or irregular beats)
Retinal damage
Infection
Hydroxychloroquine (Plaquenil) education
eye exam every 6 months
clotting ability (bleeding and bruising)
Call HCP with fever, bleeding, bruising, vision changes (getting sick)
How do you prevent exacerbations (FLARES) in SLE?
maintain good nutrition (avoid processed and sugars)
avoid infection exposure
teach medications
avoid sunlight exposure
- risk for early cataracts (sunglasses)
HCP before taking immunizations - not live
Avoid pregnancy
How does the nurse provide adequate tissue perfusion in SLE pts?
assess impairment of peripheral perfusion
prevent injuries to extremities
monitor for fluid retention
How does the nurse effectively manage pain control in SLE pts?
balance rest and activity
NSAIDs for arthritic pain
therapies
short-term corticosteroids
How does the nurse maintain renal function in SLE pts?
edema, HTN, hematuria, and low output
BUN and Creatinine
UTIs and glomerulonephritis
excess fluid volume
How does the nurse have psychological equilibrium?
observe for CNS involvement
- HA, inappropriate speech, diff. concentrating
assess for mood changes
support groups and resources
Acute Care for Lupus Flare
quickly very ill
log = severity of symptoms, triggers, fever patterns, inflammation, ROM, response therapy
Acute Care for SLE
Observation
fever pattern
joint inflammation
limitation of motion
location and degree of discomfort
fatigue
Nursing Implementations for SLE pts in Acute Care
Monitor WT and I&Os
collect a 24-hour urine sample
neuro status (visual, HA, seizures, personality, memory loss)
explain disease
support
In SLE, adherence to treatment is always a guarantee against flares. T/F
False, no guarantee
Why is infertility a common result in SLE?
renal involvement
high-dose corticosteroids
immunosuppressive drugs
What does a woman with SLE need for education regarding pregnancy?
communication btw doctors
impact placenta and within vessels = serious consequences such as miscarriage or still birth
Vigilant birth controls
Postpartum causes sudden changes in hormones leading to serious flares
C-section
Expected Outcomes of SLE pts
Use energy conservation techniques
Lifestyle changes
Adherence to medication regimen
Avoid / delay organ dysfunction
Maintain positive self-image
A patient is undergoing diagnostic testing for symptoms of polyarthralgia, fatigue, and hair loss. Laboratory results include the presence of anti-DNA, antinuclear antibodies, and anti-Smith in the blood. The nurse recognizes that these findings are most likely to be related to which diagnosis?
Systemic sclerosis
Rheumatoid arthritis
Chronic fatigue syndrome
Systemic lupus erythematosus
Systemic lupus erythematosus
A patient is to begin taking hydroxychloroquine, what should be included in the nurse’s teaching plan?
Select all that apply.
Have eye exams every 6 months
Monitor for signs of infection
Take with food
Avoid taking while pregnant
Report irregular heart beats
Have eye exams every 6 months
Monitor for signs of infection
Report irregular heart beats
Is it okay for a pregnant or breastfeeding woman to continue taking hydroxychloroquine?
yes, with lowest dose possible
A nurse is teaching a newly diagnosed patient about SLE. Which factor might increase a flare up of SLE?
Pregnancy
Hypotension
Fever
GI upset
Pregnancy
