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Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus (SLE). Cheryl McConnell RN, MSN. Lupus: Prevalence. 1 in 700 (ages 15 -64) women have lupus 1 in 250 are African American Women Asian and Native Americans = ↑ incidence Usually affects women between 15 to 40 In this age group 1:200 will develop lupus

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Systemic Lupus Erythematosus (SLE)

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  1. Systemic Lupus Erythematosus (SLE) Cheryl McConnell RN, MSN

  2. Lupus: Prevalence 1 in 700 (ages 15 -64) women have lupus 1 in 250 are African American Women Asian and Native Americans = ↑ incidence Usually affects women between 15 to 40 In this age group 1:200 will develop lupus Usual onset is during childbearing age Possible hormonal link 8 – 10 times more prevalent in women

  3. Types of Lupus • SLE – Systemic • Chronic, progressive, inflammatory connective tissue disorder that causes organ failure; potentially fatal with a 5-year survival rate of 85% • Drug Induced Lupus • Procainimide • Hydralazine • INH • DLE – Discoid • Affects only the skin

  4. Pathophysiology of Lupus • Autoimmune: Exact Mechanism Unknown • Viruses • Environmental chemicals • Genetic • Antibodies “attack” healthy tissue • Causes inflammation to the organ or to the vessels supplying blood to the organ • Deprives organs of arterial blood supply

  5. Prognosis • Potentially fatal disorder • Increase in survival rate in last 20 years • Now… 85% of clients survive at least 5 years • Leading cause of death are related to infection

  6. Diagnostics • DLE = skin biopsy • Serum ANA, ESR, protein electrophoresis, complement, immunoglobins • Lupus cell prep (LE prep) • CBC • Electrolytes • Liver and cardiac enzymes • Coag studies • Anticardiolipin Antibodies

  7. Diagnostic Criteria • Must have four of the following eleven symptoms or findings: Malar rash Discoid lupus Mouth sores Photosensitivity Arthritis Abnormal UA Serositis Neurologic disorder + ANA Hematologic disorder Immunologic Disorder

  8. Signs and Symptoms of Lupus • Skin: • Dry, scaly, raised rash on face • Appears to be in butterfly pattern—the “Bite of the Wolf.” • Individual round lesions • Hair • Hair loss • Change in texture

  9. Signs and Symptoms of Lupus • Musculoskeletal • Joints are affected causing painful mobility (Polyarthritis in 90% of SLE patients). • Joint inflammation • Avascular necrosis – after 5 years of diagnosis • Muscle atrophy (results from autoimmune complex invasion—leading to Myositis). • Muscle pain

  10. Sign and Symptoms of Lupus • Renal • Lupus nephritis • Changes in the glomeruli • Decreased urinary output • Proteinuria • Hematuria • Fluid retention • Leading cause of death • 50% of all lupus pts have this

  11. Signs and Symptoms of Lupus • Respiratory • Pleural effusions • Results in restrictive and obstructive changes • Dyspnea • Hypoventilation

  12. Signs and Symptoms of Lupus • Cardiac Pericarditis Raynaud’s Disease • Tachycardia Lack of circulation • Pain to hands and feet • Myocardial ischemia Chest Pain Cardiac Dysrrhythmias

  13. Signs and Symptoms of Lupus • Neurological • Psychoses • Paresis • Seizures • Headaches • Strokes • Peripheral neuropathies • http://www.mtio.com/lupus/lal_7.htm

  14. GI Tract Abdominal pain Mesenteric arteritis Pancreatitis Ulcers Liver enlargement Spleenomegaly Sexual Dysfunction Pain Fatigue/weakness Self esteem Decreased desire Psychosocial Dealing with illness Fear of death chronic Lack of socialization Body image changes Rash Medication related Systemic Fever Generalized weakness Fatigue Anorexia Weight loss Signs and Symptoms of Lupus

  15. Medications: Topical steroids for lesions Plaquenil (hydroxychloroquine) Can damage retina Steroids Immunosuppressives Anticoagulants if needed Skin protection Avoid sunlight Mild soaps Cosmetic cover-ups Daily inspection Hair loss Mild shampoo No chemicals Treatment

  16. Patient teaching • May need repeated hospitalizations • Recognize signs of exacerbation • Coping strategies • Need for continued medical follow up • Healthy lifestyle • Lupus support group

  17. More Patient Teaching • Energy conservation • Sexual counseling • Pregnancy aggravates the signs and symptoms • No pregnancy if patient has complications involving cardiac, renal, or CNS • Has increased risk of miscarriage, stillbirth, premature birth

  18. Lupus Support • The National Lupus Foundation • www.lupus.org

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