Systemic Lupus Erythematosus (Exam 3) Flashcards
Lupus
Autoimmune multisystem inflammatory disease
Has chronic unpredictable remissions and exacerbations
Lupus: Risk Factors
Females
African Americans
20-40’s
Genetic
Hormonal
Environmental
Immunologic Origin
Lupus: Typically Affects
Skin
Joints
Serous membranes
-pleura
-pericardium
Renal System
Hematologic system
Neurologic System
What percentage of people with lupus develop damage in one or more organs?
50%
Lupus: Clinical Manifestations
90% Joint pain
Photosensitivity
50% Butterfly rash (after being in sun)
40% Lupus nephritis (within 5 yrs of dx)
PANCYTOPENIA (think about three risk factors)
Unexplained fever
Lupus: Joint pain
Earliest symptoms of lupus
Polyarthralgia with morning stiffness
May precede other symptoms by years:
-Pain and stiffness tends to move from one part to another
-Only a few joints are affected at any time
Swollen and Warm
Extreme (debilitating) fatigue
Raynaud’s phenomenon
What joints are typically affected by lupus?
Fingers
Wrist
Knees
Kidney failure is lupus is called
Lupus nephritis
If a patient has lupus we often have them do what?
Take their temperature everyday to assess for / try to catch an exacerbation
Lupus: Other Clinical Manifestations
Unusual hair loss (brittle)
Edema in legs or around eyes
Ulcers of mouth and nose
Pleurisy and Pericarditis
Lupus: Nervous System Manifestations (lupus cerebritis)
Difficult concentrating (brain fog)
Depression
Headaches
Seizures
Lupus: Skin Involvement
AREAS Exposed to sun
Face area (most common)
Shoulders down arms (common)
Chest / Legs (Uncommon)
Pelvic / Trunk (Rare)
Lupus Arthritis
Swan neck deformities
Similar to RA
How Do We Diagnose Lupus?
Based on distinct criteria revealed through patient history - physical exam - lab findings
No one specific test is diagnostic for SLE
ANA+ in virtually all patients at some time in course of their disease
Anti-DNA antibody testing
Elevated ESR & CRP
Serum complement
CBC: Anemia
Urinalysis
What test is the most specific indicator of SLE?
Anti-DNA antibody test
Lupus: Urinalysis
Proteinuria
Hematuria
Blood cell casts (kidney involvement)
Lupus: CBC
Anemia
Leukopenia
Thrombocytopenia
Lupus: ESR and CRP
Elevated
Lupus: Serum Complement
Decreased
Lupus: Nursing Problems
-Fatigue
-Impaired skin integrity (skin rash)
-Impaired comfort or PAIN
-Body image disturbance
-Ineffective coping
-Deficient knowledge
-Ineffective self health management
-Risk for infection (decrease WBC’s)
-Risk for bleeding (decrease platelets)
-Ineffective role performance (women)
SLE: Therapy
Choice of therapy is highly individualized, depending on preliminary symptoms and organ involvement (severity)
SLE: Cornerstone of treartment
hydroxychloroquine (MAIN)
+
Mild: With or without NSAIDS & short-term low dose glucocorticoids (<7.5 mg of prednisone daily(
or
Moderate: Add short-term therapy of 5-15 mg prednisone daily (taper off once hydroxychloroquine takes effect)
or
Severe / Life Threatening: Intensive immunosuppressants (methotrexate) and high dose steroids to halt tissue injury
Lupus: Collaborative Care During Exacerbation
Directed toward:
-Fever
-Joint inflammation
-Limitation of movement
-Location / degree of discomfort
-Fatigue
-Adverse effects of steroid therapy
-Monitor neuro status
Lupus: Teach Patients to
Avoid Triggers
-Ultraviolet light
-Abruptly stopping drugs
-Infections
