Central Mindanao University

College of Nursing

University Town, Musuan, Maramag

MCM 64: Care of Clients with Problem in Inflammatory and Immunologic Response
Perception and Coordination

SYSTEMIC LUPUS ERYTHEMATOUS

Prepared By:

Lepon, Airene Joy D.

Submitted to:

Dr. Ellen Gay S. Intong, RN

February 2018
 I. INTRODUCTION

The immune system normally fights off dangerous infections and bacteria to keep
the body healthy. An autoimmune disease occurs when the immune system attacks
the body because it confuses it for something foreign. There are many autoimmune
diseases, including systemic lupus erythematosus (SLE).

Systemic Lupus Erythematosus (SLE), or lupus, is an autoimmune disease in which

a person's immune system attacks various organs or cells of the body, causing
damage and dysfunction. Lupus is called a multisystem disease because it can
affect many different tissues and organs in the body. Some patients with lupus have
very mild disease, which can be treated with simple medications, whereas others
can have serious, life-threatening complications.

About 20 percent of people with lupus developed the disease before 20 years of
age. It is rare to get lupus before age 5 years. Lupus is more common in females
and in certain ethnic groups, including African-American, Hispanic, South and
Southeast Asian and North American First Nations populations.

While lupus is a chronic illness, it is characterized by periods when the disease

activity is minimal or absent (remission) and when it is active (relapse or flare). The
outlook (prognosis) for patients with lupus today is much better than years ago
because of greater awareness and more accurate tests leading to earlier diagnosis
and treatment as well as more effective and safer medications and monitoring
methods.

II. RISK FACTORS

 Gender - more than 90% of people with lupus are women. Before puberty, boys and
girls are equally likely to develop the condition

 Age - symptoms and diagnosis of lupus often occur between the ages of 15-45.
Around 15% of people who are later diagnosed with lupus, experienced symptoms
before the age of 18
 Family history - first-degree or second-degree relatives of a person with lupus have
a 4-8% risk of developing lupus. One study suggests that sisters of lupus patients
have as high as a 10% chance of developing lupus. In another 10-year prospective
study, researchers observed a 7% incidence of lupus in first-degree relatives of
lupus patients.

CAUSES

Lupus occurs when your immune system attacks healthy tissue in your body
(autoimmune disease). It's likely that lupus results from a combination of your
genetics and your environment.

It appears that people with an inherited predisposition for lupus may develop the
disease when they come into contact with something in the environment that can
trigger lupus. The cause of lupus in most cases, however, is unknown. Some
potential triggers include:

 Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an
internal response in susceptible people.

 Infections. Having an infection can initiate lupus or cause a relapse in some

people.

 Medications. Lupus can be triggered by certain types of blood pressure

medications, anti-seizure medications and antibiotics. People who have drug-
induced lupus usually get better when they stop taking the medication. Rarely,
symptoms may persist even after the drug is stopped.

Lupus is not contagious, and it cannot be transmitted sexually.

COMPLICATIONS

Inflammation caused by lupus can affect many areas of your body, including your:

 Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of
the leading causes of death among people with lupus.
  Brain and central nervous system. If your brain is affected by lupus, you may
experience headaches, dizziness, behavior changes, vision problems, and even
strokes or seizures. Many people with lupus experience memory problems and
may have difficulty expressing their thoughts.

 Blood and blood vessels. Lupus may lead to blood problems, including
anemia and increased risk of bleeding or blood clotting. It can also cause
inflammation of the blood vessels (vasculitis).

 Lungs. Having lupus increases your chances of developing an inflammation of

the chest cavity lining (pleurisy), which can make breathing painful. Bleeding
into lungs and pneumonia also are possible.

 Heart. Lupus can cause inflammation of your heart muscle, your arteries or
heart membrane (pericarditis). The risk of cardiovascular disease and heart
attacks increases greatly as well.

