Systemic Lupus Erythematosus SLE

Question 1

What is Systemic Lupus Erythematosus and its etiology

Answer 1

Chronic multisystem inflammatory autoimmune disease
Etiology is unknown
Most probable causes
Genetic influence
Hormones-Ages start at menses and oral birth control-during and after pregnancy
Environmental factors-sun exposure and sun burns
Certain medications- Hydralazine and anti seizure medications

Question 2

Clinical Manifestations

Answer 2

SLE is extremely variable in severity
Ranges from a relatively mild disorder to rapidly progressive disease affecting many organ systems
Most commonly affects skin, muscles, lining of lungs, heart, nervous tissue, and kidneys

Question 3

Multisystem Involvement of SLE Picture

Answer 3

Question 4

Dermatologic Clinical Manifestations

Answer 4

Cutaneous vascular lesions
Most commonly in sun-exposed areas
Oral/nasopharyngeal ulcers
In up to 33% of cases
Alopecia
Butterfly rash
Occurs in 50% of cases

Question 5

Butterfly Rash of SLE

Answer 5

Question 6

Musculoskeletal clinical manifestations

Answer 6

Polyarthralgia-multiple joints inflamed with morning stiffness

Arthritis

Swan neck fingers

Ulnar deviation

Subluxation with hyperlaxity (joints that move easily beyond expected movement) of joints

Increased risk of bone loss and fracture

Question 7

Swan Neck Deformity

Answer 7

Question 8

Cardiopulmonary Clinical Manifestations

Answer 8

Tachypnea
Cough
Pleurisy
Dysrhythmias
Fibrosis of SA and AV nodes
Pericarditis
Accelerated CAD
At risk for coagulation disorder

Question 9

Clinical Manifestations Renal

Answer 9

Lupus nephritis
Manifests in about 40% of cases within 5 years of onset
Ranging from mild proteinuria to glomerulonephritis
Primary goal in treatment is slowing the progression- Can give autoimmune suppressants and cytotoxins

Question 10

Clinical Manifestations Nervous System

Answer 10

Generalized/focal seizures- Give corticoid steroids and ant seizure medications
Peripheral neuropathy
Cognitive dysfunction
Disorientation
Memory deficits
Psychiatric symptoms

Question 11

Clinical Manifestations Hematologic

Answer 11

Formation of antibodies against blood cells- Destroying our own cells
Anemia
Leukopenia
Thrombocytopenia- Look for bleeding D/O. Educate patients regarding it

Question 12

Clinical manifestations of Infection-Due to leukopenia

Answer 12

Increased susceptibility to infections
Defects in ability to phagocytize invading bacteria
Deficiencies in antibody production
Immunosuppressive effect of many antiinflammatory drugs
Infection is a major cause of death

Question 13

Diagnostic Studies

Answer 13

No specific test
Anti-DNA antibodies
Anti-Smith (Sm) antibodies-almost always considered diagnostic
Presence of Anti Nuclear Antibody

Question 14

Collaborative Care major challenges and survival

Answer 14

Major challenge to manage active disease yet prevent treatment complications that cause tissue damage
Survival influenced by:
Age, race, gender, socioeconomic status, comorbid conditions, and severity of disease
Early diagnosis and effective treatment

Question 15

Collaborative Care Drug Therapy

Answer 15

NSAIDs- Mild conditions only
Mild polyarthralgia or polyarthritis
Antimalarial drugs-Planquentil
Corticosteroids- BS increase taper off don’t give for long periods of time, higher risk for infection
Severe cutaneous SLE
Immunosuppressive drugs- steroid sparing- So we don’t overload them with steroids
Azathioprine (Imuran) – Immunosupressive drug. Do not give live vaccine

Question 16

Collaborative Care Biologic and targeted therapy agents to:

Answer 16

Interfere with immune response
Combat osteoporosis
Improve cutaneous cases
Safe use, proper administration, and possible side effects should be taught
Abrupt cessation may cause exacerbation- Must taper off

Question 17

Nursing Management Nursing Assessment

Answer 17

Assess patient’s physical, psychologic, and sociocultural problems with long-term management of SLE
Evaluate influence of pain and fatigue on ADLs

Question 18

Nursing Management Nursing Diagnoses

Answer 18

Fatigue
Impaired skin integrity
Impaired comfort

Question 19

Nursing Management Planning Overall goals

Answer 19

Demonstrate awareness of, and avoid activities that cause, disease exacerbation- Educate them. Avoid activities in the sun. How they know what exacerbation is, compliance with medications
Maintain optimal role function and a positive self-image

Question 20

Nursing Management Nursing Implementation Health Promotion

Answer 20

Prevention of SLE is not possible
Promote early diagnosis and treatment through education of both health professionals and the community

Unpredictable nature of the disease presents many challenges to patient, caregiver, and multidisciplinary health care team
Physical, psychologic, and sociocultural problems

Question 21

Nursing Management Nursing Implementation Acute Interventions

Answer 21

During exacerbation, patient will become abruptly, dramatically ill
Record
Severity of symptoms
Response to therapy

Question 22

Nursing Management Nursing Implementation Acute intervention

Observe for:

Answer 22

Fever pattern
Joint inflammation
Limitation of motion
Location and degree of discomfort
Fatigue

Question 23

Nursing Management Nursing Implementation Acute Interventions

Answer 23

Monitor weight and I&O
Collect 24-hour urine sample
Assess neurologic status
Visual disturbances, headaches, seizures, personality changes, forgetfulness
Explain nature of disease
Provide support

Question 24

Nursing Management Nursing Implementation Ambulatory and home care

Answer 24

Emphasize importance of patient cooperation for successful home management
Reiterate that adherence to treatment is no guarantee against exacerbations
Minimize exposure to precipitating factors

Question 25

Nursing Management Nursing Implementation Lupus and pregnancy

Answer 25

Infertility can result
Renal involvement
High-dose corticosteroids
Chemotherapy drugs
Women with serious SLE should be counseled against pregnancy

Question 26

Nursing Management Nursing Implementation Psychosocial issues

Answer 26

Supportive therapies to help with coping become very important
Counsel patient and family that SLE has good prognosis for most
Physical effects can lead to isolation, self-esteem, and body image disturbances
Assist patient in developing goals

Question 27

Nursing Management Evaluation Expected outcomes

Answer 27

Use energy conservation techniques
Adapt lifestyle to energy level
Maintain skin integrity with the use of topical treatments
Prevent exacerbations with the use of sunscreens and limited sun exposure