Systemic Lupus Erythematosus (SLE)
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Transcript Systemic Lupus Erythematosus (SLE)
Systemic Lupus
Erythematosus (SLE)
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Systemic Lupus
Erythematosus (SLE)
• Chronic multisystem inflammatory
disease
• Associated with abnormalities of
immune system
• Results from interactions among
genetic, hormonal, environmental,
and immunologic factors
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Systemic Lupus Erythematosus
• Affects the
Skin
Joints
Serous membranes
Renal system
Hematologic system
Neurologic system
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Systemic Lupus Erythematosus
• A variable disease
Chronic
Unpredictable
Characterized by exacerbations &
remissions
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Incidence
• SLE affects 2 to 8 persons per
100,000 in United States
• Most cases occur in women of
childbearing years
• African, Asian, Hispanic, and Native
Americans three times more likely to
develop than whites
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Etiology
• Etiology is unknown
• Most probable causes
Genetic influence
Hormones
Environmental factors
Certain medications
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Pathophysiology
• Autoimmune reactions directed
against constituents of cell nucleus,
DNA
• Antibody response related to B and
T cell hyperactivity
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Clinical Manifestations
• Ranges from a relatively mild
disorder to rapidly progressing,
affecting many body systems
• Most commonly affects the
skin/muscles, lining of lungs, heart,
nervous tissue, and kidneys
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Clinical Manifestations
Fig 65-9
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Clinical Manifestations
• Dermatologic
Cutaneous vascular lesions
Butterfly rash
Oral/nasopharyngeal ulcers
Alopecia
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Dermatologic Manifestations
Fig 65-10
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Clinical Manifestations
• Musculoskeletal
Polyarthralgia with morning stiffness
Arthritis
• Swan neck fingers
• Ulnar deviation
• Subluxation with hyperlaxity of joints
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Swan Neck Deformity
Fig. 65-4 D
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Clinical Manifestations
• Cardiopulmonary
Tachypnea
Pleurisy
Dysrhythmias
Accelerated CAD
Pericarditis
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Clinical Manifestations
• Renal
Lupus nephritis
• Ranging from mild proteinuria to
glomerulonephritis
• Primary goal in treatment is slowing the
progression
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Clinical Manifestations
• Nervous system
Generalized/focal seizures
Peripheral neuropathy
Cognitive dysfunction
• Disorientation
• Memory deficits
• Psychiatric symptoms
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Clinical Manifestations
• Hematologic
Formation of antibodies against blood
cells
Anemia
Leukopenia
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Clinical Manifestations
• Hematologic (cont’d)
Thrombocytopenia
Coagulopathy
Anti-phospholipid antibody syndrome
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Clinical Manifestations
• Infection
Increased susceptibility to infections
Fever should be considered serious
Infections such as pneumonia are a
common cause of death
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Diagnostic Studies
• No specific test
• SLE is diagnosed primarily on
criteria relating to patient history,
physical examination, and laboratory
findings
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Diagnostic Studies
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Diagnostic Studies
• Antinuclear antibodies
ANA and other antibodies indicate
autoimmune disease
Anti-DNA and anti-Smith antibody tests
most specific for SLE
LE prep can be positive with other
rheumatoid diseases
ESR & CRP are indicative of inflammatory
activity
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Diagnostic Tests
•
•
•
•
•
CBC for hematologic problems
UA for lupus nephritis
X-rays of affected joints
Chest x-ray for pulmonary problems
ECG for cardiac problems
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Collaborative Care
• Prognosis is improved with
Earlier diagnosis
Earlier and better treatment regimens
Careful monitoring for organ
involvement
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Collaborative Care
• Drug therapy
NSAIDs
Antimalarial drugs
Steroid-sparing drugs
Corticosteroids
Immunosuppressive drugs
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Nursing Management
Nursing Assessment
• Assess patient’s physical,
psychologic, and sociocultural
problems with long-term
management of SLE
• Assess pain and fatigue daily
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Nursing Management
Nursing Assessment
• Obtain subjective and objective data
• Educate and counsel on expected
issues
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Nursing Management
Nursing Diagnoses
•
•
•
•
Fatigue
Acute pain
Impaired skin integrity
Ineffective therapeutic regimen
management
• Body image disturbance
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Nursing Management
Planning
• Overall goals
Have satisfactory pain relief
Comply with therapeutic regimen to
achieve maximum symptom
management
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Nursing Management
Planning
• Overall goals (cont’d)
Demonstrate awareness of, and avoid
activities that cause disease
exacerbation (triggers)
Maintain optimal role function and a
positive self-image
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Nursing Management
Nursing Implementation
• Health promotion
Prevention of SLE is not possible
Promote early diagnosis and treatment
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Nursing Management
Nursing Implementation
• Acute intervention
During exacerbation, patient will
become abruptly, dramatically ill
Record severity of symptoms and
response to therapy
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Nursing Management
Nursing Implementation
• Acute intervention (cont’d)
Observe for
• Fever pattern
• Joint inflammation
• Limitation of motion
• Location and degree of discomfort
• Fatigability
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Nursing Management
Nursing Implementation
• Acute intervention (cont’d)
Monitor weight and I&O
Collect 24-hour urine sample
Assess neurological status
Explain nature of disease
Provide support
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Nursing Management
Nursing Implementation
• Ambulatory and home care
Reiterate that adherence to treatment
does not necessarily halt progression
Minimize exposure to precipitating
factors – fatigue, sun, stress, infection,
drugs
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Nursing Management
Nursing Implementation
• Ambulatory and home care
Teach energy conservation and
relaxation exercises
For joint problems, all the teaching for
RA related to joint protection, ROM,
and positioning to prevent contractures
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Nursing Management
Nursing Implementation
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Nursing Management
Nursing Implementation
• Lupus and pregnancy
Infertility can result from SLE treatment
regimen
SLE is associated with complications of
pregnancy
Pregnancy & post partum can cause
exacerbations of SLE
Women with serious SLE should be
counseled against pregnancy
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Nursing Management
Nursing Implementation
• Psychosocial issues
Counsel patient and family that SLE
has good prognosis
Physical effects can lead to isolation,
self-esteem, and body image
disturbances
Assist patient in developing goals
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Nursing Management
Evaluation
• Expected outcomes
Completion of priority activities
Verbalization of having more energy
Expression of satisfaction with pain
relief measures
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Nursing Management
Evaluation
• Expected outcomes (cont’d)
Performance of activities of daily living
without pain
Limitation of direct exposure to sun
and use of sunscreen
No open skin lesions
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Nursing Management
Evaluation
• Expected outcomes (cont’d)
Expression of satisfaction with activity
level
Pacing of activities to match level of
tolerance
Expression of confidence in ability to
manage SLE over time and in home
environment
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