UNIT 3- SYSTEMIC LUPUS ERYTHEMATOSUS Flashcards
What is the patho of SLE?
Multisystem inflammatory autoimmune disease
What are the most probable causes of SLE?
- Genetic influence
- Hormones- (women are more prone)
- Environmental factors- UV light, stress, exposure to chemicals
4.Certain medications
What few medications did we talk about that could cause SLE?
- Propenamide (pronestal)
- Hydralazine (apressin)
- Quinidine (quinine gut)
What are the 4 types of lupus?
- SLE
- Discoid lupus- limited to skin
- Drug-induced lupus
- Neonatal lupus
What are the risk factors of SLE?
- Most cases in women 20-40
- More common in African Americans, Asian Americans, Hispanics, and Native Americans than in whites
True or False: SLE is characterized by unpredictable alternating periods of remission and worsening disease
True– periods of worsening disease are known as “flares’
Severity of SLE is ______
extremely variable– ranges from disorder to rapidly progressive disease
What parts of the body does SLE most commonly effect
- Skin
- Kidneys
- Muscles
- Lungs
- Heart
- Nervous tissue
What are three big complications from SLE?
- Pneumonia
- Kidney failure
- Sepsis
What are some general s/s of SLE?
- Fever of unknown origin
- Achy
- Unexpected weight loss
- Extreme fatigue
- Butterfly rash
- Swollen, stiff joints
- Low WBC/RBC/Platelet counts
- Raynaud’s phenomenon
- Chest pain
- SOB
- Hair loss
- Neurological symptoms
- Cardiovascular disease
What are clinical manifestations of SLE in the integumentary system?
- Malar “butterfly” problems
- Rash w/sunlight exposure
- Oral/nasopharyngeal ulcers
- Discoid lesions (may or may not)
What are clinical manifestations of musculoskeletal problems?
- Polyarthralgia w/morning stiffness
- Arthritis
-swan neck fingers
-Ulnar deviation- Subluxation and hyperlaxity of joints
- Increased risk of bone loss and fracture
- Muscle pain
What are some cardiopulmonary problems clinical manifestations
- Dyspnea
- Cough
- Pleurisy
- Raynaud’s
- Dysrhythmias
-Fibrosis of SA and AV nodes - Pericarditis
What are some renal problems that may persist with SLE?
- Proteinuria
- Glomerulonephritis
- Lupus nephritis
What are some nervous system problems that may persist with SLE?
- Seizures
- Peripheral neuropathy
- Cognitive dysfunction
-disordered thinking
-Disorientation
-Memory deficits - Psychiatric- depression and anxiety.
What are some hematologic problems you might see with SLE?
Formation of antibodies against blood cells
- Anemia
- Leukopenia
- Thrombocytopenia
- Coagulation disorders (may need to be on anticoagulation medications drugs)
How can hypercoagulopathy effect a patient with SLE
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
What clinical manifestation of infection with SLE might you expect to see?
Increased susceptibility to infections
- Defects in ability to phagocytize invading bacteria
- Deficiency production of antibodies
- Immunosuppressive effect of anti-inflammatory drugs.
True or false: Lupus patients are considered immunocompromised and will be on immunosuppression drugs?
True
What diagnostic studies would you expect to see with SLE?
- Anti-DNA antibodies- found in half of all patients
- Anti-Smith antibodies- found in 30-40% of patients almost always considered diagnostic
- ANA (Antinuclear antibodies)- present in 97% of pts.
- CRP & ESR- Increased, monitor for treatment response
How is SLE diagnosed?
- Primarily on criteria relating to patient history, physical examination, and laboratory findings
Using the acronym SOAP BRAIN MD what is the SLE diagnostic criteria?
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
What are the most common problems with SLE?
- Persistent pain
- Chronic inflammation
- Fatigue
- Possible loss of tissue integrity
- Self-esteem decreased r/t body image
What drugs are used in managing SLE?
- NSAIDS
- Antimalarial drugs- hydroxychloroquine (Plaquenil)
- Immunosuppressive drugs
- Corticosteroids
- Anticoagulants
Hydroxychloroquine is considered to be in what class of medication?
Antimalarial/Antirheumatic
Hydroxychloroquine (Plaquenil) is used to treat what disorders?
- Discoid Lupus
- RA
- Malaria
As the nurse what should we monitor/assess with a patient taking Hydroxychloroquine (Plaquenil) for SLE?
- Monitor- CBC, LFT, Glucose
- Assess for decreased deep tendon reflex, rash
What are the side effects of Hydroxychloroquine (plaquenil)?
- Hepatoxicity
- Dysrhythmias
- Retinal damage
What education do we need to give our patients starting/on hydroxychloroquine (plaquenil)?
- Eye exam every 6 months– retinal damage
- Call HCP- fever, bleeding, bruising, vision changes.
What are our nursing goals for SLE?
- Maintain good nutrition
- Avoid exposure to infections
- Teach client about medications
- Avoid sunlight exposure
- Call HCP before taking immunizations
- Avoid pregnancy
What are our nursing goals for patients with SLE in regard to adequate tissue perfusion?
- Assess for impaired peripheral perfusion
- Prevent injury to extremities
- Monitor fluid retention
What are our nursing goals for effective pain control in patients with SLE?
- Balance rest & activity
- NSAIDs for arthritic pain
- Non pharmacologic therapies for pain
- Consider short-term corticosteroids
What are our nursing goals for maintaining renal function in patients with SLE?
- Monitor for edema, HTN, hematuria & Decreased urine output
- Monitor BUN & creatinine level
- Monitor for UTIs and glomerulonphritis
- Assess for excess fluid volume
What is our nursing goals for psychological equilibrium for SLE patients?
- Observe for CNS involvement
-Headache
-Inappropriate speech
-Difficulty concentrating - Assess for change in mood
- Encourage use of support groups and other resources
Acute care for a lupus flare includes?
- Patient with a lupus flare can become very ill very quickly
- Record- severity of symptoms and response to therapy
In acute care of SLE what are we observing for?
- Fever pattern
- Join inflammation
- Limitation of motion
- Location and degree of discomfort
- Fatigue
As a nurse caring for an SLE patient what we will be monitoring/assessing/educating on?
- Monitor I&O
- Collect 24 hour urine sample
- Assess neurologic status
-Visual problems, headaches, seizures, personality changes and memory loss - Explain nature of disease
- Provide emotional support.
True or false: Adherence to treatment is a guarantee against SLE flares
False
What should we know about nursing interventions and pregnancy?
- Infertility can result
-Renal involvement
-High dose corticosteroids
-Immunosuppressive drugs - 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
What are our expected outcomes for our SLE patients?
- Use energy conservation techniques
- Lifestyle changes
- Adherence to meds
- Avoid/delay organ dysfunction
- Maintain positive self image
