systemic lupus
TRANSCRIPT
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Systemic Lupus Erythematosus (SLE)
By:Mr. M. Sivananda Reddy
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Incidence• About 90% of all cases occur in women• Most cases occur in women of
childbearing years• At the age of 30 years the ratio of
women to men is 10:1• African, Asian, Hispanic, and Native
Americans three times more likely to develop than whites
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Etiology• Auto immune• Etiology is unknown• Most probable causes:– Genetic influence– Hormones– Environmental factors- UV B rays,
infections with CMV, HCV, smoking– Certain medications- Trimethoprim,
Sulphamethaxozole
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Pathophysiology• Autoimmune reactions directed against
constituents of cell nucleus, DNA• Antibody response related to B and
T cell hyperactivity which is stimulated by the Estrogen
• The antigen antibody complexes that are developed will be in the circulation and blocks the microvasculature and the spaces
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Clinical Manifestations• Ranges 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 kidneys
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• Dermatologic:– Cutaneous vascular lesions– Butterfly rash– Oral/nasopharyngeal ulcers– Alopecia
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Butterfly Rash / Malar Rash
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• Musculoskeletal–Polyarthralgia with morning
stiffness–Arthritis• Swan neck fingers• Ulnar deviation• Subluxation with hyperlaxity of joints
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Swan Neck Deformity
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Ulnar deviation:
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• Cardiopulmonary– Tachypnea– Pleuritis– Dysrhythmias– Accelerated CAD– Pericarditis
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• Renal– Lupus nephritis• Ranging from mild proteinuria to
glomerulonephritis
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• Nervous system– Generalized/focal seizures– Peripheral neuropathy– Cognitive dysfunction• Disorientation• Memory deficits• Psychiatric symptoms
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• Hematologic– Formation of antibodies against blood cells– Anemia– Leukopenia– Thrombocytopenia– Coagulopathy– Anti-phospholipid antibody syndrome
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• Infection– Increased susceptibility to infections– Fever should be considered serious– Infections such as pneumonia are a
common cause of death
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Diagnostic Studies
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• Antinuclear antibodies– ANA and other antibodies indicate
autoimmune disease– Anti-DNA and anti-Smith antibody tests
most specific for SLE– ESR & CRP are indicative of
inflammatory activity.
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• CBC for hematologic problems• Ultrasound Abdomen for lupus
nephritis• X-rays of affected joints• Chest x-ray for pulmonary problems• ECG for cardiac problems
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Treatment• Drug therapy–NSAIDs- Acetaminophen–Antimalarial drugs-
Hydroxychloroquine–Corticosteroids- Prednisone– Immunosuppressive drugs
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Nursing ManagementNursing Diagnoses
• Fatigue• Acute pain• Impaired skin integrity• Ineffective therapeutic regimen
management• Body image disturbance
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Nursing Interventions–Observe for• Fever pattern• Joint inflammation• Limitation of motion• Location and degree of discomfort• Fatigability
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–Monitor weight and I&O– Collect 24-hour urine sample– Assess neurological status– Explain nature of disease– Provide support
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• Ambulatory and home care– Reiterate that adherence to treatment
does not necessarily halt progression–Minimize exposure to precipitating factors
– fatigue, sun, stress, infection, drugs– Teach energy conservation and relaxation
exercises– Teach regarding ROM to prevent
contractures
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• Psychosocial 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
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