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Module 4 > UNIT 3- SYSTEMIC LUPUS ERYTHEMATOSUS > Flashcards

UNIT 3- SYSTEMIC LUPUS ERYTHEMATOSUS Flashcards

1
Q

What is the patho of SLE?

A

Multisystem inflammatory autoimmune disease

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2
Q

What are the most probable causes of SLE?

A
  1. Genetic influence
  2. Hormones- (women are more prone)
  3. Environmental factors- UV light, stress, exposure to chemicals
    4.Certain medications
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3
Q

What few medications did we talk about that could cause SLE?

A
  1. Propenamide (pronestal)
  2. Hydralazine (apressin)
  3. Quinidine (quinine gut)
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4
Q

What are the 4 types of lupus?

A
  1. SLE
  2. Discoid lupus- limited to skin
  3. Drug-induced lupus
  4. Neonatal lupus
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5
Q

What are the risk factors of SLE?

A
  1. Most cases in women 20-40
  2. More common in African Americans, Asian Americans, Hispanics, and Native Americans than in whites
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6
Q

True or False: SLE is characterized by unpredictable alternating periods of remission and worsening disease

A

True– periods of worsening disease are known as “flares’

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7
Q

Severity of SLE is ______

A

extremely variable– ranges from disorder to rapidly progressive disease

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8
Q

What parts of the body does SLE most commonly effect

A
  1. Skin
  2. Kidneys
  3. Muscles
  4. Lungs
  5. Heart
  6. Nervous tissue
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9
Q

What are three big complications from SLE?

A
  1. Pneumonia
  2. Kidney failure
  3. Sepsis
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10
Q

What are some general s/s of SLE?

A
  1. Fever of unknown origin
  2. Achy
  3. Unexpected weight loss
  4. Extreme fatigue
  5. Butterfly rash
  6. Swollen, stiff joints
  7. Low WBC/RBC/Platelet counts
  8. Raynaud’s phenomenon
  9. Chest pain
  10. SOB
  11. Hair loss
  12. Neurological symptoms
  13. Cardiovascular disease
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11
Q

What are clinical manifestations of SLE in the integumentary system?

A
  1. Malar “butterfly” problems
  2. Rash w/sunlight exposure
  3. Oral/nasopharyngeal ulcers
  4. Discoid lesions (may or may not)
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12
Q

What are clinical manifestations of musculoskeletal problems?

A
  1. Polyarthralgia w/morning stiffness
  2. Arthritis
    -swan neck fingers
    -Ulnar deviation
    • Subluxation and hyperlaxity of joints
  3. Increased risk of bone loss and fracture
  4. Muscle pain
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13
Q

What are some cardiopulmonary problems clinical manifestations

A
  1. Dyspnea
  2. Cough
  3. Pleurisy
  4. Raynaud’s
  5. Dysrhythmias
    -Fibrosis of SA and AV nodes
  6. Pericarditis
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14
Q

What are some renal problems that may persist with SLE?

A
  1. Proteinuria
  2. Glomerulonephritis
  3. Lupus nephritis
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15
Q

What are some nervous system problems that may persist with SLE?

A
  1. Seizures
  2. Peripheral neuropathy
  3. Cognitive dysfunction
    -disordered thinking
    -Disorientation
    -Memory deficits
  4. Psychiatric- depression and anxiety.
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16
Q

What are some hematologic problems you might see with SLE?

A

Formation of antibodies against blood cells

  1. Anemia
  2. Leukopenia
  3. Thrombocytopenia
  4. Coagulation disorders (may need to be on anticoagulation medications drugs)
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17
Q

How can hypercoagulopathy effect a patient with SLE

A

Can cause the patient to clot easier. They are more likely to prone to develop micro clots which can effect vision as well as the kidney

18
Q

What clinical manifestation of infection with SLE might you expect to see?

A

Increased susceptibility to infections

  1. Defects in ability to phagocytize invading bacteria
  2. Deficiency production of antibodies
  3. Immunosuppressive effect of anti-inflammatory drugs.
19
Q

True or false: Lupus patients are considered immunocompromised and will be on immunosuppression drugs?

A

True

20
Q

What diagnostic studies would you expect to see with SLE?

A
  1. Anti-DNA antibodies- found in half of all patients
  2. Anti-Smith antibodies- found in 30-40% of patients almost always considered diagnostic
  3. ANA (Antinuclear antibodies)- present in 97% of pts.
  4. CRP & ESR- Increased, monitor for treatment response
21
Q

How is SLE diagnosed?