SIGNS AND SYMPTOMS

Symptoms can vary and can change over time. Common symptoms include:

 Fever

 joint pain

 Anorexia

 a rash on the cheeks and nose, which is called a “butterfly rash”

 hair loss

 blood-clotting problems

 fingers turning white or blue and tingling when cold, which is known as Raynaud’s
phenomenon

Other symptoms depend on the part of the body the disease is attacking, such as
the digestive tract, the heart, or the skin.
 III. ASSESSMENT AND DIAGNOSTIC FINDINGS

HOW SLE IS DIAGNOSED

Doctor will do a physical exam to check for typical signs and symptoms of lupus,
including:

 sun sensitivity rashes, such as a malar or butterfly rash

 mucous membrane ulcers, which may occur in the mouth or nose
 arthritis, which is swelling or tenderness of the small joints of the hands, feet,
knees, and wrists
 hair loss

Signs of cardiac or lung involvement, such as murmurs, rubs, or irregular heartbeats

The diagnosis of systemic lupus erythematosus (SLE) must be based on the proper
constellation of clinical findings and laboratory evidence. Familiarities with the
diagnostic criteria helps clinicians to recognize SLE and to sub classify this complex
disease based on the pattern of target-organ manifestations.

IV. INTERVENTIONS

Testing
The following are useful standard laboratory studies when SLE is suspected:
 CBC with differential
 Serum creatinine
 Urinalysis with microscopy
Imaging studies
The following imaging studies may be used to evaluate patients with suspected SLE:
 Joint radiography
 Chest radiography and chest CT scanning
 Echocardiography
 Brain MRI/MRA
 Cardiac MRI
Procedures
Procedures that may be performed in patients with suspected SLE include the
following:
 Lumbar puncture

MEDICAL INTERVENTIONS (Pharmacologic Interventions)

Management of SLE often depends on the individual patient’s disease severity and
disease manifestations, although hydroxychloroquine has a central role for long-term
treatment in all SLE patients.
Pharmacotherapy
Medications used to treat SLE manifestations include the following:
 Antimalarials (eg, hydroxychloroquine)
 Corticosteroids (eg, methylprednisolone, prednisone), short-term use
recommended
 Nonbiologic DMARDS: Cyclophosphamide, methotrexate, azathioprine,
mycophenolate, cyclosporine
 Nonsteroidal anti-inflammatory drugs (NSAIDS; eg, ibuprofen, naproxen,
diclofenac)
 Biologic DMARDs (disease-modifying antirheumatic drugs): Belimumab,
rituximab, and/or IV immune globulin

V. NURSING RESPONSIBILITIES

 Assess patient’s general fatigue level.

 Assess for the presence of depression, anxiety, and other stressors.
 Conduct assessment to determine patient’s daily activities that contribute to
fatigue.
 Help patient to develop an energy-conserving plan for completing daily and
other activities and work.
 Suggest planning for rest periods as needed throughout the day to conserve
energy.
 Encourage patient to get 8-10 hours of sleep at night.
 Encourage exercise as tolerated.
 Assess patient’s prescription and non-prescription drug regimen and dosages.
 Assess the patient’s usual daily dietary intake by asking her or him to keep a
food diary.
 Develop a dietary plan with the patient that encourages healthful eating.
 Encourage exercise as tolerated.
 Record patient’s weight.
 Monitor patient’s WBC count.
 Teach patient to monitor temperature during a lupus flare.
 Teach patient to look for signs and symptoms of infection, particularly urinary
and respiratory infections. (Note: The cardinal signs of infection may be
masked because of corticosteroids and antipyretic medications.)
 Allow patient to express feelings and needs.
 Assess patient’s usual coping mechanisms.
 Acknowledge that feelings of denial and anger are normal.
 Participation in support groups
 Daily management tips and social support
 Patient should be instructed to avoid exposure to ultra violet
 Watch for signs and symptoms of infection
REFERENCES

Margiotta DP, Vadacca M, Navarini L, Basta F, Vullo ML, et al. (2016) SAT0298
Retrospective Evaluation of Basal Leptin Levels in Sle Patients Who Developed
Disease Flares and Damage Accrual. Annals of the Rheumatic Diseases 75:776-
777.

Rodriguez E, Galindo M, Gonzalo-Gil E, Usategui A, Herráiz I, et al.(2016) SAT0299

Angiogenesis Biomarkers and Doppler Ultrasound of Uterine Arteries in Patients with
Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome Can Be Helpful
in Differential Diagnosis between Preeclampisa and Disease Activity. Annals of the
Rheumatic Diseases 75:776-777

Serum cryoglobulins and disease activity in systematic lupus erythematosus

M Karimifar, S Pourajam, A Tahmasebi, P Mottaghi

Saritas F, Pamuk GE, Gurkan H, Tozkir H, Julide D, et al. (2016) SAT0300 The
Relationship between Genetic Variations of Adaptive Immune System Intracellular
Signal Transduction Pathways and Clinical Findings in Systemic Lupus
Erythematous. Annals of the Rheumatic Diseases 75:776-777.