Sle

Systemic Lupus
Erythematosus (SLE)
Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Systemic Lupus
Erythematosus (SLE)
Chronic multisystem inflammatory
disease
Associated with abnormalities of
immune system
Results from interactions among
genetic, hormonal, environmental,
and immunologic factors
Systemic Lupus Erythematosus

Affects the
Skin
Joints
Serous membranes
Renal system
Hematologic system
Neurologic system
Systemic Lupus Erythematosus

A variable disease
Chronic
Unpredictable
Characterized by exacerbations &
remissions
Incidence
SLE affects 2 to 8 persons per
100,000 in United States
Most cases occur in women of
childbearing years
African, Asian, Hispanic, and Native
Americans three times more likely to
develop than whites
Etiology
Etiology is unknown
Most probable causes
Genetic influence
Hormones
Environmental factors
Certain medications
Pathophysiology
Autoimmune reactions directed
against constituents of cell nucleus,
DNA
Antibody response related to B and
T cell hyperactivity
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
Fig 65-9
Dermatologic
Cutaneous vascular lesions

Butterfly rash
Oral/nasopharyngeal ulcers
Alopecia
Dermatologic Manifestations
Fig 65-10
Musculoskeletal
Polyarthralgia with morning stiffness

Arthritis
Swan neck fingers
Ulnar deviation
Subluxation with hyperlaxity of joints
Swan Neck Deformity
Fig. 65-4 D
Cardiopulmonary
Tachypnea
Pleurisy
Dysrhythmias
Accelerated CAD
Pericarditis
Renal
Lupus nephritis
Ranging from mild proteinuria to
glomerulonephritis
Primary goal in treatment is slowing the
progression
Nervous system
Generalized/focal seizures
Peripheral neuropathy
Cognitive dysfunction
Disorientation
Memory deficits
Psychiatric symptoms
Hematologic
Formation of antibodies against blood

cells
Anemia
Leukopenia
Hematologic (contd)
Thrombocytopenia
Coagulopathy
Anti-phospholipid antibody syndrome
Infection
Increased susceptibility to infections

Fever should be considered serious
Infections such as pneumonia are a
common cause of death
Diagnostic Studies
No specific test
SLE is diagnosed primarily on
criteria relating to patient history,
physical examination, and laboratory
findings
Diagnostic Studies
Diagnostic Studies
Antinuclear antibodies
ANA and other antibodies indicate

autoimmune disease
Anti-DNA and anti-Smith antibody tests
most specific for SLE
LE prep can be positive with other
rheumatoid diseases
ESR & CRP are indicative of inflammatory
activity
Diagnostic Tests
CBC for hematologic problems

UA for lupus nephritis
X-rays of affected joints
Chest x-ray for pulmonary problems
ECG for cardiac problems
Collaborative Care
Prognosis is improved with
Earlier diagnosis
Earlier and better treatment regimens
Careful monitoring for organ
involvement
Collaborative Care
Drug therapy
NSAIDs
Antimalarial drugs
Steroid-sparing drugs
Corticosteroids
Immunosuppressive drugs
Nursing Management
Nursing Assessment
Assess patients physical,
psychologic, and sociocultural
problems with long-term
management of SLE
Assess pain and fatigue daily
Nursing Management
Nursing Assessment
Obtain subjective and objective data
Educate and counsel on expected
issues
Nursing Management
Nursing Diagnoses
Fatigue
Acute pain
Impaired skin integrity
Ineffective therapeutic regimen
management
Body image disturbance
Nursing Management
Planning
Overall goals
Have satisfactory pain relief

Comply with therapeutic regimen to
achieve maximum symptom
management
Nursing Management
Planning
Overall goals (contd)
Demonstrate awareness of, and avoid

activities that cause disease
exacerbation (triggers)
Maintain optimal role function and a
positive self-image
Nursing Management
Nursing Implementation
Health promotion
Prevention of SLE is not possible

Promote early diagnosis and treatment
Nursing Management
Acute intervention
During exacerbation, patient will

become abruptly, dramatically ill
Record severity of symptoms and
response to therapy
Nursing Management
Acute intervention (contd)
Observe for
Fever pattern
Joint inflammation
Limitation of motion
Location and degree of discomfort
Fatigability
Nursing Management
Acute intervention (contd)
Monitor weight and I&O

Collect 24-hour urine sample
Assess neurological status
Explain nature of disease
Provide support
Nursing Management
Ambulatory and home care
Reiterate that adherence to treatment

does not necessarily halt progression
Minimize exposure to precipitating
factors fatigue, sun, stress, infection,
drugs
Nursing Management
Ambulatory and home care
Teach energy conservation and

relaxation exercises
For joint problems, all the teaching for
RA related to joint protection, ROM,
and positioning to prevent contractures
Nursing Management
Nursing Management
Lupus and pregnancy
Infertility can result from SLE treatment

regimen
SLE is associated with complications of
pregnancy
Pregnancy & post partum can cause
exacerbations of SLE
Women with serious SLE should be
counseled against pregnancy
Nursing Management
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
Nursing Management
Evaluation
Expected outcomes
Completion of priority activities

Verbalization of having more energy
Expression of satisfaction with pain
relief measures
Nursing Management
Evaluation
Expected outcomes (contd)
Performance of activities of daily living

without pain
Limitation of direct exposure to sun
and use of sunscreen
No open skin lesions
Nursing Management
Evaluation
Expected outcomes (contd)
Expression of satisfaction with activity

level
Pacing of activities to match level of
tolerance
Expression of confidence in ability to
manage SLE over time and in home
environment

Sle

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Systemic Lupus

Systemic Lupus Erythematosus

Systemic Lupus Erythematosus

Cutaneous vascular lesions

Polyarthralgia with morning stiffness

Swan Neck Deformity

Formation of antibodies against blood

Increased susceptibility to infections

ANA and other antibodies indicate

CBC for hematologic problems

Have satisfactory pain relief

Demonstrate awareness of, and avoid

Prevention of SLE is not possible

During exacerbation, patient will

Monitor weight and I&O

Reiterate that adherence to treatment

Teach energy conservation and

Infertility can result from SLE treatment

Counsel patient and family that SLE

Completion of priority activities

Performance of activities of daily living

Expression of satisfaction with activity

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