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Systemic Lupus Systemic Lupus Erythematosus (SLE)Erythematosus (SLE)


Systemic Lupus Systemic Lupus Erythematosus (SLE)Erythematosus (SLE)

• Chronic multisystem inflammatory Chronic multisystem inflammatory diseasedisease

• Associated with abnormalities of Associated with abnormalities of immune systemimmune system

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


Systemic Lupus ErythematosusSystemic Lupus Erythematosus

• Affects theAffects the SkinSkin JointsJoints Serous membranes Serous membranes Renal systemRenal system Hematologic systemHematologic system Neurologic systemNeurologic system


Systemic Lupus ErythematosusSystemic Lupus Erythematosus

• A variable diseaseA variable disease ChronicChronic UnpredictableUnpredictable Characterized by exacerbations & Characterized by exacerbations &

remissionsremissions


IncidenceIncidence

• SLE affects 2 to 8 persons per SLE affects 2 to 8 persons per 100,000 in United States100,000 in United States

• Most cases occur in women of Most cases occur in women of childbearing yearschildbearing years

• African, Asian, Hispanic, and Native African, Asian, Hispanic, and Native Americans three times more likely to Americans three times more likely to develop than whitesdevelop than whites


EtiologyEtiology

• Etiology is unknownEtiology is unknown

• Most probable causesMost probable causes Genetic influenceGenetic influence HormonesHormones Environmental factorsEnvironmental factors Certain medicationsCertain medications


PathophysiologyPathophysiology

• Autoimmune reactions directed Autoimmune reactions directed against constituents of cell nucleus, against constituents of cell nucleus, DNADNA

• Antibody response related to B and Antibody response related to B and T cell hyperactivityT cell hyperactivity


Clinical ManifestationsClinical Manifestations

• Ranges from a relatively mild Ranges from a relatively mild disorder to rapidly progressing, disorder to rapidly progressing, affecting many body systemsaffecting many body systems

• Most commonly affects the Most commonly affects the skin/muscles, lining of lungs, heart, skin/muscles, lining of lungs, heart, nervous tissue, and kidneysnervous tissue, and kidneys


Fig 65-9Fig 65-9




• Dermatologic Dermatologic Cutaneous vascular lesionsCutaneous vascular lesions Butterfly rashButterfly rash Oral/nasopharyngeal ulcersOral/nasopharyngeal ulcers AlopeciaAlopecia


Dermatologic ManifestationsDermatologic Manifestations

Fig 65-10Fig 65-10



• MusculoskeletalMusculoskeletal Polyarthralgia with morning stiffnessPolyarthralgia with morning stiffness ArthritisArthritis• Swan neck fingersSwan neck fingers• Ulnar deviationUlnar deviation• Subluxation with hyperlaxity of jointsSubluxation with hyperlaxity of joints


Swan Neck DeformitySwan Neck Deformity

Fig. 65-4 DFig. 65-4 D



• CardiopulmonaryCardiopulmonary TachypneaTachypnea PleurisyPleurisy DysrhythmiasDysrhythmias Accelerated CADAccelerated CAD PericarditisPericarditis



• RenalRenal Lupus nephritisLupus nephritis• Ranging from mild proteinuria to Ranging from mild proteinuria to

glomerulonephritisglomerulonephritis• Primary goal in treatment is slowing the Primary goal in treatment is slowing the

progressionprogression



• Nervous systemNervous system Generalized/focal seizuresGeneralized/focal seizures Peripheral neuropathyPeripheral neuropathy Cognitive dysfunctionCognitive dysfunction• DisorientationDisorientation• Memory deficitsMemory deficits• Psychiatric symptomsPsychiatric symptoms



• HematologicHematologic Formation of antibodies against blood Formation of antibodies against blood

cellscells AnemiaAnemia LeukopeniaLeukopenia



• Hematologic (cont’d)Hematologic (cont’d) ThrombocytopeniaThrombocytopenia CoagulopathyCoagulopathy Anti-phospholipid antibody syndromeAnti-phospholipid antibody syndrome



• InfectionInfection IncreasedIncreased susceptibility to infections susceptibility to infections Fever should be considered seriousFever should be considered serious Infections such as pneumonia are a Infections such as pneumonia are a

common cause of deathcommon cause of death


Diagnostic StudiesDiagnostic Studies

• No specific testNo specific test

• SLE is diagnosed primarily on SLE is diagnosed primarily on criteria relating to patient history, criteria relating to patient history, physical examination, and laboratory physical examination, and laboratory findingsfindings



• Antinuclear antibodiesAntinuclear antibodies ANA and other antibodies indicate ANA and other antibodies indicate

autoimmune diseaseautoimmune disease Anti-DNA and anti-Smith antibody tests Anti-DNA and anti-Smith antibody tests

most specific for SLEmost specific for SLE LE prep can be positive with other LE prep can be positive with other

rheumatoid diseasesrheumatoid diseases ESR & CRP are indicative of inflammatory ESR & CRP are indicative of inflammatory

activityactivity


Diagnostic TestsDiagnostic Tests

• CBC for hematologic problemsCBC for hematologic problems

• UA for lupus nephritisUA for lupus nephritis

• X-rays of affected jointsX-rays of affected joints

• Chest x-ray for pulmonary problemsChest x-ray for pulmonary problems

• ECG for cardiac problemsECG for cardiac problems


Collaborative CareCollaborative Care

• Prognosis is improved withPrognosis is improved with Earlier diagnosisEarlier diagnosis Earlier and better treatment regimensEarlier and better treatment regimens Careful monitoring for organ Careful monitoring for organ

involvementinvolvement


Collaborative CareCollaborative Care

• Drug therapyDrug therapy NSAIDsNSAIDs Antimalarial drugsAntimalarial drugs Steroid-sparing drugsSteroid-sparing drugs CorticosteroidsCorticosteroids Immunosuppressive drugsImmunosuppressive drugs


