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Systemic Lupus Erythematosus By: Ambar, Jackie, Kim, Romy, & Yazmin…

- - - - Butterfly Rash:<3:
        -dry, scaly, raised rash
        Discoid Lesions
        -scaring lesions
        Mouth Ulcers
        Alopecia
        Palmar erythema
        
        Usually on sun exposed areas
        Present during flare up
        disappear when in remission
    - - Nephritis
        Hematuria
        Proteinuria
        
        Leading cause of death :explode:
    - - Pericarditis :<3:
        Raynaud's phenomenon
        Endocarditis
        Myocarditis
        
        Report chest pain immediately
        Ask about stress and cold exposure
    - - Pleural effusions
        Pneumonitis
        
        Restrictive or obstructibe changes
        Dyspnea
        ABG abnormalities
    - - CNS Lupus
        Stroke
        Seizures
        Peripheral neuropathy
        Cognitive impairment
        
        May report migraine headaches or weakness of voluntary movements
    - - Abdominal Pain
        Diarrhea
        Dysphagia
        N/V
        
        From inflammation of the pancreatic and mesenteric arteries
        Colon ulcers
    - - Joint Inflammation
        Myositis
        Synovitis
        Arthritis
        
        Small Joints and knees :<3:
        Bone necrosis with steroids
    - - Fever :<3:
        Fatigue
        Anorexia
        Vasculitis
        Anemia
        Leukopenia
        Lymphadenopathy
        Splenomegaly
        Thrombocytopenia
        
        Vasculitis affecting any major or small vessel can lead to organ failure :explode:
    - - Menstrual Abnormalities (Women)
  - - - Rash
        Side effects of steroid therapy
    - - Unpredictable disease
        Knowing other people with disease
    - - Weak and tired
        Avoid gatherings
        Withdraw from friends/family
    - - Both patient and family
        Support system
- - - - for mild polyarthralgias
        or polyarthritis
        
        monitor for potential GI & renal effects
    - - for fatigue,
        moderate skin & joint problems,
        & flares
        
        hydroxychloroquine (Plaquenil)
        
        Funduscopic & visual field exams q6-12mo
        
        Retinopathy can develop
        with high doses
        
        chloroquine (Aralen)
      - If pt. cannot tolerate
        antimalarial agent
        
        antileprosy drug
        
        dapsone
    - - controls severe exacerbations
        of polyarthritis
        
        tapering doses of IV
        methylprednisolone
        
        however, high doses if pt. has
        severe cutaneous SLE
        
        alternative:
        steroid-sparing
        immunosuppressants
        
        methotrexate
        
        with folic acid to decrease
        SE of corticosteroids
    - - azathroprine,
        cyclophosphamide (Cytoxan),
        mycophenolate mofetil (CellCept)
        
        to reduce the need for long-term
        corticosteroid therapy
        
        for severe organ-system disease
        
        close monitoring in needed to minimize
        drug toxicity & SE
    - - blood clots:
        life-threatening complication
        
        warfarin
        
        heparin
    - - alternative to corticosteroids
        for treating serious
        skin conditions
      - suppress immune
        activity in the skin
        
        butterfly rash & possibly
        discoid lesions
      - tacrolimus (Protopic, Prograf)
      - pimecrolimus (Elidel)
    - - abrupt cessation may
        exacerbate disease activity :explode:
- - - - proteinuria, hematuria and fluid retention
    - - assess patient's and family's feelings about the illness to identify areas requiring intervention.
      - determine their usual coping mechanisms and support system before developing a plan of care.
      - NURSING SAFETY PRIORITY
        
        when taking hydroxychloroquine (Plaquenil)
        teach patient to have frequent eye examinations.
        
        pt is taking NSAIDS regularly so teach patient to report any black tarry stools
        
        when patients are taking steroids and immunosuppresants, stress the importance of
        
        to report any sign and symptoms of infection to the health care provider
        
        **Clean your skin with a mild soap such as ivory dry your skin throughtly by patting rather than rubbing
        
        **Apply lotion liberally to dry sin areas
        
        **Avoid powder or other drying agents, such as rubbing alcohol!
        **Use cosmetics that contains moisturizers.
        
        *teach possible effects of the disease on lifestyle, including fatigue.
        *woman childbearing need to know that pregnancy can be stressor and can cause an exacerbation of the disease, either during pregnancy or after delivery.
        
        *the pregnant woman may also have an increase risk for miscarriage, stillbirth, or premature birth.
        *pregnancy is not recommended for those with cardiac, renal or central nervous system involvement.
        *sexual counseling regarding contraception options may be necessary.
        
        Hair should receive special attention because alopecia is common.
        -- recommend the use of mild protein shampoos and the avoidance of harsh treatments e.g, (permanents or highlights) until the hair regrows during remission.
        
        *instruct patients to avoid prolonged exposure to sunlight or other ultraviolet lighting
        *Remain them to wear long sleeve and large-brimmed hat when outdoors
        *use sun-blocking agents with a sun exposure factor of (SPF) of 30 or higher on exposed skin surfaces.
        
        --AVOID large crows and people who are ill.
      - inform the patient and family that control of lupus is generally possible with regular medical monitoring, medications and healthy practices such as: limiting sun exposure to prevent exacerbation of the disease
- - - - Antinuclear antibodies (ANAs) primarily affects
        
        Autoimmune process
        
        Immune complexes form in the serum, and organ tissues, which cause inflammation, damage, and destruction
        
        these complexes invade organs directly or cause vasculitis which deprives the organs of arterial blood oxygen