Unit 9 Chapter 18 Systemic Lupus Erythematosus Flashcards
What is Systemic lupus erythematosus (SLE) ?
Systemic lupus erythematosus (SLE) is a chronic and progressive autoimmune disorder in which inflammatory and immune attacks occur against multiple self tissues and organs.
s/s of SLE
Skin
* Dry, scaly raised rash “butterfly” rash
* Discoid lesions (coinlike)-scarring
- Renal
- nephritis
Cardiovascular
* Pericarditis
* Raynaud’s
Pulmonary
* Pleural effusions
* Pneumonia, or pleurisy
*Neurologic
* Seizures, migraine HA, peripheral neuropathies, memory issues
- Anorexia
- Vasculitis – vessels inflamed, deprives organs of arterial blood supply and
oxygen RAYNAUDS - Polyarthritis (small joints and knees most often)
- Muscle atrophy-musclewasting
- Generalized weakness
- Anemia
Hematologic problems with hemolytic anemia (most common),
decreased white blood cells (leukopenia), decreased lymphocytes (lymphopenia), decreased platelets (thrombocytopenia)
^APLASTIC ANEMIA OR PANCYTOPENIA^
S/S OF PERICARDITIS
pericardial friction rub; This scratchy, high- pitched sound is produced when the inflamed, roughened pericardial
-pain in supine position
-pain in include substernal precordial pain that radiates to the left side of the neck, the shoulder, or the back
cardiac tamponade
Jugular vein distention
Clear lungs
Muffles heart tones
pulses paradoxes
-decreased cardiac output
(4-8ML per min is normal)
-Tachycardia
-Hypotension
-decrease O2 sat
-Decrease CO
Which of the following findings should the nurse report to the health care provider?
A. Butterly rash on face
B. Joint pain
C. Dry skin
D. Temperature of 100.1
D. Temperature of 100.1
Fever and Fatigue – most common findings. Fever is the classic sign of a flare
or exacerbation
Which of the following statements by the nurse requires further teaching for a female client with SLE?
A. Pregnancy can cause remission of this disease
B. Wear a brimmed hat and long sleeves before going outside
C. Exercise will increase the mobility of your lower joints
D. Stay away from sick people
A. Pregnancy can cause remission of this disease
Pregnancy can cause exacerbation of this disease, if patient is planning to get pregnant they will need a consultation due to the risk of exacerbation
-short low impact with periods off rest
Which of the following statements by the nurse requires further teaching for a female client with SLE?
A. you should not report stiff neck or palpitations because it is a normal finding
B. Wear a brimmed hat and long sleeves before going outside
C. Exercise will increase the mobility of your lower joints
D. Stay away from sick people
A. you should not report stiff neck or palpitations because it is a normal finding
Medications used for SLE
Topical cortisone – reduce inflammation OF BUTTERFLY RASH
*Methotraxate- immunosupressant
- Hydroxychloroquine– deceases absorption of ultraviolet light –decreases risk of skin lesions
- Acetaminophen or NSAID’s – muscle pain and inflammation
-
Chronic steroid therapy may cause constriction of small blood vessels
supplying the joint causing tissue to die
Side effects of long term corticorsteroids use
Side effects with long-term therapy include weight gain, fat redistribution (moon face; buffalo hump between the shoulders), increased risk for GI ulcers and bleeding, fragile skin that bruises easily, reduced muscle mass and strength, thinning scalp hair, increased facial and body hair, increased susceptibility to colds and other infections, and stretch marks.
ters and affects every type of body cell and produces many side effects. Common side effects that appear within a week of corticosteroid therapy include acne, sodium and fluid retention, hypertension, sensation of “nervousness,” difficulty sleeping, and emotional changes such as crying easily.
Drug alert for Corticorsteroids
The most important precaution to teach patients taking long-term corticosteroids is to never stop taking the drug abruptly because adrenal crisis can result and may be life threatening. If the patient becomes ill and cannot tolerate the prescribed oral corticosteroid, instruct her or him to immediately contact the rheumatology health care provider to receive the drug parenterally.
What drug can cause Drug-induced SLE?
A. Prednisone
B. Hydralazine
C. Methotrexate
D. Ibuprofen
B. Hydralazine
Certain drugs can cause an SLE-like reaction. Drug-induced SLE can be caused by hydralazine, isoniazid, penicillamine D, and procainamide. Determine whether these or any other drugs were taken on a long-term basis within the year before symptoms were first noticed.
Patient Teaching for Skin (SLE)
Protect skin to prevent exacerbation
* Avoid sunlight, fluorescent light, wear sun block, etc
* Clean skin with mild soap and mild lotion
* Avoid perfumes
* Used cosmetics with moisturizers
Sun Protection Factor (SPF) – at
least 30 everyday
*Exercise regularly
*Limit caffeine and alcohol
*Avoid pregnancy
*wear long sleeve
*use no powders
*Inspect skin daily
AVOID INFECTION
Patient teaching for SLE
- Accept fatigue as a continuing but manageable condition of SLE.
- Avoid self-blame for the need to alter activity. It is not your fault that you have lupus.
- Avoid sick people
*Check Temperature daily - Keep in mind that your health comes first.
- Establish good sleep pa tterns and a healthy diet for more energy.
- Make rest time a priority, and make sure your family knows why. If you rest now, you can participate later. However, be aware that sleeping during the day may make sleeping at night more difficult.
- If you smoke, stop and avoid nicotine in any form. Nicotine use reduces your available energy by restricting blood flow to your heart
and lungs. - Plan ahead and prioritize your activities, keeping in mind that you do not have to be a “super” person involved in everything. It is okay to say “no.”
- Group your errands when driving, starting with those farther from home and heading toward home.
- When possible, shop online and have items delivered directly to you, especially heavy items such as groceries.
- Prepare meals in advance on less busy days; engage other family members in prepping items to cook.
- When possible, prepare items while si tting (e.g., cutt ing vegetables).
- Carefully select which activities and events you can a ttend or participate in and which ones you must regretfully decline. For example, you might not want to volunteer to take and chaperone first graders on a trip to the zoo but may be able to organize volunteers or type meeting minutes.
- Work on asking for what you need. Asking for help will become easier with time and practice. (You may be able to help those who help you by performing tasks for them that are less physically challenging).
- Accept help offered by others. This practice often results in stronger bonds between you and those who care about you.
- Make adjustments in your life that will help you live be er, such as joining a support group or carving out some “me” time (perhaps for a relaxing massage).
Is exercise good for patients with SLE?
A. No
B. Yes
B. Yes
In fact, aerobic exercise is known to be effective in improving endurance in lupus fatigue. Although high-impact exercises should be performed only on the advice of the rheumatology specialist, daily performance of lower-impact activities and strength-building exercises are helpful. For adults whose fitness level is low, walking and stretching exercises are appropriate for initial activity. Duration and intensity can gradually be increased.
