SYSTEMIC LUPUS ERYTHEMATOSIS
INTRODUCTION
DEFINITION
 SLE is a chronic multisystem inflammatory disease
of autoimmune in origin
INCIDENCE
 More women are affected than men
ETIOLOGY
 Viral infection
 Genetic factors
 bacterial infection
 drugs, (Sulpha drugs hydralazine procainamide)
 Purp...
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
 Skin
 Butterfly-shaped rash
 Discoid lesions are ring-shaped
 Discoid lesions may also result...
ARTHRITIS:
 Generally bilateral and symmetric,.
 Can resemble RA
 Unlike RA, the arthritis is non erosive;.
 Tendon in...
CARDIAC
 Pericarditis.
 Pleural effusion.
 Myocarditis.
 Endocarditis.
 Coronary arteritis—less common.
PULMONARY:
 Pleuritis.
 Pleural effusion.
 Lupus pneumonitis.
 Pulmonary hemorrhage.
 Pulmonary embolism.
GASTROINTESTINAL.
 Oral ulcers.
 Acute or sub acute abdominal pain.
 Pancreatitis.
 Spontaneous bacterial peritonitis....
RENAL:
 Nephritis.
 Focal segmental glomerulonephritis
 Proliferative
 Membranous nephritis
CENTRAL NERVOUS SYSTEM:
 Neuropsychiatric disorders.
 Depression
 Psychosis.
 Transient ischemic attacks/stroke.
 Epi...
HEMATOLOGIC:
 Hemolytic anemia.
 Leucopenia.
 Thrombocytopenia
CONSTITUTIONAL:
 Fever.
 Weight loss.
 Fatigue.
DIAGNOSTIC EVALUATION
 CBC
 ESR
 Complement levels
 Urinalysis
 24-hour urine for protein and creatinine clearance.
...
MANAGEMENT
 Pharmacologic
 NSAIDs—to reduce pain and inflammation.
 Antimalarials—to decrease disease activity.
 Corti...
NON PHARMACOLOGIC
 Avoid direct exposure to sunlight to reduce the
chance of exacerbation.
 Behavior modification to pre...
OTHER MANAGEMENT
 Close follow-up for evaluation of
cardiac, neurologic, renal, and other body systems.
 Referral to spe...
NURSING ASSESSMENT
 Obtain clinical history, review systems, and perform
physical examination for characteristic findings...
NURSING DIAGNOSES
 Fatigue related to chronic inflammation and altered
immunity as evidenced by lack of energy inability ...
 Impaired skin integrity related to photosensitivity
,skin rash ,and alopecia as evidenced by rash
anywhere on body butte...
NURSING INTERVENTIONS REDUCING PAIN
 Administer and teach self-administration of
medications
 use of hot or cold applica...
INCREASING CONTROL OVER DISEASE
PROCESS
 Instruct patient to avoid factors that may exacerbate
disease.
 Avoid exposure ...
MEDICATIONS
 Teach self-administration of pharmacologic agents to
reduce disease activity.
 Encourage good nutrition, sl...
MAINTAINING SKIN AND MUCOUS MEMBRANE
INTEGRITY
 Apply topical corticosteroids to skin lesions as
ordered.
 Suggest alter...
REDUCING FATIGUE
 Advise patient that fatigue level will fluctuate with
disease activity.
 Encourage patient to modify s...
PRESERVING URINARY ELIMINATION
 Assist with monitoring of urinary status as indicated
by degree of renal involvement.
 M...
PATIENT EDUCATION AND HEALTH
MAINTENANCE
 Stress that close follow-up is mandatory, even in
times of remission, to detect...
COMPLICATIONS
 Renal failure.
 Permanent neurologic impairment.
 Infection.
GOUT
INTRODUCTION
DEFINITION
 Gout is a disorder of purine metabolism
characterized by elevated uric acid levels and
deposition of urate in...
INCIDENCE
 more commonly in men, middle aged men are more
affected
ETIOLOGY
 Common causes
 Under excretion of uric acid
 Medications and chemicals
COMMON CAUSES
 Inherited enzyme defects.
 Certain disease conditions:
 Myelo proliferative disorders.
 Lymphoprolifera...
UNDER EXCRETION OF URIC ACID (90% OF
CASES)
 Renal disease.
 Endocrine disorders
MEDICATIONS AND CHEMICALS:
 Diuretics.
 Ethanol (alcohol).
 Low-dose aspirin.
 Pyrazinamide— anti tuberculosis agent.
...
PATHOPHYSIOLOGY
 Uric acid is the major end product of purine
catabolism and is primarily excreted by the kidneys
hyperur...
