Download 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
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Skin
Joints
Serous membranes
Renal system
Hematologic system
Neurologic system
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Systemic Lupus Erythematosus
• A variable disease
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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
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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
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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
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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
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Tachypnea
Pleurisy
Dysrhythmias
Accelerated CAD
Pericarditis
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Clinical Manifestations
• Renal
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Lupus nephritis
• Ranging from mild proteinuria to
glomerulonephritis
• Primary goal in treatment is slowing the
progression
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Clinical Manifestations
• Nervous system
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Generalized/focal seizures
Peripheral neuropathy
Cognitive dysfunction
• Disorientation
• Memory deficits
• Psychiatric symptoms
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Clinical Manifestations
• Hematologic
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Formation of antibodies against blood
cells
Anemia
Leukopenia
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Clinical Manifestations
• Hematologic (cont’d)
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Thrombocytopenia
Coagulopathy
Anti-phospholipid antibody syndrome
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Clinical Manifestations
• Infection
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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
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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
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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
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Earlier diagnosis
Earlier and better treatment regimens
Careful monitoring for organ
involvement
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Collaborative Care
• Drug therapy
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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
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Fatigue
Acute pain
Impaired skin integrity
Ineffective therapeutic regimen
management
• Body image disturbance
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Nursing Management
Planning
• Overall goals
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Have satisfactory pain relief
Comply with therapeutic regimen to
achieve maximum symptom
management
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Nursing Management
Planning
• Overall goals (cont’d)
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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
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Prevention of SLE is not possible
Promote early diagnosis and treatment
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Nursing Management
Nursing Implementation
• Acute intervention
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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)
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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)
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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
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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
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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
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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
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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
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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)
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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)
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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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