Download Systemic Lupus

Systemic Lupus Erythematosus
(SLE)
Cheryl McConnell RN, MSN
Lupus: Prevalence
1 in 700 (ages 15 -64) women have lupus
1 in 250 are African American Women
Asian and Native Americans = ↑ incidence
Usually affects women between 15 to 40
In this age group 1:200 will develop lupus
Usual onset is during childbearing age
Possible hormonal link
8 – 10 times more prevalent in women
Types of Lupus
•
SLE – Systemic
–
•
Chronic, progressive, inflammatory
connective tissue disorder that causes organ
failure; potentially fatal with a 5-year survival
rate of 85%
Drug Induced Lupus
–
–
–
•
Procainimide
Hydralazine
INH
DLE – Discoid
–
Affects only the skin
Pathophysiology of Lupus
• Autoimmune: Exact Mechanism Unknown
– Viruses
– Environmental chemicals
– Genetic
• Antibodies “attack” healthy tissue
• Causes inflammation to the organ or to the
vessels supplying blood to the organ
– Deprives organs of arterial blood supply
Prognosis
• Potentially fatal disorder
• Increase in survival rate in last 20 years
• Now… 85% of clients survive at least 5
years
– Leading cause of death are related to
infection
Diagnostics
• DLE = skin biopsy
• Serum ANA, ESR, protein
electrophoresis, complement,
immunoglobins
• Lupus cell prep (LE prep)
• CBC
• Electrolytes
• Liver and cardiac enzymes
• Coag studies
• Anticardiolipin Antibodies
Diagnostic Criteria
• Must have four of the following eleven
symptoms or findings:
Malar rash
Mouth sores
Arthritis
Serositis
+ ANA
Immunologic Disorder
Discoid lupus
Photosensitivity
Abnormal UA
Neurologic disorder
Hematologic disorder
Signs and Symptoms of Lupus
• Skin:
– Dry, scaly, raised rash on
face
– Appears to be in butterfly
pattern—the “Bite of the
Wolf.”
– Individual round lesions
• Hair
– Hair loss
– Change in texture
Signs and Symptoms of Lupus
Musculoskeletal
 Joints are affected
causing painful mobility
(Polyarthritis in 90% of
SLE patients).
 Joint inflammation
 Avascular necrosis –
after 5 years of diagnosis
 Muscle atrophy (results
from autoimmune
complex invasion—
leading to Myositis).
 Muscle pain
Sign and Symptoms of Lupus
• Renal
– Lupus nephritis
• Changes in the glomeruli
– Decreased urinary
output
– Proteinuria
– Hematuria
– Fluid retention
– Leading cause of death
– 50% of all lupus pts have
this
Signs and Symptoms of Lupus
• Respiratory
– Pleural effusions
• Results in restrictive and obstructive
changes
–Dyspnea
–Hypoventilation
Signs and Symptoms of Lupus
• Cardiac
Pericarditis
• Tachycardia
• Pain
• Myocardial ischemia
Chest Pain
Cardiac Dysrrhythmias
Raynaud’s Disease
Lack of circulation
to hands and feet
Signs and Symptoms of Lupus
• Neurological
–Psychoses
–Paresis
–Seizures
–Headaches
–Strokes
–Peripheral neuropathies
– http://www.mtio.com/lupus/lal_7.htm
Signs and Symptoms of Lupus
• GI Tract
– Abdominal pain
• Mesenteric arteritis
• Pancreatitis
• Ulcers
• Liver enlargement
• Spleenomegaly
• Sexual Dysfunction
– Pain
– Fatigue/weakness
– Self esteem
– Decreased desire
• Psychosocial
– Dealing with illness
– Fear of death chronic
– Lack of socialization
– Body image changes
• Rash
• Medication related
• Systemic
– Fever
– Generalized weakness
– Fatigue
– Anorexia
– Weight loss
Treatment
• Medications:
– Topical steroids for
lesions
– Plaquenil
(hydroxychloroquine)
Can damage retina
– Steroids
– Immunosuppressives
– Anticoagulants if
needed
• Skin protection
– Avoid sunlight
– Mild soaps
– Cosmetic cover-ups
- Daily inspection
• Hair loss
– Mild shampoo
– No chemicals
Patient teaching
• May need repeated
hospitalizations
• Recognize signs of
exacerbation
• Coping strategies
• Need for continued medical
follow up
• Healthy lifestyle
• Lupus support group
More Patient Teaching
• Energy conservation
• Sexual counseling
• Pregnancy aggravates the signs and
symptoms
– No pregnancy if patient has complications
involving cardiac, renal, or CNS
– Has increased risk of miscarriage, stillbirth,
premature birth
Lupus Support
• The National Lupus Foundation
– www.lupus.org