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WVC conTiss.Dis Ch20
WVC conTiss.Dis Ch20 Lupus, Scleroderma, Fibromyalgia
| Question | Answer |
|---|---|
| The two classifications of lupus: | *discoid lupus erythematosus (DLE) *systemic lupus erythematosus (SLE) |
| DLE only affects the… | skin |
| Systemic lupus erythematosus (SLE) is a… | chronic, progressive, inflammatory connective tissue disorder that cause major body organs/systems to fail. |
| SLE is characterized by… | spontaneous remissions and exacerbations and onset may be acute or insidious (slow) |
| Lupus is thought to be an… | autoimmune process |
| Pathophysiology of lupus… | antinuclear antibodies (ANAs) start to affect DNA w/in cell nuclei->as a result, immune complexes form in serum and organ tissuescause inflammation/damage. |
| The immune complexes that are formed invade organs directly or cause… | vasculitis (vessel inflammation) which deprives organs of arterial blood and O2. |
| Autoimmune complexes tend to be attracted to… | the glomeruli of the kidneys->therefore many pts with SLE have some degree of kidney involvement. |
| Leading causes of death caused by lupus… | *Renal failure *cardiac *CNS involvement |
| In kidney disease, ________ _________ show the progressive changes within the glomeruli affected by the autoimmune complexes… | renal biopsies |
| The onset of lupus most often occurs… | during the childbearing years. |
| Like RA, lupus is probably caused by… | a combination of genetic and environmental factors. |
| Lupus has an extreme range of symptoms with no classic presentation of the disease however, certain manifestations occur with… | SLE |
| Manifestations that occur in SLE… | *inflamed red rash (butterfly)/discoid lesions *nephritis *pericarditis *raynaud’s phenomenon *pleural effusions *CNS lupus *abd. px *joint inflammation *myositis *fever/fatigue *anorexia *vasculitis |
| Because SLE is an inflammatory condition, what are common findings? | *fever and fatiguefever is a classic sign of flare. |
| Various degrees of what may also occur? | *generalized weakness *fatigue *anorexia *wt loss |
| Any or all ______ _______ may be affected by SLE… | body systems-because lupus nephritis is the leading cause of death, carefully assess for s/s renal involvement (I&O, proteinuria, hematuria, fluid retention.) |
| What is also found in almost half of all cases of SLE? | pleural effusions or pneumonia-progressive involvement can lead to dyspnea or blood gas abnormalities. -assess breath sounds |
| ___________ is the most common cardiovascular manifestation… | pericarditis, which causes tachycardia, chest px, and myocardial eschemia.-monitor v/s every 4 hrs. |
| _________, ___________, ___________ are also common in pts with SLE… | anemia, leucopenia, thrombocytopenia. |
| Raynaud’s Phenomenon | *caused by arteriolar vasospasm *occur in small amount of lupus pts *report of red, white, and blue color changes and severe pain in digits *incidence occurs when pt exposed to cold temps or increased stress. |
| Neurological manifestations of Lupus… | *psychoses *paresis *seizures *migraine HA *cranial nerve palsies *peripheral neuropathies |
| Another thing to monitor for in lupus pts is… | abdominal px d/t serositis (peritoneal involvement)mesenteric arteritis, pancreatitis, colonic ulcers. |
| Psychosocial issues that can result d/t lupus… | *altered body image d/t use of medications (steroids) that cause acne, striae, fat pads, wt gain *chronic fatigue and weakness may prevent pt from being active and become withdrawn *unpredictability of SLE can cause fear/anxiety |
| The only significant test to dx DLE is… | a skin biopsy since it only affects the skin. |
| Laboratory tests used to dx SLE: | *rheumatoid factor *antinuclear antibody (ANA) *erythrocyte sedimentation rate (ESR) *serum protein electrophoresis *serum complement (esp. C3 and C4) *immunoglobulins *CBC |
| What kind of test is common in showing up as a false-positive for lupus pts? | Venereal Disease Research Laboratory (VDRL)syphilis test |
| A complete blood count (CBC) commonly shows what in pts with lupus? | pancytopenia (a decrease in all cell types)probably caused by direct attack of blood cells or bone marrow by immune complexes. |
| What are also routinely assessed to determine other body system functioning in pts with lupus? | *serum electrolyte levels *renal fxn *cardiac and liver enzymes *clotting factors |
| Interventions used by HCP’s for Lupus… | potent drugs used either *topically or *systemically |
| Topicals used for tx of lupus: | topical cortisone preparations that help reduce inflammation and promote fading of skin lesions. |
| In addition to the use of topical drugs, HCP’s may also prescribe an anti-malarial agent used to fight inflammation as well called… | hydroxychloroquine (Plaquenil)frequent eye exams are needed w/ this medication |
| ___________ and _____________ may be used in Lupus to treat musculoskeletal problems like arthritis and myalgias… | acetaminophen (Tylenol) and NSAIDs |
| The aim of management of SLE is to… | treat the disease aggressively until remission. |
| In addition to medications for skin lesions, the HCP may prescribe chronic steroid therapy for lupus to treat… | the systemic disease process.(prednisone) |
| For renal or CNS lupus, the HCP may prescribe immunosuppressive agents such as… | *methotrexate (Rheumatrex) or *azathioprine (Imuran)maintenance doses of these drugs are still cont’d in remission to prevent further exacerbations. |
| Important things to know about immunosuppressive drugs… | *they make pts susceptible to infections so it should be stressed that pts should avoid large crowds and people who are ill. |
| For severe renal involvement in lupus, immunosuppressants may be given in combination with… | steroids |
| Important preventative measures to teach your pt about lupus… | *avoid prolonged exposure to sunlight and ultraviolet lighting *clean skin with mild soap (ivory) and use lotion *pts hair should receive special attention d/t risk of alopecia (hair loss) so use mild protein shampoos |
| Two major things that Lupus patients should know… | *instruct patients how to protect their skin *teach them how to monitor body temperature because fever is the major sign of exacerbation. |
| Focus on Scleroderma: Scleroderma is aka… | systemic sclerosis (SSc) |
| Scleroderma is a… | chronic, inflammatory, autoimmune connective tissue disease. |
| Scleroderma means… | hardening of the skin, which is only 1 manifestation of the disease other manifestations include other body system involvement |
| SSc is less common than systemic lupus erythematosus, but… | has a higher mortality rate. |
| In SSc, the inflamed tissue becomes fibrotic and then… | sclerotic (hard) |
| The leading cause of death however in SSc is… | renal involvementRespiratory involvement and hypertension are also common problems. |
| Patients with SSc do not respond well to… | steroids and immunosuppresents like lupus pts, so that is why the mortality rate is higher. |
| The classification for systemic sclerosis is… | *Diffuse Scleroderma *Limited Scleroderma |
| Diffuse Scleroderma | skin thickening on the trunk, face, and proximal and distal extremities |
| Limited Scleroderma | thick skin limited to sites distal to the elbows and knees but also involves face and neck. |
| Pts with SSc often have the CREST syndrome which stands for… | *Calcinosis (Ca+ deposits) *Raynaud’s phenomenon *Esophageal dysmotility *Sclerodactyly (scleroderma of digits) *Telangiectasia(spider-like hemangiomas) |
| Common clinical manifestations with SSc: | *Arthralgia (joint pain)/stiffness *painless, symmetric, pitting edema on hands/fingers *skin taut, shiny, free of wrinkles * |
| The edema that occurs with SSc in the hands and fingers may progress to include the… | the entire upper and lower extremities and facein this phase, the fingers are described as sausage-like. |
| If diffuse scleroderma occurs, the swelling is replaced by… | tightening, hardening and thickening of skin tissue(this phase sometimes called indurative phase) |
| In this endurative phase, the skin… | *loses its elasticity *ROM decreases *ulcerations may occur *joint contractures may develop *pts may be unable to perform ADL’s independently |
| Major organ damage that occurs with SSc: | *GI tract *cardiovascular system *pulmonary system *renal system. |
