1. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Systemic Lupus Erythematosus (SLE)

2. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Systemic Lupus Erythematosus (SLE) Chronic multisystem inflammatory diseaseChronic multisystem inflammatory disease Associated with abnormalities of immune system Associated with abnormalities of immune system Results from interactions among genetic, hormonal, environmental, and immunologic factorsResults from interactions among genetic, hormonal, environmental, and immunologic factors

3. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Systemic Lupus Erythematosus Affects theAffects the  Skin  Joints  Serous membranes  Renal system  Hematologic system  Neurologic system

4. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Systemic Lupus Erythematosus A variable diseaseA variable disease  Chronic  Unpredictable  Characterized by exacerbations & remissions

5. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Incidence SLE affects 2 to 8 persons per 100,000 in United StatesSLE affects 2 to 8 persons per 100,000 in United States Most cases occur in women of childbearing yearsMost cases occur in women of childbearing years African, Asian, Hispanic, and Native Americans three times more likely to develop than whitesAfrican, Asian, Hispanic, and Native Americans three times more likely to develop than whites

6. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology Etiology is unknownEtiology is unknown Most probable causesMost probable causes  Genetic influence  Hormones  Environmental factors  Certain medications

7. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pathophysiology Autoimmune reactions directed against constituents of cell nucleus, DNAAutoimmune reactions directed against constituents of cell nucleus, DNA Antibody response related to B and T cell hyperactivityAntibody response related to B and T cell hyperactivity

8. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations Ranges from a relatively mild disorder to rapidly progressing, affecting many body systemsRanges 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 kidneysMost commonly affects the skin/muscles, lining of lungs, heart, nervous tissue, and kidneys

9. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig 65-9 Clinical Manifestations

10. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations DermatologicDermatologic  Cutaneous vascular lesions  Butterfly rash  Oral/nasopharyngeal ulcers  Alopecia

11. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Dermatologic Manifestations Fig 65-10

12. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations MusculoskeletalMusculoskeletal  Polyarthralgia with morning stiffness  Arthritis Swan neck fingersSwan neck fingers Ulnar deviationUlnar deviation Subluxation with hyperlaxity of jointsSubluxation with hyperlaxity of joints

13. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Swan Neck Deformity Fig. 65-4 D

14. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations CardiopulmonaryCardiopulmonary  Tachypnea  Pleurisy  Dysrhythmias  Accelerated CAD  Pericarditis

15. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations RenalRenal  Lupus nephritis Ranging from mild proteinuria to glomerulonephritisRanging from mild proteinuria to glomerulonephritis Primary goal in treatment is slowing the progressionPrimary goal in treatment is slowing the progression

16. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations Nervous systemNervous system  Generalized/focal seizures  Peripheral neuropathy  Cognitive dysfunction DisorientationDisorientation Memory deficitsMemory deficits Psychiatric symptomsPsychiatric symptoms

17. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations HematologicHematologic  Formation of antibodies against blood cells  Anemia  Leukopenia

18. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations Hematologic (cont’d)Hematologic (cont’d)  Thrombocytopenia  Coagulopathy  Anti-phospholipid antibody syndrome

19. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations InfectionInfection  Increased susceptibility to infections  Fever should be considered serious  Infections such as pneumonia are a common cause of death

20. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies No specific testNo specific test SLE is diagnosed primarily on criteria relating to patient history, physical examination, and laboratory findingsSLE is diagnosed primarily on criteria relating to patient history, physical examination, and laboratory findings

21. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies

22. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies Antinuclear antibodiesAntinuclear antibodies  ANA and other antibodies indicate autoimmune disease  Anti-DNA and anti-Smith antibody tests most specific for SLE  LE prep can be positive with other rheumatoid diseases  ESR & CRP are indicative of inflammatory activity

23. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Tests CBC for hematologic problemsCBC for hematologic problems UA for lupus nephritisUA for lupus nephritis X-rays of affected jointsX-rays of affected joints Chest x-ray for pulmonary problemsChest x-ray for pulmonary problems ECG for cardiac problemsECG for cardiac problems

24. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care Prognosis is improved withPrognosis is improved with  Earlier diagnosis  Earlier and better treatment regimens  Careful monitoring for organ involvement

25. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care Drug therapyDrug therapy  NSAIDs  Antimalarial drugs  Steroid-sparing drugs  Corticosteroids  Immunosuppressive drugs

26. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Assessment Assess patient’s physical, psychologic, and sociocultural problems with long-term management of SLEAssess patient’s physical, psychologic, and sociocultural problems with long-term management of SLE Assess pain and fatigue dailyAssess pain and fatigue daily

27. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Assessment Obtain subjective and objective dataObtain subjective and objective data Educate and counsel on expected issuesEducate and counsel on expected issues

28. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Diagnoses FatigueFatigue Acute painAcute pain Impaired skin integrityImpaired skin integrity Ineffective therapeutic regimen managementIneffective therapeutic regimen management Body image disturbanceBody image disturbance

29. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Planning Overall goalsOverall goals  Have satisfactory pain relief  Comply with therapeutic regimen to achieve maximum symptom management

30. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Planning Overall goals (cont’d)Overall goals (cont’d)  Demonstrate awareness of, and avoid activities that cause disease exacerbation (triggers)  Maintain optimal role function and a positive self-image

31. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation Health promotionHealth promotion  Prevention of SLE is not possible  Promote early diagnosis and treatment

32. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation Acute interventionAcute intervention  During exacerbation, patient will become abruptly, dramatically ill  Record severity of symptoms and response to therapy

33. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation Acute intervention (cont’d)Acute intervention (cont’d)  Observe for Fever patternFever pattern Joint inflammationJoint inflammation Limitation of motionLimitation of motion Location and degree of discomfortLocation and degree of discomfort FatigabilityFatigability

34. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation Acute intervention (cont’d)Acute intervention (cont’d)  Monitor weight and I&O  Collect 24-hour urine sample  Assess neurological status  Explain nature of disease  Provide support

35. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation Ambulatory and home careAmbulatory and home care  Reiterate that adherence to treatment does not necessarily halt progression  Minimize exposure to precipitating factors – fatigue, sun, stress, infection, drugs

36. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation Ambulatory and home careAmbulatory and home care  Teach energy conservation and relaxation exercises  For joint problems, all the teaching for RA related to joint protection, ROM, and positioning to prevent contractures

37. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation

38. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation Lupus and pregnancyLupus and pregnancy  Infertility can result from SLE treatment regimen  SLE is associated with complications of pregnancy  Pregnancy & post partum can cause exacerbations of SLE  Women with serious SLE should be counseled against pregnancy

39. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation Psychosocial issuesPsychosocial 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

40. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Evaluation Expected outcomesExpected outcomes  Completion of priority activities  Verbalization of having more energy  Expression of satisfaction with pain relief measures

41. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Evaluation Expected outcomes (cont’d)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

42. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Evaluation Expected outcomes (cont’d)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