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Nursing 3 Test 3

Systemic Lupus Erythmatosus (SLE)

QuestionAnswer
Autoimmunity immune response against "self", formation of antinuclear antibodies(antibodies to one's own DNA), attacks nucleus of cell, cause is unknown
possible causes for autoimmunity genetic link triggers: infections, durgs, hormones
Autoimmune disease organ specific or systemic
ogan specific autoimmune disease hashimoto's thyroiditis, glomerulonephritis
systemic autoimmune disease lupus erythematosus, rheumatoid arthritis
SLE multisystem disease(mult organ involvement), eventual mult organ failure
SLE: chronic disease upredictable, exacerbations and remissions, maybe mild(usually) or severe(sometimes)
localized form of SLE is called Discoid LE (DLE)
SLE etiology unknown, genetic influence(HLA link found)
Triggers for SLE environmental, infections, drugs, hormones(sex hormones), greater in males and african americans, asians and latinos
SLE pathophysiology autoantibodies to cell nucleus, Type III hypersensitivity(immune complex mediated), inflammatory responses cause tissue damage, manifestations depend on tissue involved
SLE manifestations onset maybe acute or insidious, s/s depend on organ involved, 90% have joint changes, almost always some renal involvement
SLE manifestations: skin mallor, butterfly rash, ulcers in mouth, alopecia, photosensitivity
SLE manifestations: joints symmetric polyarthritis, pain(myalgia), redness and swelling
SLE manifestations: kidney proteinuria, hematuria, casts, renal failure, **leading cause of death**
SLE manifestations:cardiovascular,blood, lungs & nervous system chest pain, anemia, SOB, decreased LOC(1st thing that happens in neuro
Systemic Manifestations of SLE fever(classic sign of flare), generalized weakness & fatigue, anorexia, wt loss, sometimes these are the only presenting symptoms
pregnancy and oral contraceptives may cause... exacerbation
SLE diagnostic tests ANA(antinuclear antibodies), LE cell prep(not very specific), Anti-DNA, Anti-Sm(more specific), ESR, CRP, Complement
ESR Eryhtrocyte Sedimentation Rate
CRP C-Reactive Protein
ESR & CRP test for inflammation
ANA Antinuclear Antibodies), not specific for lupus, positive titer is >1:40
SLE diagnostic tests CBC, urinalysis, renal function tests, kidney bx, skin bx(for DLE as no systemic s/s)
SLE therapeutics NSAIDS & Acetylsalicylic Acid(ASA), antipyretic & analgesic effects, hydroxychloroquine(plaquenil), corticosteroids(prednisone), immunosuppressants, gammaglobulins, plasmapheresis, Belimumab(Benlysta)
NSAIDS are taken for... joint symptoms
ASA is taken to prevent thrombosis
Hydroxychloroquine (Plaquenil), anti-malarial(now recommended for all pt's, has anti-inflammatory effects, decreases photosensitivity, prevents musculoskeletal flares, causes retinal toxicity(baseline ocular exam & Q6 month opthalmologic exams a must)
Corticosteroids (Prednisone), suppress disease activity, symptom management:high doses in flares prevents organ damage, tapered to lowest possible dose to prevent s/e
side effects of corticosteroids osteoporosis, wt gain, cushingoid appearance, risk for infection, DO NOT STOP SUDDENLY
immunosuppressants modulate the immune response, may cause suppression of bone marrow
plasmapheresis plasma exchange, removes antibodies, removes immune complexes, monitor BP
Belimumab Benlysta(approved in 3/11), inhibits proliferation of B lymphocytes, given to clients w/active disease on standard therapy, given IV every 4wks, African-Americans don't respond, can cause anaphylaxis, dont give with live vaccines
SLE interventions rest & nutrition, avoid environmental triggers(SUN), administer meds, monitor symptoms, complications, disease progression, anticipatory guidance, emotional support
SLE client education recognizing s/s of flare ups, early s/s of renal failure, infection control, stress reduction, tx regimen, disease process, skin & mouth care
SLE client education avoid exposure to sunlight, planned pregnancy, routine follow ups, support services
Created by: jbittner
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