Module1_SLE GRID.docx

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) Patho Chronic & progressive autoimmune disorder. Progressive loss of tissue integrity through excessive inflammation and overactive immunity leads to organ failure & death. Exacerbations accelerate organ damage. Arthritis & joint pain (90%) Vasculit...

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) Patho Chronic & progressive autoimmune disorder. Progressive loss of tissue integrity through excessive inflammation and overactive immunity leads to organ failure & death. Exacerbations accelerate organ damage. Arthritis & joint pain (90%) Vasculitis & rash (70-80%) Kidney damage to glomular & tubular basement membranes (40-50%) Hematologic problems (50%) CV problems (30-50%) Cause Genetic susceptibility not clearly identified. Triggers include infection, injury, drugs, hormones, and exposure to environmental substances, especially UV light. Most common cause of death are CKD and CV impairment. Disease Course & Expected Findings Onset of sx is slow. Avg time from initial mild sx to actual dx is 6 years. Chronic fatigue Recurrent fevers with unknown origin Persistent joint & muscle pain, swelling, tenderness, weakness Alopecia Blurred vision Pleuritic pain, pericarditis (pericardial friction rub) Anorexia/weight loss, anemia Depression Butterfly rash Raynaud’s phenomenon Risk Factors Present in women (30-44yo initial dx) 10x more frequently than men Incidence declines in females following menopause which suggests estrogen (childbearing years) as a trigger African Americans compared to whites in 8:1 Labs & Diagnostics Skin Biopsy – used in dx. Lupus cells & cellular inflammation is seen. Antinuclear antibodies (ANAs) - (+) titers in 95% of clients ESR – inflammatory biomarker, elevated BUN/Creat – Increased with kidney involvement UA – protein, casts, & RBCs (kidney involvment) CBC – pancytopenia Meds NSAIDs: used to reduce inflammation/pain. Contraindicated with kidney disease. Corticosteroids: prednisone used for inflammation & immunosuppression. Monitor fluid status for fluid retention, HTN, impaired kidney function. Do not stop abruptly, must taper dosage. Risk for fracture. Watch for hyperglycemia. Immunosuppressant agents: DMARDs (methotrexate), belimumab, azathioprine. Monitor for infection secondary to immunosuppression. Monitor liver enzymes (AST/ALT) Antimalarial: hydroxychloroquine used to suppress synovitis, fever, & fatigue. Complications & Nursing Care rheumatology specialist Assess/monitor the following. Pain, mobility, and fatigue Vital signs (especially blood pressure) Systemic manifestations Hypertension and edema (renal compromise) Urine output (renal compromise) Diminished breath sounds (pleural effusion) Tachycardia and sharp inspiratory chest pain (pericarditis) Rubor, pallor, and cyanosis of hands/feet (vasculitis/vasospasm, Raynaud’s phenomenon) Arthralgias, myalgias, and polyarthritis (joint and connective tissue involvement) Changes in mental status that indicate neurologic involvement (psychoses, paresis, seizures) BUN, blood creatinine level, and urinary output for renal involvement Nutritional status Provide small, frequent meals if anorexia is a concern. Offer between‐meal supplements. Encourage the client to limit salt intake for fluid retention secondary to steroid therapy. Provide emotional support to the client and family. Education Wear a wide‐brimmed hat, long‐sleeve shirt, and long pants when outdoors. Avoid UV and prolonged sun exposure. Use sunscreen when outside and exposed to sunlight. Use mild protein shampoo and avoid harsh hair treatments. Use steroid creams for skin rash. Report peripheral and periorbital edema promptly. Report evidence of infection related to immunosuppression. Avoid crowds and individuals who are sick, because illness can precipitate an exacerbation. Understand the risks of pregnancy with lupus and treatment medications. Cleanse skin with mild soap and inspect for open areas and rashes daily. Apply lotion to dry skin. Avoid applying drying agents to skin, such as powder or rubbing alcohol. Pat skin dry rather than rubbing. Understand the effect of the disease on lifestyle. ARTICLES: