Ch 88 Sytemic Lupus Erythematous Flashcards Preview

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Flashcards in Ch 88 Sytemic Lupus Erythematous Deck (24):
1

What is SLE

It is an autoimmune disorder in which atypical immune response results in chronic inflammation and destruction of healthy tissue.

2

What can trigger autoimmune disorders

In autoimmune disorders small antigens may bond with healthy tissue. The body then produces antibodies that attack healthy tissue... This may be triggered by toxins, meds, bacteria, mad or viruses.

3

Is there a cure for autoimmune disorders

No

4

Name other autoimmune disorders

Rheumatoid arthritis
Vasculitis
Multiple sclerosis
Scleroderma ( including Raynaud's phenomenon)
Psoriasis

5

Occurrence of auto immune disorders increases with what

Age

6

What is SLE characterized by

Periods of exacerbations and remissions

7

SLE can be classified into what 2 groups

Discoid SLE- primarily affects the skin; characterized by butterfly rash on the nose and cheeks, generally self limiting

systemic SLE- affects the connective tissues of multiple organs systems and can lead to multiple organ failure

8

What causes medication induced SLE

Procainamide
Hydralazine
Isoniazid

9

What are risk factors for SLE

Female between the ages of 20-40
African American, Asian, or Native American descent
The incidence of SLE declines in woman following menopause. It remains steady on men.

10

What is subjective data of SLE

Fatigue/ malaise
Alopecia
Blurred vision
Pleuritic pain
Anorexia/ weight loss
Depression
Joint pain, swelling, tenderness

11

What is objective assessment data of SLE

Fever( a major symptom of exacerbation)
Anemia
Lymphadenopathy
Pericarditis ( presence of a cardiac friction rub or pleural friction rub)
Raynaud's phenomenon ( arteriolar vasospasm in response to cold/ stress)
Butterfly rash on face

12

What are lab tests to diagnose SLE

+ ANA titer ( antibody produced against ones own DNA)
Anti - DNA + ( not specific to SLE but in the majority of ppl)
Anti sm +
Anti- RO (SSA) +
Anti - LA ( SSB) +
Anti - RNP +
Anti- phospholipids (AP) +
Serum complement C3,C4 decreased
BUN & Cr increased with renal involvement
Urinalysis + for protein and RBC ( renal involvement)
CBC- pantocytopenia

13

What are systemic manifestations of SLE

HTN and edema & urine output indicate renal compromise
Diminished breath sounds indicate pleural effusion
Tachycardia and shape insipiratory chest pain indicate pericarditis
Rubor, pallor and cyanosis of hands, feet indicate vaculitits/ vasospasm, Raynaud's phenomenon
Arthalgias, myalgias and polyarthritis indicate joint and connective tissue involvement
Changes in mental status indicates neurological involvement
Nutritional status

14

What are medications for SLE

1. NSAIDS- used to reduce inflammation and arthritic pain
( NSAIDS are contraindicated in renal compromise / monitor for drug induced hepatitis)
2. Corticosteroids { prednisone, deltasone}( monitor for fluid retention, HTN, and renal dysfunction)
3. Immunosuppressant agents { methotrexate, azathioprine}
4. Anti malarial { hydroxychloroquine , Plaquenil}

15

Why are corticosteroids used to treat SLE

It is used as an immunosuppressant and to reduce inflammation

16

Why are anti malarial drugs used to treat SLE

They are used for the suppression of synovitis, fever and fatigue

17

What is a recommended teaching of the use of corticosteroids

Do not stop taking steroids or decrease dose abruptly

18

What is recommended teaching of immunosuppressant agents such as methotrexate and azathioprine

Monitor for toxic effects ( bone marrow suppression, increased liver enzymes)

19

What are nursing considerations of anti malarial medications

Encourage frequent eye exams

20

What is client education care after discharge instructions

Avoid UV and sun exposure ( use sunscreen when outdoors)
Use mild protein shampoo and avoid harsh hair treatments
Use steroid creams for skin rash
Report peripheral and peri orbital edema promptly
Report evidence of infection related to immunosuppression

21

What are complications of SLE

Lupus nephritis
Clients whose SLE is unable to b managed with immunosuppressants and corticosteroids may experience renal failure secondary to glomerulonephritis... THIS IS A MAJOR CAUSE OF DEATH AND A RENAL TRANSPLANT MAY BE NECESSARY

22

What is pericarditis and myocarditis

Inflammation of the the heart, it's vessels and the surrounding sac can occur secondary to SLE
( monitor for chest pain, fatigue, arrhythmias and fever)

23

For a client with suspected systemic SLE, what are anticipated lab findings?

+ ANA
^ urine protein due to renal involvement
decreased C3,C4
^ BUN

24

For a client prescribed prednisone, what should be included in the teaching

Prednisone causes fluid retention which results in weight gain
Because of the weight gain, abdominal striae may appear in the abdomen

Moon fancies ( rounding of the face due to accumulation of fatty tissue) is an adverse effect of this medication