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Presented by:
Noreeka Nia J. Tamayo
BSN III - B
Presented to:
Sir Lordley Pagdilao
Clinical Instructor
2016
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
I. DESCRIPTION
Lupus - latin for wolf, to describe erosive skin lesions evocative of a wolfs bite
Systemic Lupus Erythematosus can manifest in a variety of ways. The onset may be
acute or insidious, and the course of disease is characterized by exacerbations/flares and
remissions.
Fatigue
Weakness
Lack of energy
Weight loss
Fever
Joint and muscle pain, stiffness and swelling (most frequently in hands and feet)
Malar rash or butterfly rash (redness over the cheeks and nose)
Persons with SLE appear to have B-cell hyper reactivity and increased production of
antibodies against self (example: autoantibodies) and non self antigens. These B cells are
polyclonal, each producing different type of antibody. The autoantibodies can directly damage
tissues or combine with corresponding antigens to form tissue-damaging immune complexes.
Antibodies have been identified against an array of cell components and cell types. Some
autoantibodies that have been identified in SLE are anti-nuclear antibodies (ANA), including
anti-deoxyribonucleic acid (anti-DNA).
Other antibodies may be produced against cell surface antigens of blood cells, including
red blood cells, white blood cells and platelets. Autoantibodies against RBC can lead to anemia,
those against WBC can lead to leucopenia and those against platelets to thrombocytopenia.
III. MEDICAL and NURSING MANAGEMENT
a. DIAGNOSTIC
The diagnosis of the SLE is based on a complete history, physical examination, and
analysis of blood work but no single laboratory test can diagnose or confirm SLE.
The most common laboratory test performed is the immunofluoresence test for ANA -
laboratory technique to identify specific antibodies or antigens. Although, this test is not specific
for lupus, it establishes that the differential diagnosis includes autoimmunity.
The anti-DNA antibody test is more specific for the diagnosis of SLE. This test is
ordered when a person shows signs and symptoms that could be due to lupus and has had a
positive ANA test, especially when the result of the ANA test presents as a "homogeneous" or
"speckled" fluorescent pattern.
Other serum tests may reveal moderate to severe anemia, thrombocytopenia, and
leukocytosis or leukopenia.
b. MEDICAL MANAGEMENT
Treatment of SLE focuses on managing the acute and chronic symptoms of the disease.
The goals of treatment include:
Preventing progressive loss of organ function
Reducing the possibility of exacerbations
Minimizing disability from the disease process
Preventing complications from medication therapy
d. NURSING MANAGEMENT
Be sensitive to the psychological reactions of the patient due to the changes and the
unpredictable course of SLE; encourage participation in support groups, which can
provide disease information, daily management tips, and social support.
Teach patient to avoid sun and ultraviolet light exposure or to protect themselves with
sunscreen and clothing.
Because of the increased risk of involvement of multiple organ systems, teach patients
the importance of routine periodic screenings as well as health promotion activities.
Refer to dietician if necessary.
Instruct the patient about the importance of continuing prescribed medications, and
address the changes and potential side effects that are likely to occur with their use.
Remind the patient of the importance of monitoring because of the increased risk of
systemic involvement, including renal and cardiovascular effects.
Provide instruction about fatigue: Describe relationship of disease activity to fatigue;
describe comfort measures while providing them; develop and encourage a sleep
routine (warm bath and relaxation techniques that promote sleep); explain importance of
rest for relieving systematic, articular, and emotional stress.
Explain how to use energy conservation techniques (pacing, delegating, setting
priorities).
Identify physical and emotional factors that can cause fatigue.
Facilitate development of appropriate activity/rest schedule.
Encourage adherence to the treatment program.
Refer to and encourage a conditioning program.
Encourage adequate nutrition, including source of iron from food and supplements.
IV. NURSING DIAGNOSIS and NURSING INTERVENTIONS
A. Impaired skin integrity related to photosensitivity as manifested by skin rash.
4. Instruct the patient to avoid scratching the To avoid worsening of the condition and
areas of skin with rash. disruption of the skin.
B. Disturbed body image related to presence of rash, lesions, oral ulcer, alopecia, weight
loss and weakness.
1. Encourage good nutrition, sleep habits, To improve general health and help prevent
exercise, and rest and relaxation technique. infection.
6. Instruct the patient to avoid scratching the To avoid worsening of the condition and
areas of skin with rash. disruption of the skin.
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarths
textbook of medical-surgical nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.
Anon. The American College of Rheumatology nomenclature and case definitions for
neuropsychiatric lupus syndromes. Arthritis Rheum 1999;42:599608.
Wallace D, Hahn BHH, eds. Dubois lupus erythematosus, 7th edn. Lippincott Williams and
Wilkins, 2007.
Arntfield RT, Jicks CM. Systemic lupus erythematosus and the vasculitides. In: Marx JA,
Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine. Philadelphia, PA: Elsevier
Saunders; 2014:chap 118.
http://emedicine.medscape.com/article/332244-overview#a3
http://patient.info/health/systemic-lupus-erythematosus-leaflet