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Medical Surgical Exam 4 > Systemic Lupus Erythematosus SLE > Flashcards

Systemic Lupus Erythematosus SLE Flashcards

1
Q

What is Systemic Lupus Erythematosus and its etiology

A

Chronic multisystem inflammatory autoimmune disease
Etiology is unknown
Most probable causes
Genetic influence
Hormones-Ages start at menses and oral birth control-during and after pregnancy
Environmental factors-sun exposure and sun burns
Certain medications- Hydralazine and anti seizure medications

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2
Q

Clinical Manifestations

A

SLE is extremely variable in severity
Ranges from a relatively mild disorder to rapidly progressive disease affecting many organ systems
Most commonly affects skin, muscles, lining of lungs, heart, nervous tissue, and kidneys

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3
Q

Multisystem Involvement of SLE Picture

A
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4
Q

Dermatologic Clinical Manifestations

A

Cutaneous vascular lesions
Most commonly in sun-exposed areas
Oral/nasopharyngeal ulcers
In up to 33% of cases
Alopecia
Butterfly rash
Occurs in 50% of cases

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5
Q

Butterfly Rash of SLE

A
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6
Q

Musculoskeletal clinical manifestations

A

Polyarthralgia-multiple joints inflamed with morning stiffness

Arthritis

Swan neck fingers

Ulnar deviation

Subluxation with hyperlaxity (joints that move easily beyond expected movement) of joints

Increased risk of bone loss and fracture

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7
Q

Swan Neck Deformity

A
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8
Q

Cardiopulmonary Clinical Manifestations

A

Tachypnea
Cough
Pleurisy
Dysrhythmias
Fibrosis of SA and AV nodes
Pericarditis
Accelerated CAD
At risk for coagulation disorder

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9
Q

Clinical Manifestations Renal

A

Lupus nephritis
Manifests in about 40% of cases within 5 years of onset
Ranging from mild proteinuria to glomerulonephritis
Primary goal in treatment is slowing the progression- Can give autoimmune suppressants and cytotoxins

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10
Q

Clinical Manifestations Nervous System

A

Generalized/focal seizures- Give corticoid steroids and ant seizure medications
Peripheral neuropathy
Cognitive dysfunction
Disorientation
Memory deficits
Psychiatric symptoms

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11
Q

Clinical Manifestations Hematologic

A

Formation of antibodies against blood cells- Destroying our own cells
Anemia
Leukopenia
Thrombocytopenia- Look for bleeding D/O. Educate patients regarding it

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12
Q

Clinical manifestations of Infection-Due to leukopenia

A

Increased susceptibility to infections
Defects in ability to phagocytize invading bacteria
Deficiencies in antibody production
Immunosuppressive effect of many antiinflammatory drugs
Infection is a major cause of death

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13
Q

Diagnostic Studies

A

No specific test
Anti-DNA antibodies
Anti-Smith (Sm) antibodies-almost always considered diagnostic
Presence of Anti Nuclear Antibody

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14
Q

Collaborative Care major challenges and survival

A

Major challenge to manage active disease yet prevent treatment complications that cause tissue damage
Survival influenced by:
Age, race, gender, socioeconomic status, comorbid conditions, and severity of disease
Early diagnosis and effective treatment

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15
Q

Collaborative Care Drug Therapy

A

NSAIDs- Mild conditions only
Mild polyarthralgia or polyarthritis
Antimalarial drugs-Planquentil
Corticosteroids- BS increase taper off don’t give for long periods of time, higher risk for infection
Severe cutaneous SLE
Immunosuppressive drugs- steroid sparing- So we don’t overload them with steroids
Azathioprine (Imuran) – Immunosupressive drug. Do not give live vaccine

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16
Q

Collaborative Care Biologic and targeted therapy agents to:

A

Interfere with immune response
Combat osteoporosis
Improve cutaneous cases
Safe use, proper administration, and possible side effects should be taught
Abrupt cessation may cause exacerbation- Must taper off

17
Q

Nursing Management Nursing Assessment

A

Assess patient’s physical, psychologic, and sociocultural problems with long-term management of SLE
Evaluate influence of pain and fatigue on ADLs

18
Q

Nursing Management Nursing Diagnoses

A

Fatigue
Impaired skin integrity
Impaired comfort

19
Q

Nursing Management Planning Overall goals

A

Demonstrate awareness of, and avoid activities that cause, disease exacerbation- Educate them. Avoid activities in the sun. How they know what exacerbation is, compliance with medications
Maintain optimal role function and a positive self-image

20
Q

Nursing Management Nursing Implementation Health Promotion

A

Prevention of SLE is not possible
Promote early diagnosis and treatment through education of both health professionals and the community

Unpredictable nature of the disease presents many challenges to patient, caregiver, and multidisciplinary health care team
Physical, psychologic, and sociocultural problems

21
Q

Nursing Management Nursing Implementation Acute Interventions

A

During exacerbation, patient will become abruptly, dramatically ill
Record
Severity of symptoms
Response to therapy

22
Q

Nursing Management Nursing Implementation Acute intervention

Observe for:

A

Fever pattern
Joint inflammation
Limitation of motion
Location and degree of discomfort
Fatigue

23
Q

Nursing Management Nursing Implementation Acute Interventions

A

Monitor weight and I&O
Collect 24-hour urine sample
Assess neurologic status
Visual disturbances, headaches, seizures, personality changes, forgetfulness
Explain nature of disease
Provide support

24
Q

Nursing Management Nursing Implementation Ambulatory and home care

A

Emphasize importance of patient cooperation for successful home management
Reiterate that adherence to treatment is no guarantee against exacerbations
Minimize exposure to precipitating factors

25
Q

Nursing Management Nursing Implementation Lupus and pregnancy

A

Infertility can result
Renal involvement
High-dose corticosteroids
Chemotherapy drugs
Women with serious SLE should be counseled against pregnancy

26
Q

Nursing Management Nursing Implementation Psychosocial issues

A

Supportive therapies to help with coping become very important
Counsel patient and family that SLE has good prognosis for most
Physical effects can lead to isolation, self-esteem, and body image disturbances
Assist patient in developing goals

27
Q

Nursing Management Evaluation Expected outcomes

A

Use energy conservation techniques
Adapt lifestyle to energy level
Maintain skin integrity with the use of topical treatments
Prevent exacerbations with the use of sunscreens and limited sun exposure

28
Q
A

Medical Surgical Exam 4 (11 decks)

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