Podcast
Questions and Answers
What is the most accurate statement about the prevalence of Systemic Lupus Erythematosus (SLE) across different populations?
What is the most accurate statement about the prevalence of Systemic Lupus Erythematosus (SLE) across different populations?
Which group is statistically most likely to develop SLE when compared to European Americans?
Which group is statistically most likely to develop SLE when compared to European Americans?
Which of the following is a characteristic of the clinical manifestations of SLE?
Which of the following is a characteristic of the clinical manifestations of SLE?
Which of the following factors is LEAST likely to contribute to a poorer prognosis in individuals with SLE?
Which of the following factors is LEAST likely to contribute to a poorer prognosis in individuals with SLE?
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A patient with SLE exhibits Raynaud's phenomenon, photosensitivity, and mucosal ulceration. Based on the text, this patient is MOST likely:
A patient with SLE exhibits Raynaud's phenomenon, photosensitivity, and mucosal ulceration. Based on the text, this patient is MOST likely:
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Which statement best describes the relationship between genetics and the development of SLE?
Which statement best describes the relationship between genetics and the development of SLE?
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Which of the following is NOT cited as a potential trigger for a SLE?
Which of the following is NOT cited as a potential trigger for a SLE?
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What is the primary mechanism by which SLE causes organ damage?
What is the primary mechanism by which SLE causes organ damage?
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Which of the following is a symptom that is not consistently present in all SLE cases, making diagnosis challenging?
Which of the following is a symptom that is not consistently present in all SLE cases, making diagnosis challenging?
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Compared to women, men with SLE are more likely to suffer from which of the following complications?
Compared to women, men with SLE are more likely to suffer from which of the following complications?
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A patient with SLE is prescribed trimethoprim-sulfamethoxazole. What is the most critical consideration for the nurse?
A patient with SLE is prescribed trimethoprim-sulfamethoxazole. What is the most critical consideration for the nurse?
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Which surgical intervention is most likely to be considered for a patient with severe lupus nephritis?
Which surgical intervention is most likely to be considered for a patient with severe lupus nephritis?
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A patient with SLE presents with fatigue, joint pain, and a butterfly rash. Which of these findings indicates the need for further investigation by a specialist?
A patient with SLE presents with fatigue, joint pain, and a butterfly rash. Which of these findings indicates the need for further investigation by a specialist?
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A patient with SLE has been experiencing increased fatigue, fever, and mucosal ulcers. What does the nurse recognize these symptoms are indicative of?
A patient with SLE has been experiencing increased fatigue, fever, and mucosal ulcers. What does the nurse recognize these symptoms are indicative of?
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A patient with SLE has a history of migraine headaches and Raynaud's phenomenon. What is most critical for the nurse to emphasize regarding medication management?
A patient with SLE has a history of migraine headaches and Raynaud's phenomenon. What is most critical for the nurse to emphasize regarding medication management?
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Which laboratory finding is most indicative of decreased renal function in a patient with SLE?
Which laboratory finding is most indicative of decreased renal function in a patient with SLE?
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A patient with SLE is experiencing shortness of breath and decreased oxygen saturation. Which complication should the nurse suspect?
A patient with SLE is experiencing shortness of breath and decreased oxygen saturation. Which complication should the nurse suspect?
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A patient with SLE is diagnosed with thrombocytopenia. What is an important nursing intervention related to this laboratory finding?
A patient with SLE is diagnosed with thrombocytopenia. What is an important nursing intervention related to this laboratory finding?
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A patient with SLE on immunosuppressants develops a fever. What is the most critical assessment the nurse should prioritize?
A patient with SLE on immunosuppressants develops a fever. What is the most critical assessment the nurse should prioritize?
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A patient with SLE is being discharged. Which teaching point is most critical regarding medication management to control the disease?
A patient with SLE is being discharged. Which teaching point is most critical regarding medication management to control the disease?
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What is the primary purpose of using C-reactive protein and ESR tests in the context of SLE?