CLINICAL MANIFESTATIONS ACUTE GOUTY
ARTHRITIS
 Generally affects one joint—often first
metatarso-phalangeal joint
 Other...
CHRONIC TOPHACEOUS GOUT
 Occurs if acute gout is inadequately treated or if it
goes untreated.
 Characterized by develop...
RENAL DISEASE
 Caused by hyperuricemia (persistent elevation of
uric acid in the blood).
 Kidney stones are composed of ...
DIAGNOSTIC EVALUATION
 Synovial fluid analysis.
 Identification of monosodium urate crystals under
polarized microscopy....
PHARMACOLOGIC MANAGEMENT
 NSAIDs—for acute attacks to relieve pain and
swelling.
 Colchicines—for prevention of acute at...
CORTICOSTEROIDS.
 Intra-articular if attack confined to one joint.
 Oral—in short tapering course if other treatments
ar...
URATE-LOWERING AGENTS
 Uricosuric drugs, such as probenecid
(Benamid), inter-fere with
 tubular reabsorption of uric aci...
NONPHARMACOLOGIC
 Avoidance of obesity.
 Avoidance of alcohol.
 Low-purine diet gives only a minor decrease in
serum ur...
NURSING ASSESSMENT
 Obtain history for factors predisposing to gout.
 Perform physical examination.
 Inspect involved j...
NURSING INTERVENTIONS RELIEVING PAIN
 Administer and teach self-administration of pain
relieving medications as prescribe...
FACILITATING MOBILITY
 Elevate and protect affected joint during acute
attack.
 Assist with activities of daily living.
...
PATIENT EDUCATION
 Instruct patient and family about nature of disease.
 Encourage to avoid alcohol.
 Avoid rapid weigh...
COMPLICATIONS
 Uric acid kidney stone.
 Urate nephropathy.
 deforming arthritis
SIDE EFFECTS OF TREATMENT
 Include skin rash
 hypersensitivity syndrome
 renal failure
 bone marrow depression
EVIDENCE BASED RESEARCH
CONCLUSION
BIBLIOGRAPHY
Thank you
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Systemic lupus erythematosis.

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Systemic lupus erythematosis.

  1. 1. SYSTEMIC LUPUS ERYTHEMATOSIS
  2. 2. INTRODUCTION
  3. 3. DEFINITION  SLE is a chronic multisystem inflammatory disease of autoimmune in origin
  4. 4. INCIDENCE  More women are affected than men
  5. 5. ETIOLOGY  Viral infection  Genetic factors  bacterial infection  drugs, (Sulpha drugs hydralazine procainamide)  Purperium  Exposure to sunlight, sun burns  Hormones
  6. 6. PATHOPHYSIOLOGY
  7. 7. CLINICAL MANIFESTATIONS  Skin  Butterfly-shaped rash  Discoid lesions are ring-shaped  Discoid lesions may also result in erythematous, scaly plaques
  8. 8. ARTHRITIS:  Generally bilateral and symmetric,.  Can resemble RA  Unlike RA, the arthritis is non erosive;.  Tendon involvement is common
  9. 9. CARDIAC  Pericarditis.  Pleural effusion.  Myocarditis.  Endocarditis.  Coronary arteritis—less common.
  10. 10. PULMONARY:  Pleuritis.  Pleural effusion.  Lupus pneumonitis.  Pulmonary hemorrhage.  Pulmonary embolism.
  11. 11. GASTROINTESTINAL.  Oral ulcers.  Acute or sub acute abdominal pain.  Pancreatitis.  Spontaneous bacterial peritonitis.  Bowel infarction.
  12. 12. RENAL:  Nephritis.  Focal segmental glomerulonephritis  Proliferative  Membranous nephritis
  13. 13. CENTRAL NERVOUS SYSTEM:  Neuropsychiatric disorders.  Depression  Psychosis.  Transient ischemic attacks/stroke.  Epilepsy.  Migraine headache.  Myleopathy.  Guillain-Barre syndrome.  Chorea and other movement disorders.
  14. 14. HEMATOLOGIC:  Hemolytic anemia.  Leucopenia.  Thrombocytopenia
  15. 15. CONSTITUTIONAL:  Fever.  Weight loss.  Fatigue.
  16. 16. DIAGNOSTIC EVALUATION  CBC  ESR  Complement levels  Urinalysis  24-hour urine for protein and creatinine clearance.  Chest x-ray  Computed tomography (CT) scan or MRI.
  17. 17. MANAGEMENT  Pharmacologic  NSAIDs—to reduce pain and inflammation.  Antimalarials—to decrease disease activity.  Corticosteroids—to reduce inflammatory process.  Immunosuppressive—to suppress immune process
  18. 18. NON PHARMACOLOGIC  Avoid direct exposure to sunlight to reduce the chance of exacerbation.  Behavior modification to prevent exacerbations and to reduce symptoms.  Joint protection and energy conservation.