Nursing ManagementNursing ManagementNursing AssessmentNursing Assessment

• Assess patient’s physical, Assess patient’s physical, psychologic, and sociocultural psychologic, and sociocultural problems with long-term problems with long-term management of SLEmanagement of SLE

• Assess pain and fatigue dailyAssess pain and fatigue daily


Nursing ManagementNursing ManagementNursing AssessmentNursing Assessment

• Obtain subjective and objective dataObtain subjective and objective data

• Educate and counsel on expected Educate and counsel on expected issuesissues


Nursing ManagementNursing ManagementNursing DiagnosesNursing Diagnoses

• FatigueFatigue

• Acute painAcute pain

• Impaired skin integrityImpaired skin integrity

• Ineffective therapeutic regimen Ineffective therapeutic regimen managementmanagement

• Body image disturbance Body image disturbance


Nursing ManagementNursing ManagementPlanningPlanning

• Overall goalsOverall goals Have satisfactory pain reliefHave satisfactory pain relief Comply with therapeutic regimen to Comply with therapeutic regimen to

achieve maximum symptom achieve maximum symptom managementmanagement


Nursing ManagementNursing ManagementPlanningPlanning

• Overall goals (cont’d)Overall goals (cont’d) Demonstrate awareness of, and avoid Demonstrate awareness of, and avoid

activities that cause disease activities that cause disease exacerbation (triggers)exacerbation (triggers)

Maintain optimal role function and a Maintain optimal role function and a positive self-imagepositive self-image


Nursing ManagementNursing ManagementNursing ImplementationNursing Implementation

• Health promotionHealth promotion Prevention of SLE is not possiblePrevention of SLE is not possible Promote early diagnosis and treatmentPromote early diagnosis and treatment



• Acute interventionAcute intervention During exacerbation, patient will During exacerbation, patient will

become abruptly, dramatically illbecome abruptly, dramatically ill Record severity of symptoms and Record severity of symptoms and

response to therapy response to therapy



• Acute intervention (cont’d)Acute intervention (cont’d) Observe forObserve for• Fever patternFever pattern

• Joint inflammationJoint inflammation• Limitation of motionLimitation of motion• Location and degree of discomfortLocation and degree of discomfort• Fatigability Fatigability



• Acute intervention (cont’d)Acute intervention (cont’d) Monitor weight and I&OMonitor weight and I&O Collect 24-hour urine sampleCollect 24-hour urine sample Assess neurological statusAssess neurological status Explain nature of diseaseExplain nature of disease Provide supportProvide support



• Ambulatory and home careAmbulatory and home care Reiterate that adherence to treatment Reiterate that adherence to treatment

does not necessarily halt progressiondoes not necessarily halt progression Minimize exposure to precipitating Minimize exposure to precipitating

factors – fatigue, sun, stress, infection, factors – fatigue, sun, stress, infection, drugsdrugs



• Ambulatory and home careAmbulatory and home care Teach energy conservation and Teach energy conservation and

relaxation exercisesrelaxation exercises For joint problems, all the teaching for For joint problems, all the teaching for

RA related to joint protection, ROM, RA related to joint protection, ROM, and positioning to prevent contracturesand positioning to prevent contractures



• Lupus and pregnancyLupus and pregnancy Infertility can result from SLE treatment Infertility can result from SLE treatment

regimenregimen SLE is associated with complications of SLE is associated with complications of

pregnancypregnancy Pregnancy & post partum can cause Pregnancy & post partum can cause

exacerbations of SLEexacerbations of SLE Women with serious SLE should be Women with serious SLE should be

counseled against pregnancycounseled against pregnancy



• Psychosocial issuesPsychosocial issues Counsel patient and family that SLE Counsel patient and family that SLE

has good prognosishas good prognosis Physical effects can lead to isolation, Physical effects can lead to isolation,

self-esteem, and body image self-esteem, and body image disturbancesdisturbances

Assist patient in developing goalsAssist patient in developing goals


Nursing ManagementNursing ManagementEvaluationEvaluation

• Expected outcomesExpected outcomes Completion of priority activitiesCompletion of priority activities Verbalization of having more energyVerbalization of having more energy Expression of satisfaction with pain Expression of satisfaction with pain

relief measuresrelief measures



• Expected outcomes (cont’d)Expected outcomes (cont’d) Performance of activities of daily living Performance of activities of daily living

without painwithout pain Limitation of direct exposure to sun Limitation of direct exposure to sun

and use of sunscreen and use of sunscreen No open skin lesionsNo open skin lesions



• Expected outcomes (cont’d)Expected outcomes (cont’d) Expression of satisfaction with activity Expression of satisfaction with activity

levellevel Pacing of activities to match level of Pacing of activities to match level of

tolerancetolerance Expression of confidence in ability to Expression of confidence in ability to

manage SLE over time and in home manage SLE over time and in home environmentenvironment