What is the primary purpose of using C-reactive protein and ESR tests in the context of SLE?
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Which of the following is considered the most specific laboratory finding for SLE?
Which of the following is considered the most specific laboratory finding for SLE?
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Which nonpharmacological intervention is specifically aimed at preventing SLE disease flares and serious organ disease?
Which nonpharmacological intervention is specifically aimed at preventing SLE disease flares and serious organ disease?
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What is a crucial consideration when prescribing nonsteroidal anti-inflammatory medications (NSAIDs) for SLE patients?
What is a crucial consideration when prescribing nonsteroidal anti-inflammatory medications (NSAIDs) for SLE patients?
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A patient is diagnosed with SLE and has a positive ANA, low complement, positive anti-Sm, and antiphospholipid antibodies. According to the criteria given, how many criteria are met for supporting a diagnosis?
A patient is diagnosed with SLE and has a positive ANA, low complement, positive anti-Sm, and antiphospholipid antibodies. According to the criteria given, how many criteria are met for supporting a diagnosis?
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What is the primary mechanism of action of belimumab (Benlysta) in treating SLE?
What is the primary mechanism of action of belimumab (Benlysta) in treating SLE?
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What is a characteristic side effect that requires regular monitoring for patients taking hydroxychloroquine (Plaquenil)?
What is a characteristic side effect that requires regular monitoring for patients taking hydroxychloroquine (Plaquenil)?
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What type of laboratory test is used to evaluate for leukopenia, thrombocytopenia, and anemia in SLE?
What type of laboratory test is used to evaluate for leukopenia, thrombocytopenia, and anemia in SLE?
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What is the most accurate description of how a lupus diagnosis is made?
What is the most accurate description of how a lupus diagnosis is made?
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Why are patients who smoke encouraged to quit when they have SLE?
Why are patients who smoke encouraged to quit when they have SLE?
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Study Notes
Epidemiology of Lupus
- Affects fewer than 25 people per 100,000 in North America, South America, Europe, and Asia.
- Prevalence varies by sex, ethnicity, geography, and age.
- Female-to-male ratio is 3:1 in children, 15:1 in childbearing years.
- African American females are almost four times more likely to develop SLE than European American females.
- SLE less frequent in Black populations in Africa, Asians, and African Caribbeans.
- Hispanic Americans have a higher prevalence than European Americans in the US.
- 65% of patients are diagnosed between ages 16 and 55.
- Prognosis for renal disease is poorer in African Americans and Mexican Americans than European Americans.
- Lower education levels and socioeconomic status correlate with poorer disease control.
- Males more likely than females to have renal disease, skin manifestations, lab abnormalities, neurological involvement, thrombosis, CVD, and vasculitis.
- Females more likely to have Raynaud's phenomenon, photosensitivity, and mucosal ulceration.
- Family history of SLE increases risk.
- Genes predispose to SLE.
Pathophysiology of Lupus
- Chronic inflammatory disease affecting virtually any organ system.
- Exact cause unknown, like other autoimmune diseases.
- Multiple factors trigger disease: pregnancy, sunlight, illness, surgery, silica dust, medication allergies.
- Most manifestations due to antibodies and immune complexes deposited in tissues.
Clinical Manifestations of Lupus
- Diverse, vague symptoms not following a pattern, varying greatly between individuals.
- Includes fatigue, fever, myalgia, weight changes.
- Symptoms not always present, impacting diagnosis.
- Periods of remission and disease flares are common.
Diagnosis of Lupus
- No single test for diagnosis.
- Laboratory findings, combined with history and physical exam, support diagnosis.
- ACR and Systemic Lupus International Collaborating Clinics guidelines and criteria are used.
- 17 criteria (clinical and immunological) are defined.
- At least one clinical and one immunological criterion are needed for diagnosis.
- Symptoms may not meet all 4 criteria if sufficient other evidence exists for diagnosis.
Laboratory Testing for Lupus
- Tests confirm autoantibodies.
