sle ins and outs elaborated in detail explained

Systemic Lupus Erythematosus
(SLE)
Chapter 65
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

,
 Chronic multisystem inflammatory
autoimmune disease
 Complex interactions among many
factors including
 Genetic
 Hormonal
 Environmental
 Immunologic

,
 Affects
 Skin
 Joints
 Serous membranes
 Pleura
 Pericardium
 Renal system
 Hematologic system
 Neurologic system

,
 Characterized by an unpredictable
course with alternating exacerbations
and remissions
 Most common in women of childbearing
years
 More common in African Americans,
Asian Americans, Hispanics, and Native
Americans than in whites

,
Etiology and Pathophysiology
 Etiology is unknown
 Most probable causes
 Genetic influence
 Hormones
 Environmental factors
 Certain medications

,
Etiology and Pathophysiology
 Overaggressive autoimmune
reactions directed against
constituents of:
 Cell nucleus
 Single- and double-stranded DNA
 Antibody response related to B- and
T-cell hyperactivity

,
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

,
 Dermatologic
 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
 Polyarthralgia with morning stiffness
 Arthritis
 Swan neck fingers
 Ulnar deviation
 Subluxation with hyperlaxity of joints
 Increased risk of bone loss and fracture

,
Swan Neck Deformity

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

,
 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

,
 Nervous system
 Generalized/focal seizures
 Peripheral neuropathy
 Cognitive dysfunction
 Disorientation
 Memory deficits
 Psychiatric symptoms

,
 Hematologic
 Formation of antibodies against
blood cells
 Anemia
 Leukopenia
 Thrombocytopenia

,
 Infection
 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

,
Case Study
 J.C. is a 36-year-old female who was
diagnosed with SLE 8 years ago.
 Her chart noted polyarthritis, facial and
palmar erythema, and general malaise
as symptoms.
Jupiterimages/Polka Dot/Thinkstock

,
Case Study
 She was started on prednisone 100
mg/every other day but developed
cushingoid syndrome within several
weeks.

,
Case Study
 J.C. later developed intermittent tonic-
clonic (grand mal) seizures that are
treated with phenytoin (Dilantin).
 During the past year, her lab studies
indicate early kidney failure.

,
Case Study
 She has had occasional UTIs that have
responded to treatment.
 How might this disease be affecting the
life of a 36-year-old woman?

,
Diagnostic Studies
 No specific test
 SLE is diagnosed primarily on criteria
relating to patient history, physical
examination, and laboratory findings
 ANA is present in 97% of persons with
the disease

,
Collaborative Care
 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 polyarthralgia or polyarthritis
 Antimalarial drugs
 Steroid-sparing drugs
 Corticosteroids
 Severe cutaneous SLE
 Immunosuppressive drugs

,
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

,
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

,
Case Study
 What psychosocial issues do you think
J.C. might have that you should be
prepared to discuss with her?

,
Nursing Management
Planning
 Overall goals
 Have satisfactory pain management
 Comply with therapeutic regimen to
achieve maximum symptom
management

,
Nursing Management
Planning
 Overall goals
 Demonstrate awareness of, and avoid
activities that cause, disease
exacerbation
 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

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

,
Nursing Management
 Acute intervention
 During exacerbation, patient will
become abruptly, dramatically ill
 Record
 Severity of symptoms
 Response to therapy

,
Nursing Management
 Observe for:
 Fever pattern
 Joint inflammation
 Limitation of motion
 Location and degree of discomfort
 Fatigability

,
Nursing Management
 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
 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
 Lupus and pregnancy
 Infertility can result
 Renal involvement
 High-dose corticosteroids
 Chemotherapy drugs
 Women with serious SLE should be
counseled against pregnancy

,
Nursing Management
 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

,
Case Study
 What patient teaching might J.C.
need?

,
Case Study
 What resources are available in your
community for patients like J.C. with
chronic, often debilitating, illnesses?

,
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

,
A patient is undergoing diagnostic testing for symptoms of
polyarthralgia, fatigue, and hair loss. Laboratory results
include the presence of anti-DNA, antinuclear antibodies,
and anti-Smith in the blood. The nurse recognizes that these
findings are most likely to be related to which diagnosis?
a.Systemic sclerosis
b.Rheumatoid arthritis
c.Chronic fatigue syndrome
d.Systemic lupus erythematosus
Audience Response Question

,
Reflection Question
 SLE can affect women of childbearing
age. If she has a serious form of the
disease, childbearing is discouraged.
 What might it be like to have to tell
someone they cannot have children?
 How will you approach having such a
conversation?
 What can/should you do?

sle ins and outs elaborated in detail explained

Recommended

Recommended

More Related Content

Similar to sle ins and outs elaborated in detail explained

Similar to sle ins and outs elaborated in detail explained (10)

More from Bosan Khalid

More from Bosan Khalid (9)

Recently uploaded

Recently uploaded (20)

sle ins and outs elaborated in detail explained