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Module 4 (MedSurg 2) > Systemic Lupus Erythematosus > Flashcards

Systemic Lupus Erythematosus Flashcards

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1
Q

SLE potential causes

A

Genetic with 1st degree family members
women (estrogen)
stress
exposure to toxins, sunlight, UV lights
40 Different medications

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2
Q

What are the top 3 meds causing lupus?

A

Procainamide (Pronestal)
Hydralazine (Apresaline)
Quinine
Isoniazid(from video)

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3
Q

Describe Lupus in 4 words

A

Multisystem inflammatory autoimmune disease
-affects multiple organs but knowingly causes reddening of the skin

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4
Q

Pathology of Lupus

A

susceptibility genes pt is triggered by an environmental factor (sunburn)
cell DNA becomes damaged and undergoes apoptosis and dies
the DNA from the nucleus is exposed and causes the susp. genes to attack forming nuclear antigens and unable to clear the dead cells out
Antibodies are formed for the nuclear antigens
The antigen-antibodies complex form and enter the bloodstream
they attach to the bloodstream and organs causing inflammation
Complement system with enzymes allowing for fluid to enter cells and continue cell deaths

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5
Q

When antibodies attach to WBC, RBC, and phospholipids and caused phagocytosis this is called?

A

Type 2 Hypersensitivity

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6
Q

What month is Lupus month?

A

May

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7
Q

When tissues become damaged as a result of the antibody-antigen complexes it is called?

A

Type 3 Hypersensitivity

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8
Q

What are the different classifications of Lupus?

A

SLE - most common
Discoid - limited to skin upper - round rashes
Drug-induced
Neonatal Lupus

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9
Q

Risk factors of SLE

A

unpredictable alternating remissions and worsening
Women 20-40
AA, Asian, Hispanics, and Native Americans more than Caucasians
unexpected flares

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10
Q

The severity of SLE is

A

extremely variable
- range from disorder to rapidly progressive

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11
Q

SLE most commonly affects what systems

A

skin
kidneys
muscles
lungs
heart
nervous tissue

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12
Q

What are the biggest complications of SLE

A

pneumonia
sepsis
kidney failure

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13
Q

What are the skin conditions of SLE?

A

alopecia
Butterly malar rash
rash with sunlight exposure
discoid erythema
palmar erythema
mucosal ulcers (oral and pharyngeal)

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14
Q

What are the neuro conditions of SLE?

A

stroke
seizures
peripheral neuropathy
psychosis
cog. impaired (disordered, disoriented, and memory deficit)

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15
Q

What are the psychiatric conditions of SLE?

A

depression
anxiety

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16
Q

What are the cardiopulmonary conditions of SLE?

A

inflammation of all heart parts (endo, myo, and peri)
Dyspnea and cough
dysrhythmias
pleural effusion (pleurisy)
pneumonitis
Raynaud’s phenomenon

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17
Q

SLE dysrhythmias are caused by what

A

fibrosis of the SA and AV nodes

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18
Q

SLE pericarditis can develop into

A

endocarditis (out to in)

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19
Q

What are the urinary conditions of SLE?

A

glomerulonephritis
hematuria
proteinuria
Lupus nephritis

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20
Q

Renal samples need to be assessed every

A

3-6 months

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21
Q

Proteinuria

A

the filter is damaged and larger molecules (protein) get through and out of the urine

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22
Q

Lupus nephritis

A

Kidney disease caused by lupus may get worse over time and lead to kidney failure
- from the complexes being excreted

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23
Q

Hypercoagulability

A

antiphospholipid state
more prone to clots
DVT
hepatic vein thrombosis
stroke
lifelong therapy

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24
Q

SLE can lead to what severe renal problem?

A

end-stage renal disease (75%)