- Anti-nuclear antibodies (ANA) indicate autoimmune disease but do not confirm SLE (2% of healthy individuals are positive).
- Anti-dsDNA and Anti-Sm antibodies are highly specific for SLE.
- Antiphospholipid antibodies assessed for potential blood clots.
- CBC (for leukopenia, thrombocytopenia, anemia).
- Urinalysis (for protein, creatinine) to monitor for kidney disease.
- C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) for inflammation, not specific for SLE.
Radiographical Imaging for Lupus
- Used to diagnose features, rule out other causes.
Treatment of Lupus
Non-pharmacological Therapy
- Avoid prolonged sun exposure, use high SPF sunscreen daily.
- Healthy diet.
- Adequate rest and sleep.
- Regular exercise.
- Smoking cessation.
Pharmacological Therapy
- Antimalarials (e.g., hydroxychloroquine) commonly used to treat symptoms and prevent disease flares.
- Mechanism not fully understood but thought to affect complement-dependent antigen-antibody reactions
- Treats fatigue, skin & joint issues, and prevents organ damage (lupus nephritis).
- Side effects: abdominal pain, nausea (may resolve).
- NSAIDs (e.g., ibuprofen) for arthralgia, myalgia, headache, fever.
- Glucocorticoids for suppressing inflammation.
- Immunosuppressants (e.g., methotrexate) for severe inflammation not responding to NSAIDs or steroids.
- Belimumab (Benlysta): biological response modifier approved in 2011. Binds to BLyS, interferes with the inflammatory cascade, reducing immune response.
Common Lupus Medications (Specific Concerns)
- Plaquenil (hydroxychloroquine): Requires baseline and regular eye exams for retinal toxicity.
- NSAIDs: should be avoided in renal impairment due to prostaglandin inhibition.
- Allergy to sulfonamide antibiotics like trimethoprim-sulfamethoxazole (30% of SLE patients).
Surgical Interventions for Lupus
- Renal transplant for severe lupus nephritis.
- Joint replacement for avascular necrosis risk.
Complications of Lupus
- Renal failure, premature heart disease, interstitial lung disease, hypercoagulation, stroke, avascular necrosis of joints, increased infection risk, therapy toxicities
Nursing Management of Lupus
Assessment & Analysis
- Fatigue
- Difficulty concentrating
- Joint pain
- Rash
- Photosensitivity
- Oral/nasal ulcers
- Dry eyes/mouth
- Hypertension
- Leukopenia
- Thrombocytopenia
- Alopecia
- Chest pain
Nursing Diagnoses/Problems
- Fatigue
- Impaired skin integrity
- Altered self-image
Nursing Interventions
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Vital signs (especially hypertension, fever, decreased oxygen saturation)
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Thorough history/physical exam (including symptoms in 17 criteria)
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Monitor lab values (BUN/creatinine, urinalysis, CBC, CRP/ESR, coagulation).
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Administer analgesics, anti-inflammatory meds as directed.
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Administer medications for specific symptoms.
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Teaching (disease process, sun protection, energy conservation, activity prioritization, immunizations/live vaccines).
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Avoid oral contraceptives in some lupus cases with higher risk factors (migraines, Raynaud's, phlebitis, antiphospholipid antibodies)
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Referrals to specialists (pulmonologist, nephrologist, neurologist, cardiologist, dermatologist).
Evaluating Lupus Care Outcomes
- Medication compliance for disease control is key.
- Disease flares are expected with possible increased symptoms.
- Regular rheumatologist follow-up for disease monitoring and treatment adjustments.
- Well-managed lupus allows patients to maintain daily activities.
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Description
This quiz explores the epidemiology of systemic lupus erythematosus (SLE), focusing on its prevalence across various demographics such as sex, ethnicity, and geography. Learn about the significant differences in diagnosis rates and disease manifestations among different populations. Test your knowledge on how factors like age and socioeconomic status affect lupus prognosis.
