Systemic Lupus-Student

Systemic Lupus Erythematosus (SLE) : 

Systemic Lupus Erythematosus (SLE) Cheryl McConnell RN, MSN

Lupus: Prevalence : 

Lupus: Prevalence 1 in 700 (ages 15 -64) women have lupus 1 in 250 are African American Women Asian and Native Americans = ? incidence Usually affects women between 15 to 40 In this age group 1:200 will develop lupus Usual onset is during childbearing age Possible hormonal link 8 – 10 times more prevalent in women

Types of Lupus : 

Types of Lupus SLE – Systemic Chronic, progressive, inflammatory connective tissue disorder that causes organ failure; potentially fatal with a 5-year survival rate of 85% Drug Induced Lupus Procainimide Hydralazine INH DLE – Discoid Affects only the skin

Pathophysiology of Lupus : 

Pathophysiology of Lupus Autoimmune: Exact Mechanism Unknown Viruses Environmental chemicals Genetic Antibodies “attack” healthy tissue Causes inflammation to the organ or to the vessels supplying blood to the organ Deprives organs of arterial blood supply

Prognosis : 

Prognosis Potentially fatal disorder Increase in survival rate in last 20 years Now… 85% of clients survive at least 5 years Leading cause of death are related to infection

Diagnostics : 

Diagnostics DLE = skin biopsy Serum ANA, ESR, protein electrophoresis, complement, immunoglobins Lupus cell prep (LE prep) CBC Electrolytes Liver and cardiac enzymes Coag studies Anticardiolipin Antibodies

Diagnostic Criteria : 

Diagnostic Criteria Must have four of the following eleven symptoms or findings: Malar rash Discoid lupus Mouth sores Photosensitivity Arthritis Abnormal UA Serositis Neurologic disorder + ANA Hematologic disorder Immunologic Disorder

Signs and Symptoms of Lupus : 

Signs and Symptoms of Lupus Skin: Dry, scaly, raised rash on face Appears to be in butterfly pattern—the “Bite of the Wolf.” Individual round lesions Hair Hair loss Change in texture

Signs and Symptoms of Lupus : 

Signs and Symptoms of Lupus Musculoskeletal Joints are affected causing painful mobility (Polyarthritis in 90% of SLE patients). Joint inflammation Avascular necrosis – after 5 years of diagnosis Muscle atrophy (results from autoimmune complex invasion—leading to Myositis). Muscle pain

Sign and Symptoms of Lupus : 

Sign and Symptoms of Lupus Renal Lupus nephritis Changes in the glomeruli Decreased urinary output Proteinuria Hematuria Fluid retention Leading cause of death 50% of all lupus pts have this

Signs and Symptoms of Lupus : 

Signs and Symptoms of Lupus Respiratory Pleural effusions Results in restrictive and obstructive changes Dyspnea Hypoventilation

Signs and Symptoms of Lupus : 

Signs and Symptoms of Lupus Cardiac Pericarditis Raynaud’s Disease Tachycardia Lack of circulation Pain to hands and feet Myocardial ischemia Chest Pain Cardiac Dysrrhythmias

Signs and Symptoms of Lupus : 

Signs and Symptoms of Lupus Neurological Psychoses Paresis Seizures Headaches Strokes Peripheral neuropathies http://www.mtio.com/lupus/lal_7.htm

Signs and Symptoms of Lupus : 

Signs and Symptoms of Lupus GI Tract Abdominal pain Mesenteric arteritis Pancreatitis Ulcers Liver enlargement Spleenomegaly Sexual Dysfunction Pain Fatigue/weakness Self esteem Decreased desire Psychosocial Dealing with illness Fear of death chronic Lack of socialization Body image changes Rash Medication related Systemic Fever Generalized weakness Fatigue Anorexia Weight loss

Treatment : 

Treatment Medications: Topical steroids for lesions Plaquenil (hydroxychloroquine) Can damage retina Steroids Immunosuppressives Anticoagulants if needed Skin protection Avoid sunlight Mild soaps Cosmetic cover-ups Daily inspection Hair loss Mild shampoo No chemicals

Patient teaching : 

Patient teaching May need repeated hospitalizations Recognize signs of exacerbation Coping strategies Need for continued medical follow up Healthy lifestyle Lupus support group

More Patient Teaching : 

More Patient Teaching Energy conservation Sexual counseling Pregnancy aggravates the signs and symptoms No pregnancy if patient has complications involving cardiac, renal, or CNS Has increased risk of miscarriage, stillbirth, premature birth

Lupus Support : 

Lupus Support The National Lupus Foundation www.lupus.org