A
  1. Primarily on criteria relating to patient history, physical examination, and laboratory findings
22
Q

Using the acronym SOAP BRAIN MD what is the SLE diagnostic criteria?

A

S- Serositis (pleuritis, pericarditis)
O- Oral ulcers
A- Arthritis
P- Photosensitivity

B-Blood disorder
R- Renal disorder
A- ANA+
I- Immunologic disorder
N- Neurologic disorder

M- Malar rash
D- Discoid rash

If at least 4 of the criteria on list is met either at the time of appt or in the past there is a strong chance of lupus

23
Q

What are the most common problems with SLE?

A
  1. Persistent pain
  2. Chronic inflammation
  3. Fatigue
  4. Possible loss of tissue integrity
  5. Self-esteem decreased r/t body image
24
Q

What drugs are used in managing SLE?

A
  1. NSAIDS
  2. Antimalarial drugs- hydroxychloroquine (Plaquenil)
  3. Immunosuppressive drugs
  4. Corticosteroids
  5. Anticoagulants
25
Q

Hydroxychloroquine is considered to be in what class of medication?

A

Antimalarial/Antirheumatic

26
Q

Hydroxychloroquine (Plaquenil) is used to treat what disorders?

A
  1. Discoid Lupus
  2. RA
  3. Malaria
27
Q

As the nurse what should we monitor/assess with a patient taking Hydroxychloroquine (Plaquenil) for SLE?

A
  1. Monitor- CBC, LFT, Glucose
  2. Assess for decreased deep tendon reflex, rash
28
Q

What are the side effects of Hydroxychloroquine (plaquenil)?

A
  1. Hepatoxicity
  2. Dysrhythmias
  3. Retinal damage
29
Q

What education do we need to give our patients starting/on hydroxychloroquine (plaquenil)?

A
  1. Eye exam every 6 months– retinal damage
  2. Call HCP- fever, bleeding, bruising, vision changes.
30
Q

What are our nursing goals for SLE?

A
  1. Maintain good nutrition
  2. Avoid exposure to infections
  3. Teach client about medications
  4. Avoid sunlight exposure
  5. Call HCP before taking immunizations
  6. Avoid pregnancy
31
Q

What are our nursing goals for patients with SLE in regard to adequate tissue perfusion?

A
  1. Assess for impaired peripheral perfusion
  2. Prevent injury to extremities
  3. Monitor fluid retention
32
Q

What are our nursing goals for effective pain control in patients with SLE?

A
  1. Balance rest & activity
  2. NSAIDs for arthritic pain
  3. Non pharmacologic therapies for pain
  4. Consider short-term corticosteroids
33
Q

What are our nursing goals for maintaining renal function in patients with SLE?

A
  1. Monitor for edema, HTN, hematuria & Decreased urine output
  2. Monitor BUN & creatinine level
  3. Monitor for UTIs and glomerulonphritis
  4. Assess for excess fluid volume
34
Q

What is our nursing goals for psychological equilibrium for SLE patients?

A
  1. Observe for CNS involvement
    -Headache
    -Inappropriate speech
    -Difficulty concentrating
  2. Assess for change in mood
  3. Encourage use of support groups and other resources
35
Q

Acute care for a lupus flare includes?

A
  1. Patient with a lupus flare can become very ill very quickly
  2. Record- severity of symptoms and response to therapy
36
Q

In acute care of SLE what are we observing for?

A
  1. Fever pattern
  2. Join inflammation
  3. Limitation of motion
  4. Location and degree of discomfort
  5. Fatigue
37
Q

As a nurse caring for an SLE patient what we will be monitoring/assessing/educating on?

A
  1. Monitor I&O
  2. Collect 24 hour urine sample
  3. Assess neurologic status
    -Visual problems, headaches, seizures, personality changes and memory loss
  4. Explain nature of disease
  5. Provide emotional support.
38
Q

True or false: Adherence to treatment is a guarantee against SLE flares

A

False

39
Q

What should we know about nursing interventions and pregnancy?

A
  1. Infertility can result
    -Renal involvement
    -High dose corticosteroids
    -Immunosuppressive drugs
  2. Women with serious SLE- counsel against preganancy

Sometimes pregnancy does not affect lupus and pts may see an improvement in symptoms. However, it can do the opposite as well

40
Q

What are our expected outcomes for our SLE patients?

A
  1. Use energy conservation techniques
  2. Lifestyle changes
  3. Adherence to meds
  4. Avoid/delay organ dysfunction
  5. Maintain positive self image
41
Q
A

Module 4 (29 decks)

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