  19. 19. OTHER MANAGEMENT  Close follow-up for evaluation of cardiac, neurologic, renal, and other body systems.  Referral to specialists for systemic manifestations.
  20. 20. NURSING ASSESSMENT  Obtain clinical history, review systems, and perform physical examination for characteristic findings.  Assess for signs and symptoms of infection and other side effects to medications.  Assess patient's and family's ability to cope with impact of prolonged disease.
  21. 21. NURSING DIAGNOSES  Fatigue related to chronic inflammation and altered immunity as evidenced by lack of energy inability to maintain usual routine  Acute pain related to inflammatory process and inadequate comfort measures as evidenced by complaints of joint pain lack of relief from pain relieving measures ,reduction of activity to avoid exacerbation of pain
  22. 22.  Impaired skin integrity related to photosensitivity ,skin rash ,and alopecia as evidenced by rash anywhere on body butterfly rash on face hairless areas of ulceration on fingertips, complaints of urticaria and photosensitivity  Knowledge deficit related to lack of exposure to and unfamiliarity with information resources as evidenced by questions about SLE misinterpretation of information and inaccurate follow -through of instruction
  23. 23. NURSING INTERVENTIONS REDUCING PAIN  Administer and teach self-administration of medications  use of hot or cold applications, relaxation techniques
  24. 24. INCREASING CONTROL OVER DISEASE PROCESS  Instruct patient to avoid factors that may exacerbate disease.  Avoid exposure to sunlight and ultraviolet light.  Use sunscreen with sun protection factor (SPF)of 15 or greater. Avoid prolonged sun exposure.  Wear protective, lightweight clothing, long sleeves, hats.  Avoid use of tanning beds.  Avoid exposure to drugs and chemicals.  Avoid exposure to hair spray  Avoid exposure to hair-coloring agents.
  25. 25. MEDICATIONS  Teach self-administration of pharmacologic agents to reduce disease activity.  Encourage good nutrition, sleep habits, exercise, rest, and relaxation to improve general health and to help prevent infection.  Encourage ventilation of feelings, counseling, or referrals to social work, occupational therapy, as needed.
  26. 26. MAINTAINING SKIN AND MUCOUS MEMBRANE INTEGRITY  Apply topical corticosteroids to skin lesions as ordered.  Suggest alternative hairstyles, scarves, and wigs to cover significant areas of alopecia.  Encourage good oral hygiene and inspect mouth for oral ulcers.  Avoid hot or spicy foods that may irritate oral ulcers.  Apply topical agents or analgesics to reduce pain and to promote eating.
  27. 27. REDUCING FATIGUE  Advise patient that fatigue level will fluctuate with disease activity.  Encourage patient to modify schedule to include several rest periods during the day, pace activity and exercise according to body's tolerance, use energy conservation techniques in daily activities.  Teach relaxation techniques, such as deep breathing, progressive muscle relaxation, and imagery to reduce emotional stress that causes fatigue.
  28. 28. PRESERVING URINARY ELIMINATION  Assist with monitoring of urinary status as indicated by degree of renal involvement.  Monitor intake and output and urine specific gravity.  Measure urine protein, micro albumin, or obtain24- hour creatinine clearance, as ordered.  Check test results of serum blood urea nitrogen (BUN) and creatinine.
  29. 29. PATIENT EDUCATION AND HEALTH MAINTENANCE  Stress that close follow-up is mandatory, even in times of remission, to detect early progression of organ involvement and to alter drug therapy.  Advise on the use of special cosmetics to cover skin lesions.Advise about reproduction.  Avoid pregnancy during time of severe disease activity.  Immunomodulators may have teratogenic effects.  Use of some drugs for treatment of SLE can result instability.
  30. 30. COMPLICATIONS  Renal failure.  Permanent neurologic impairment.  Infection.
  31. 31. GOUT
  32. 32. INTRODUCTION
  33. 33. DEFINITION  Gout is a disorder of purine metabolism characterized by elevated uric acid levels and deposition of urate in joints and other tissues
  34. 34. INCIDENCE  more commonly in men, middle aged men are more affected
  35. 35. ETIOLOGY  Common causes  Under excretion of uric acid  Medications and chemicals
  36. 36. COMMON CAUSES  Inherited enzyme defects.  Certain disease conditions:  Myelo proliferative disorders.  Lymphoproliferative disorders.  Cancer chemotherapy.  Hemolytic anemias.  Psoriasis.