| Involvement of the GI tract: | *mostly esophagus loses motilityresults in dysphagia/esophageal refluxleads to esophagitis/ulceration *decreased peristalsis(kinda presents same as bowel obstruction) and malabsorption in bowelsleads to diarrheal stools. |
| Involvement of Cardiovascular System: | *Raynaud’s Phenomenoncould lead to digit necrosis, vasculitic lesions around nail beds (periungual lesions) *myocardial fibrosisevidenced by ECG changes, cardiac dysrythmias, chest px. * |
| Pulmonary Involvement: | *may go undetected until autopsy *fibrosis of alveoli and interstitial tissues present in almost all cases *pulmonary arterial hypertension(pts with this have serious prognosis) |
| Renal Involvement: | *often causes malignant hypertension and death *assess for s/s of impending organ failure such as changes in I&O and ↑BP. |
| Medications used for intervention: | *NSAIDs *systemic steroids (prednisone) *immunosuppressants (both used in large doses and often in combination)goal of meds is to slow down progression and get into remission. |
| Additional Interventions used for SSc: | *identify organ involvement and tx before it becomes severe *local skin measures: mild soaps/lotions *use of bed cradle or foot board in severe cases *adjust room temp, use of gloves/socks and avoidance of smoking and stress in pts with Raynaud’s phen. |
| Additional Interventions Cont’d… | *perform a swallow study on pts with esophageal issues along with small, frequent meals. *avoidance of foods that cause reflux *keep head elevated 1-2 hrs after meals *use of histamine antagonists/antacids *change in food texture to prevent aspiration |
| Focus on Fibromyalgia: aka… | Fibromyalgia syndrome (FMS) |
| FMS is now understood to be a chronic pain syndrome, and not an… | inflammatory disease. |
| In FMS, pain and tenderness are located at… | specific sites in the back of neck, upper chest, trunk, low back, and extremities which are often called “trigger points”. |
| The pain involved in FMS is often described as… | burning or gnawing. |
| Increased muscle tenderness in FMS may be d/t… | the inability to tolerate pain possibly r/t dysfunction in the brain, esp. thalamus and hypothalamus. |
| Pain and tenderness involved with fibromyalgia tend to come and go, but typically worsen in… | response to stress, increased activity, and weather conditions. |
| Patient clinical manifestation reports with FMS: | *mild to severe fatigue *sleep disturbances *some report numbness/tingling in extremities *sensitive to odors, loud noises, bright lights *HA and jaw pain |
| Other symptoms of FMS present in: | *Gastrointestinal *Genitourinary *Cardiovascular * Visual |
| Gastrointestinal Manifestations of FMS: | *abdominal px *diarrhea *constipation *heartburn |
| Genitourinary Manifestations in FMS: | *dysuria *urinary frequency *urgency *pelvic px |
| Cardiovascular Manifestations in FMS: | *dyspnea *chest px *dysrythmias |
| Visual Manifestations in FMS: | *blurred vision *dried eyes |
| Many of these symptoms become quite frustrating to the pt because… | they are not properly diagnosed and are in constant pain and discomfort. |
| Possible precipitating factors for FMS include… | *chronic fatigue syndrome *lyme disease *trauma *meds *flu-like illnesses *deep sleep deprivation. |
| It is important to teach pts with FMS to… | limit caffeine, alcohol, and other substances that limit sleep. |
| Secondary FMS can accompany… | any connective tissue disease, particularly lupus and RA. |
| First drug approved for fibromyalgia nerve pain… | Pregabalin (Lyrica)causes drowsiness, sleepiness and alcohol should be avoided when taking. |
| Antidepressants also taken for FMS: | *Amitriptyline (Elavil) *Nortriptyline (Pamelor)taken to promote sleep and reduce pain or muscle spasmalso cause confusion and hypotension in older adults. |
| Selective serotonin reuptake inhibitors (SSRIs) prescribed for depression in FMS: | *sertraline (Zoloft) *escitalopram oxalate (Lexapro) |
| What may be prescribed to help decrease fibromyalgia pain? | *physical therapy *NSAIDs *exercise regimen of low impact aerobic exercise |
| What are some complimentary/alternative therapies prescribed for FMS? | *tai chi *acupuncture *hypnosis *stress management |
Created by:
wvc
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