Systemic Lupus Erythematosus SLE Flashcards
What is Systemic Lupus Erythematosus and its etiology
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
Clinical Manifestations
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
Multisystem Involvement of SLE Picture
Dermatologic Clinical Manifestations
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
Butterfly Rash of SLE
Musculoskeletal clinical manifestations
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
Swan Neck Deformity
Cardiopulmonary Clinical Manifestations
Tachypnea
Cough
Pleurisy
Dysrhythmias
Fibrosis of SA and AV nodes
Pericarditis
Accelerated CAD
At risk for coagulation disorder
Clinical Manifestations Renal
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
Clinical Manifestations Nervous System
Generalized/focal seizures- Give corticoid steroids and ant seizure medications
Peripheral neuropathy
Cognitive dysfunction
Disorientation
Memory deficits
Psychiatric symptoms
Clinical Manifestations Hematologic
Formation of antibodies against blood cells- Destroying our own cells
Anemia
Leukopenia
Thrombocytopenia- Look for bleeding D/O. Educate patients regarding it
Clinical manifestations of Infection-Due to leukopenia
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
Diagnostic Studies
No specific test
Anti-DNA antibodies
Anti-Smith (Sm) antibodies-almost always considered diagnostic
Presence of Anti Nuclear Antibody
Collaborative Care major challenges and survival
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
Collaborative Care Drug Therapy
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
Collaborative Care Biologic and targeted therapy agents to:
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
Nursing Management Nursing Assessment
Assess patient’s physical, psychologic, and sociocultural problems with long-term management of SLE
Evaluate influence of pain and fatigue on ADLs
Nursing Management Nursing Diagnoses
Fatigue
Impaired skin integrity
Impaired comfort
Nursing Management Planning Overall goals
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
Nursing Management Nursing Implementation Health Promotion
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
Nursing Management Nursing Implementation Acute Interventions
During exacerbation, patient will become abruptly, dramatically ill
Record
Severity of symptoms
Response to therapy
Nursing Management Nursing Implementation Acute intervention
Observe for:
Fever pattern
Joint inflammation
Limitation of motion
Location and degree of discomfort
Fatigue
Nursing Management Nursing Implementation Acute Interventions
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
Nursing Management Nursing Implementation Ambulatory and home care
Emphasize importance of patient cooperation for successful home management
Reiterate that adherence to treatment is no guarantee against exacerbations
Minimize exposure to precipitating factors
Nursing Management Nursing Implementation Lupus and pregnancy
Infertility can result
Renal involvement
High-dose corticosteroids
Chemotherapy drugs
Women with serious SLE should be counseled against pregnancy
Nursing Management Nursing Implementation Psychosocial issues
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
Nursing Management Evaluation Expected outcomes
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
