Focus on Systemic Lupus Erythematosus (SLE) (Relates to Chapter 65, “Nursing Management: Arthritis...

Focus on Systemic Lupus Erythematosus (SLE)

(Relates to Chapter 65, “Nursing Management: Arthritis and Connective Tissue Diseases,” in the textbook)

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Systemic Lupus Erythematosus Chronic multisystem

inflammatory autoimmune disease

Associated with abnormalities of immune system

Results from interactions among genetic, hormonal, environmental, and immunologic factors

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2

Systemic Lupus Erythematosus Affects the

Skin Joints Serous membranes Renal system Hematologic system Neurologic system


Systemic Lupus Erythematosus SLE affects 2 to 8 persons per

100,000 in United States. Most cases occur in women of

child-bearing years. African, Asian, Hispanic, and

Native Americans 3 times more likely to develop than whites


Etiology and Pathophysiology Etiology is unknown. Most probable causes

Genetic influence Hormones Environmental factors Certain medications


Etiology and Pathophysiology Autoimmune reactions

directed against constituents of cell nucleus, DNA

Antibody response related to B and T cell hyperactivity


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


Multisystem Involvement of SLE


Fig. 65-9. Multisystem involvement in systemic lupus erythematosus.

Clinical Manifestations Dermatologic

Cutaneous vascular lesions Butterfly rash Oral/nasopharyngeal ulcers Alopecia


Butterfly Rash of SLE


Fig. 65-10. Butterfly rash of systemic lupus erythematosus.

Clinical Manifestations Musculoskeletal

Polyarthralgia with morning stiffness

Arthritis Swan neck fingers Ulnar deviation Subluxation with hyperlaxity of

joints


Swan Neck Deformity


Fig. 65-4. Typical deformities of rheumatoid arthritis. D, Swan neck deformity.

Clinical Manifestations Cardiopulmonary

Tachypnea Pleurisy Dysrhythmias Accelerated CAD Pericarditis


Clinical Manifestations Renal

Lupus nephritis Ranging from mild proteinuria to

glomerulonephritis Primary goal in treatment is

slowing the progression.


Clinical Manifestations Nervous system

Generalized/focal seizures Peripheral neuropathy Cognitive dysfunction

Disorientation Memory deficits Psychiatric symptoms


Clinical Manifestations Hematologic

Formation of antibodies against blood cells

Anemia Leukopenia Thrombocytopenia


Clinical Manifestations Infection

Increased susceptibility to infection

Fever should be considered serious.


Diagnostic Studies No specific test

SLE is diagnosed primarily on criteria related to patient history, physical examination, and laboratory findings.


Diagnostic Studies For a complete list of

diagnostic criteria, see Table 65-14 in book.


Collaborative Care Drug therapy

NSAIDs Antimalarial drugs Steroid-sparing drugs Corticosteroids Immunosuppressive drugs


Nursing ManagementNursing Assessment Assess patient’s physical,

psychologic, and sociocultural problems with long-term management of SLE.

Assess pain and fatigue daily.


Nursing ManagementNursing Diagnoses Fatigue Acute pain Impaired skin integrity


Nursing ManagementPlanning Overall goals

Have satisfactory pain relief. Comply with therapeutic

regimen to achieve maximum symptom management.


Nursing ManagementPlanning Overall goals (cont’d)

Demonstrate awareness of, and avoid activities that cause, disease exacerbation.

Maintain optimal role function and a positive self-image.


Nursing ManagementNursing Implementation Health promotion

Prevention of SLE is not possible.

Promote early diagnosis and treatment.


Nursing ManagementNursing Implementation Acute intervention

During exacerbation, patient will become abruptly, dramatically ill.

Record severity of symptoms and response to therapy.


Nursing ManagementNursing Implementation Acute intervention (cont’d)

Observe for Fever pattern Joint inflammation Limitation of motion Location and degree of

discomfort Fatigability


Nursing ManagementNursing Implementation Acute intervention (cont’d)

Monitor weight and I&O. Collect 24-hour urine sample. Assess neurologic status. Explain nature of disease. Provide support.


Nursing ManagementNursing Implementation Ambulatory and home care

Emphasize health teaching. Reiterate that adherence to

treatment does not necessarily halt progression.

Minimize exposure to precipitating factors.


Nursing ManagementNursing Implementation Lupus and pregnancy

Infertility can result from SLE’s regimen.

Women with serious SLE should be counseled against pregnancy.

Neonatal lupus erythematosus (NLE) may occur in infants born of women with SLE.


Nursing ManagementNursing 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.


Nursing ManagementEvaluation Expected outcomes

Completion of priority activities

Verbalization of having more energy

Expression of satisfaction with pain relief measures


Nursing ManagementEvaluation 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


Nursing ManagementEvaluation 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


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:1. Systemic sclerosis.2. Rheumatoid arthritis.3. Chronic fatigue syndrome. 4. Systemic lupus erythematosus.

Audience Response Question


Case Study


Case Study 36-year-old woman was

admitted 8 years ago with polyarthritis, facial and palmar erythema, and general malaise.

She was diagnosed with probable systemic lupus erythematosus.


Case Study She was started on

prednisone 100 mg/every other day.

Within a few weeks of taking prednisone, she developed cushingoid syndrome.


Case Study She has also had intermittent

tonic - clonic (grand mal) seizures that are treated with Dilantin.

During the past year, her lab studies indicate early renal failure.


Case Study She has had occasional UTIs

that have responded to treatment.


Discussion Questions

1.What common clinical manifestations of SLE does she have?

2.What psychosocial issues should you discuss with her?

3.What patient teaching should you do with her?


Focus on Systemic Lupus Erythematosus (SLE) (Relates to Chapter 65, “Nursing Management: Arthritis...

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