Systemic Lupus Erythematosus (SLE)
Ø Chronic connective tissue disease involving multiple organ systems
Incident Rate
1. Occurs most frequently in young women
Predisposing Factors
1. Cause unknown
2. Immune
3. Genetic & viral factors have all been suggested
Pathophysiology
1. A defect in body’s immunologic mechanisms produces autoantibodies in the serum directed against components of the client’s own cell nuclei.
2. Affects cells throughout the body resulting in involvement of many organs, including joints, skin, kidney, CNS & cardiopulmonary system.
S/sx
1. Fatigue
2. Fever
3. Anorexia
4. Weight loss
5. Malaise
6. History of remissions & exacerbations
7. Joint pain
8. Morning stiffness
9. Skin lesions
Ø Erythematous rash on face, neck or extremities may occur
Ø Butterfly rash over bridge of nose & cheeks
Ø Photosensitivity with rash in areas exposed to sun
10. Oral or nasopharyngeal ulcerations
11. Alopecia
12. Renal system involvement
Ø Proteinuria
Ø Hematuria
Ø Renal failure
13. CNS involvement
Ø Peripheral neuritis
Ø Seizures
Ø Organic brain syndrome
Ø Psychosis
14. Cardiopulmonary system involvement
Ø Pericarditis
Ø Pleurisy
15. Increase susceptibility to infection
Dx
1. ESR: elevated
2. CBC: RBC anemia, WBC & platelet counts decreased
3. Anti-nuclear antibody test (ANA): positive
4. Lupus Erythematosus (LE prep): positive
5. Anti-DNA: positive
6. Chronic false-positive test for syphilis
Medical Management
1. Drug therapy
a. Aspirin & NSAID: to relieve mild symptoms such as fever & arthritis
b. Corticosteroids: to suppress the inflammatory response in acute exacerbations or severe disease
c. Immunosuppressive agents: to suppress the immune response when client unresponsive to more conservative therapy
Ø Azathioprine (Imuran)
Ø Cyclophosphamide (Cytoxan)
2. Plasma exchange: to provide temporary reduction in amount of circulating antibodies.
3. Supportive therapy: as organ systems become involved.
Nursing Interventions
1. Assess symptoms to determine systems involved.
2. Monitor vital signs, I&O, daily weights.
3. Administer medications as ordered.
4. Institute seizure precautions & safety measures: with CNS involvement.
5. Provide psychologic support to client / significant others.
6. Provide client teaching & discharge planning concerning
a. Disease process & relationship to symptoms
b. Medication regimen & side effects.
c. Importance of adequate rest.
d. Use of daily heat & exercises as prescribed: for arthritis.
e. Need to avoid physical or emotional stress
f. Maintenance of a well-balanced diet
g. Need to avoid direct exposure to sunlight: wear hat & other protective clothing
h. Need to avoid exposure to persons with infections
i. Importance of regular medical follow-up
j. Availability of community agencies
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