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Nursing 3 Test 3
Systemic Lupus Erythmatosus (SLE)
| Question | Answer |
|---|---|
| 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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