  37. 37. UNDER EXCRETION OF URIC ACID (90% OF CASES)  Renal disease.  Endocrine disorders
  38. 38. MEDICATIONS AND CHEMICALS:  Diuretics.  Ethanol (alcohol).  Low-dose aspirin.  Pyrazinamide— anti tuberculosis agent.  Lead.  Volume depletion states—nephrogenic diabetes insipidus.
  39. 39. PATHOPHYSIOLOGY  Uric acid is the major end product of purine catabolism and is primarily excreted by the kidneys hyperuricemia may be result of of increased purine synthesis decreased renal excretion or both, Gout results from an overabundant accumulation and subsequent deposition of uric acid in the body.
  40. 40. CLINICAL MANIFESTATIONS ACUTE GOUTY ARTHRITIS  Generally affects one joint—often first metatarso-phalangeal joint  Other joints can be affected, such as ankle, knee; upper extremities are less commonly involved.  Pain, warmth, erythema, and swelling of tissue surrounding the affected joint.  Fever may occur.  Onset of symptoms is sudden; intensity is severe.  Duration of symptoms is self-limiting; lasts approxi-mately 3 to 10 days without treatment
  41. 41. CHRONIC TOPHACEOUS GOUT  Occurs if acute gout is inadequately treated or if it goes untreated.  Characterized by development of tophi or deposits of uric acid in and around joints, cartilage, and soft tissues.  Arthritis is more prolonged in nature with discrete attacks less common.
  42. 42. RENAL DISEASE  Caused by hyperuricemia (persistent elevation of uric acid in the blood).  Kidney stones are composed of uric acid.  Deposition of uric acid in kidney tissue.
  43. 43. DIAGNOSTIC EVALUATION  Synovial fluid analysis.  Identification of monosodium urate crystals under polarized microscopy.  Synovial WBC count can range from 2,000 to 100,000/mm3.  Culture of synovial fluid to rule out infection.  24-hour urine for uric acid to determine overproduction of uric acid versus under excretion.  ESR—elevated.  X-rays of affected joints show changes consistent with diagnosis of gout.
  44. 44. PHARMACOLOGIC MANAGEMENT  NSAIDs—for acute attacks to relieve pain and swelling.  Colchicines—for prevention of acute attacks and their treatment.  Oral at onset of an attack, taken hourly until pain relief or first signs of toxicity (nausea, vomiting ,cramping, diarrhea
  45. 45. CORTICOSTEROIDS.  Intra-articular if attack confined to one joint.  Oral—in short tapering course if other treatments are contraindicated or if attack involves many joints.
  46. 46. URATE-LOWERING AGENTS  Uricosuric drugs, such as probenecid (Benamid), inter-fere with  tubular reabsorption of uric acid.  Allopurinol (Zyloprim)—interferes with conversion of hypoxanthine and xanthine to uric acid.
  47. 47. NONPHARMACOLOGIC  Avoidance of obesity.  Avoidance of alcohol.  Low-purine diet gives only a minor decrease in serum uric acid levels.
  48. 48. NURSING ASSESSMENT  Obtain history for factors predisposing to gout.  Perform physical examination.  Inspect involved joint.  Observe for tophi: a) Pinna of ear. b) Olecranon bursa c) Achilles tendon.  Assess pain and pain relief pattern if attack is acute
  49. 49. NURSING INTERVENTIONS RELIEVING PAIN  Administer and teach self-administration of pain relieving medications as prescribed.  Encourage adequate fluid intake to assist with excretion of uric acid and to decrease likelihood of stone formation.  Instruct patient to take prescribed medications consis-tently because interruptions in therapy can precipitate acute attacks.
  50. 50. FACILITATING MOBILITY  Elevate and protect affected joint during acute attack.  Assist with activities of daily living.  Encourage exercise and maintenance of routine activity in chronic gout, except during acute attacks.  Protect draining tophi by covering and applying anti-biotic ointment as needed.
  51. 51. PATIENT EDUCATION  Instruct patient and family about nature of disease.  Encourage to avoid alcohol.  Avoid rapid weight loss by fasting or crash  Avoid medications known to increase uric acid levels.  Advise prompt treatment of acute attack  Instruct in signs and symptoms of allopurinol hyper-sensitivity  Review foods containing purine
  52. 52. COMPLICATIONS  Uric acid kidney stone.  Urate nephropathy.  deforming arthritis
  53. 53. SIDE EFFECTS OF TREATMENT  Include skin rash  hypersensitivity syndrome  renal failure  bone marrow depression
  54. 54. EVIDENCE BASED RESEARCH
  55. 55. CONCLUSION
  56. 56. BIBLIOGRAPHY
  57. 57. Thank you

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