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NUR 211
Lupus
| Question | Answer |
|---|---|
| What is systemic lupus erythematosus? (SLE) | chronic inflammatory disease of the connective tissues where damage is caused by the immune system attacking body |
| What is discoid lupus erythematosus? (DLE) | limited to the skin (think D for Derm) |
| what is the leading cause of death in SLE? | Lupus nephritis (kidney disease) |
| are the s/s of lupus always present? | No, can have flares or exacerbations |
| What body systems are effected by SLE? | almost all systems joint, skin, brain, lungs, kidneys, blood vessels (joint damage is slight in comparison to RA) |
| What gender is more at risk of lupus? | females of childbearing age |
| Environmental triggers for lupus for people with a genetic predisposition | viruses, bacterial antigens, chemical, drugs (smoking), UV light, |
| ethnicities at highest risk for lupus | Asian Americans, African Americans, African Caribbeans, and Hispanic Americans |
| Drugs that can induce drug induced lupus (DIL) | Procainamide, hydralazine, isoniazid, all anti-TNF meds |
| what is rare in drug induced lupus | renal and CNS complications |
| What to do to prevent flare ups of lupus? | -avoid excess sun exposure -reduce stress -exercise regularly -avoid illness -flu/pneumonia vaccines -avoid meds that cause sensitivity to light |
| What are the skin manifestations of lupus? (think a Butterfly GASED UR Joints) | B- butterfly rash, erythematous G- gland enlargement A- alopecia S- sun/photosensitivity E- edema in legs/arms/eyes D- discoid lesions (raised, red, scaly) U- ulcers in mouth R- renal probs (proteinuria/hema) J- joint deformities, symmetrical |
| What are the renal manifestations of lupus? | nephrotic syndrome proteinuria CKD |
| What should you monitor to check kidney funt in a pt with lupus? | monitor swelling HTN BUN/Cr serum electrolytes I/Os proteinuria |
| What are the hematologic manifestations of lupus? | anemia (NOT iron resistant) leukopenia thrombocytopenia splenomegaly |
| What are the cardiovascular manifestations of lupus? | pericarditis vasculitis myocarditis endocarditis arterial thrombosis raynaud's phenomenon |
| What is the Raynaud phenomenon? | vasospasm in response to heat/cold (mainly cold) |
| What are the CNS manifestations of lupus? | memory loss disorientation, restlessness psychosis seizures depression stroke |
| What is antinuclear antibody (ANA)? | non specific auto antibodies indicates an autoimmune response |
| what is organic brain syndrome? | confusion with impaired memory, judgment, and cognition. Symptoms may include agitation, withdrawal, or depression |
| What are the pulmonary manifestations of lupus? | pleural effusion pneumonitis pleurisy |
| How can we treat skin involvement in lupus? | -corticosteroids/ immunosuppressants/ DMARDS -use caution with soap/perfume/detergents/make-up/ sunscreen |
| diet recommendations for lupus? | Low-fat, mostly vegetarian wholesome diet |
| Blood manifestations of lupus | Anemia, leukopenia, thrombocytopnea |
| How can we treat blood involvement in lupus? | corticosteroids, IV IgG splenectomy IV platelets |
| how is kidney failure managed in lupus | dialysis/ transplantation |
| What additional labs would be monitored for lupus? | CBC: anemia (⇣ plts/RBCs) BUN/Cr: elevated ESR: nonspecific inflammation marker UA: proteinuria/hematuria kidney biopsy |
| Why would someone with with lupus get a kidney biopsy? | to check for severity of damaged kidneys |
| What are anti-DNA antibody? | autoimmune antibodies anti-dna seen more in lupus |
| what diagnostic test is specific to SLE | Anti-DNA |
| What do you need to be mindful about in children? | be mindful of body image encourage the kids to be as normal as possible, join support gr their prognosis is better |
| If a patient has low platelets what kind of precautions should they be on? | bleeding precautions |
| What is a lifespan consideration for older adults related to lupus? | often misdiagnosed as RA missed in elderly pts because they have more nonspecific sx |
| What is the treatment for lupus? what are the med classes? | mainly pain management and non-specific immunosuppression NSAIDs DMARD/antimalarial immunosuppressives monoclonal antibodies corticosteroids |
| What would be prescribed to help with the pain of lupus? | NSAIDs: motrin (advil) naproxen (Naprosyn, Aleve) ASA |
| What should a patient with lupus always wear when in the sun? | SPF 30, long sleeves, hats, sunglasses |
| why will serum complement be low? | they're being used up |
| What meds are used for mild/remittent lupus? | Topical cortisone tylenol/ NSAIDS hydroxychloroquine (Plaquenil) ASA |
| what does hydroxychloroquine (Plaquenil) | decreases the absorption of UV light |
| pt education for hydroxychloroquine (Plaquenil) | need for frequent eye exams!!!!!!!!! NTK THIS!!!! |
| Meds used in severe lupus | Chronic steroid therapy, immunosuppressants, Belimumab (Benlysta) |
| SE of immunosuppressants (the 5 D's) | D- decreased immune system (⇡r of infection) D- decreased bone marrow D- Diarrhea, N + V D- decreased hair (alopecia) D- decreased bone strength |
| what are some live vaccines? | flu, MMR, varicella, rotavirus |
| What are you nursing interventions for mouth ulcers? | oral care avoid mouthwashes with alcohol rinse mouth |
| What are your nursing interventions for skin integrity? | monitor for rashes sunscreen no irritating perfumes, soaps, lotions, make ups |
| pt education for Belimumab (Benlysta) | Pts are at increased risk for infection PTS MUST not have ANY live vaccines 30 days before treatment |
| what do we need to educate woman of childbearing age about there contraceptives when it comes to lupus? | oral contraceptives/ contraceptives that increase estrogen levels can trigger lupus and increases risk of clots. educate on other types of and methods to not get pregnant |
| Complication if women with lupus get pregnant | preeclampsia, eclampsia, preterm labor, unplanned cesarean delivery, and higher rate of fetal complications |
| what is neonatal lupus? | if antibodies are present, they may transfer to the fetus through the placenta -minimal symptoms -may develop congenital heart block |
| Interventions for fetal congenital heart block | -fetal ECG during 2nd trimester (4-6 mths pregnant) -early treatment may make it reversible -late treatment may require pacemaker on delivery |
| what is a sign of lupus exacerbation? | fever |
Created by:
ginnyfoscue
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