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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
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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 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
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Etiology and Pathophysiology Etiology is unknown. Most probable causes
Genetic influence Hormones Environmental factors Certain medications
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Etiology and 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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Multisystem Involvement of SLE
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Fig. 65-9. Multisystem involvement in systemic lupus erythematosus.
Clinical Manifestations Dermatologic
Cutaneous vascular lesions Butterfly rash Oral/nasopharyngeal ulcers Alopecia
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Butterfly Rash of SLE
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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
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Swan Neck Deformity
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Fig. 65-4. Typical deformities of rheumatoid arthritis. D, Swan neck deformity.
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 Thrombocytopenia
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Clinical Manifestations Infection
Increased susceptibility to infection
Fever should be considered serious.
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Diagnostic Studies No specific test
SLE is diagnosed primarily on criteria related to patient history, physical examination, and laboratory findings.
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Diagnostic Studies For a complete list of
diagnostic criteria, see Table 65-14 in book.
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Collaborative Care Drug therapy
NSAIDs Antimalarial drugs Steroid-sparing drugs Corticosteroids Immunosuppressive drugs
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Nursing ManagementNursing 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 ManagementNursing Diagnoses Fatigue Acute pain Impaired skin integrity
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Nursing ManagementPlanning Overall goals
Have satisfactory pain relief. Comply with therapeutic
regimen to achieve maximum symptom management.
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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.
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Nursing ManagementNursing Implementation Health promotion
Prevention of SLE is not possible.
Promote early diagnosis and treatment.
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Nursing ManagementNursing Implementation Acute intervention
During exacerbation, patient will become abruptly, dramatically ill.
Record severity of symptoms and response to therapy.
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Nursing ManagementNursing 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 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.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 28
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.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 29
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.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 30
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.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 31
Nursing ManagementEvaluation Expected outcomes
Completion of priority activities
Verbalization of having more energy
Expression of satisfaction with pain relief measures
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 32
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
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 33
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
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 34
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
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Case Study
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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.
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Case Study She was started on
prednisone 100 mg/every other day.
Within a few weeks of taking prednisone, she developed cushingoid syndrome.
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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.
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Case Study She has had occasional UTIs
that have responded to treatment.
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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?
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 41