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25
What are the blood conditions of SLE?
**anemia leukopenia** lymphadenopathy splenomegaly **thrombocytopenia** **blood clotting problems** at the ends of fingers turn red and purple
26
What tx is used for anticoagulant therapy?
aspirin Plavix comadin
27
What are the GI conditions of SLE?
abdominal pain dysphagia N/V/D
28
What are the musculoskeletal conditions of SLE?
**Polyarthralgia with morning stiffness no limitation arthritis (swan-neck, ulnar deviation, subluxation with hyperlaxity)** myositis (muscle pain) synovitis
29
SLE has an ______________ risk of bone loss and fx.
increased
30
What are the reproductive conditions of SLE?
menstrual abnormalities
31
What are the systemic conditions (c/o) of SLE?
low-grade fever wt loss expected rash arthralgia (joint pain) extreme fatigue in a women of child bearing age
32
Why is SLE a systemic illness?
antibodies stick to various areas causing inflammation and damage to multiple organs
33
Raynaud's phenomenon
34
T/F: SLE is more susceptible for infection.
True
35
Why are SLE pts more susceptible to infections?
defects in the ability to phagocytize invading bacteria deficiency antibody production immunosuppressive therapy from anti-inflammatory or steroids
36
Diagnosis for SLE
Anti-DNA 50% Anti-Smith antibodies 30-40% always dx ANA 97% **CRP and ESR increased**
37
What tests are monitored for treatment response?
CRP ESR increased
38
SLE is primarily diagnosed on criteria r/t
pt hx physical exam lab findings
39
T/F: There is no one test to dx SLE.
True only a process of elimination
40
If treatment works in a SLE pt, the CRP and ESR do what
decrease
41
If at least _____ of the criteria on SOAP BRAIN MD is present at the present time or at some time in the past, this is a strong criterion of lupus.
4
42
Mnemonic for SLE Dx criteria
SOAP BRAIN MD
43
What are the SLE Dx criteria?
Serositis (pleuritis, pericarditis) Oral ulcers Arthritis - 2+ joints Photosensitivity Blood disorder (low blood, WBCs, etc) Renal disorders (protein or casts in urine) ANA + 97% Immunologic disorder (anti-DNA, Sm, or + antiphospholipid) Neurologic disorder (seizure/psychosis) Malar rash (butterfly) Discoid rash
44
Serositits
inflammation of the lining around the lungs (pleuritis) or inflammation of the lining around the heart that causes chest pain which is worse with deep breathing (pericarditis)
45
Photosensitivity
a reaction to sun or light that causes a skin rash to appear or get worse
46
Malar rash
a rash over the cheeks and nose, often in the shape of a butterfly
47
Discoid Rash
rash that appears as red, raised, disk-shaped patches -chronic and can scar
48
Most common problems with SLE *cues*
persistent pain overall chronic inflammation - rash low skin integrity fatigue possible loss of tissue integrity self-esteem low body image
49
Major classes of drug therapies
NSAIDs Antimalarial/antirheumatic Immunosuppressives (combined) Corticosteroids (short during flares) Anticoagulants
50
RA and SLE drugs are
similar in treatments
51
Antimalarial/Antirheumatic Drugs
hydroxychloroquine (Plaquenil) – 1st used 
52
Hydroxychloroquine (Plaquenil) Uses
Discoid Lupus/SLE RA Malaria
53
Hydroxychloroquine (Plaquenil) Prevents/Reduces
Reduces the amount of **autoantibodies** Reduces **pain & inflammation** Prevent lupus flares Prevent blood clots Prevent organ damage
54
Hydroxychloroquine (Plaquenil) monitor and assessments
Monitor CBC, LFT, glucose Assess low **TENDON REFLEX, rash** **Retinopathy, hepatotoxicity, infection**
55
How long does Hydroxychloroquine (Plaquenil) take to become effective?
1-3 months
56
Hydroxychloroquine (Plaquenil) side effects
Hepatotoxic Dysrrhytmia (skipping or irregular beats) Retinal damage Infection
57
Hydroxychloroquine (Plaquenil) education
eye exam every 6 months clotting ability (bleeding and bruising) Call HCP with fever, bleeding, bruising, vision changes (getting sick)
58
How do you prevent exacerbations (FLARES) in SLE?
maintain good nutrition (avoid processed and sugars) avoid infection exposure teach medications **avoid sunlight exposure** - risk for early cataracts (sunglasses) HCP before taking immunizations - not live Avoid pregnancy
59
How does the nurse provide adequate tissue perfusion in SLE pts?
assess impairment of peripheral perfusion prevent injuries to extremities monitor for fluid retention
60
How does the nurse effectively manage pain control in SLE pts?
balance rest and activity NSAIDs for arthritic pain therapies short-term corticosteroids
61
How does the nurse maintain renal function in SLE pts?
edema, HTN, hematuria, and low output BUN and Creatinine UTIs and glomerulonephritis excess fluid volume
62
How does the nurse have psychological equilibrium?
observe for CNS involvement - HA, inappropriate speech, diff. concentrating assess for mood changes support groups and resources
63
Acute Care for Lupus Flare
quickly very ill log = severity of symptoms, triggers, fever patterns, inflammation, ROM, response therapy
64
Acute Care for SLE Observation
fever pattern joint inflammation limitation of motion location and degree of discomfort fatigue
65
Nursing Implementations for SLE pts in Acute Care
Monitor WT and I&Os collect a 24-hour urine sample neuro status (visual, HA, seizures, personality, memory loss) explain disease support
66
In SLE, adherence to treatment is always a guarantee against flares. T/F
False, no guarantee
67
Why is infertility a common result in SLE?
renal involvement high-dose corticosteroids immunosuppressive drugs
68
What does a woman with SLE need for education regarding pregnancy?
communication btw doctors impact placenta and within vessels = serious consequences such as miscarriage or still birth **Vigilant birth controls** **Postpartum** causes sudden changes in hormones leading to serious flares **C-section**
69
Expected Outcomes of SLE pts
Use **energy conservation** techniques Lifestyle changes **Adherence** to medication regimen Avoid / delay organ dysfunction Maintain positive self-image
70
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 which diagnosis? Systemic sclerosis Rheumatoid arthritis Chronic fatigue syndrome Systemic lupus erythematosus
Systemic lupus erythematosus
71
A patient is to begin taking hydroxychloroquine, what should be included in the nurse’s teaching plan? Select all that apply. Have eye exams every 6 months Monitor for signs of infection Take with food Avoid taking while pregnant Report irregular heart beats
Have eye exams every 6 months Monitor for signs of infection Report irregular heart beats
72
Is it okay for a pregnant or breastfeeding woman to continue taking hydroxychloroquine?
yes, with lowest dose possible
73
A nurse is teaching a newly diagnosed patient about SLE. Which factor might increase a flare up of SLE? Pregnancy Hypotension Fever GI upset
Pregnancy

Module 4 (MedSurg 2) (36 decks)

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