Systemic lupus erythematosus

Under supervision of :

Assistant Prof Dr Heba Abd Al-Azim

Dr Faten Ali

Prepared by :

 Amal Abozeid Mohamed  Alaa Mohamed Nada

 Amal Mansour Abdel_hady  Alaa Mustafa Fayez
 Amany Mohamed Abdel_aziz

Medical surgical department :

Second year student nurses

2023_2024
Outlines

 Introduction

 Definition

 Anatomy

 Pathophysiology

 Risk factors

 Causes

 Signs and symptoms

 Complications

 Diagnosis

 Prevention

 Medical Management

 Pharmacological management

 Nursing diagnosis

 Nursing care plan

 Summary

 Reference
Introduction

_ There are four different types of lupus : Systemic lupus erythematosus (SLE) is
the most common type of lupus If SLE begins in childhood, it is known as
childhood-onset SLE or cSLE Approximately 10-20 percent of SLE cases begin in
childhood Most cases of SLE begin in adulthood, between the ages of 15-44
Lupus that only affects the skin is less common and is called cutaneous lupus
erythematosus (CLE) There are three types of CLE – discoid lupus, subacute
cutaneous lupus, and acute cutaneous lupus Neonatal lupus and drug-induced
lupus are the least common types of lupus

_ Systemic Lupus Erythematosus (SLE) Is a complex autoimmune disease The

Immune system attacks the body’s cells and tissue, resulting In inflammation and
tissue damage SLE can affect any part of the body, but most often harms the
heart, joints, skin, lungs , blood vessels , liver, kidneys, and nervous system
_ While anyone can be diagnosed with lupus, 90% of people with the disease are
women Lupus symptoms can range from mild to life- threatening and should be
treated by a doctor
Women of color are 2-3 times more likely to be diagnosed with lupus and have
worse stymptoms On average it takes nearly 6 years for people with lupus to be
diagnosed

Definition

SLE Is an autoimmune disease In which the Immune system attacks its own
tissues, causing widespread Inflammation and tissue damage In the affected
organs It can affect the joints, skin, brain, lungs, kidneys, and blood vessels
There is no cure for lupus, but medIcal interventions and lifestyle changes can
help control it
 Pathophysiology

SLE is a result of disturbed immune regulation that causes an exaggerated

production of autoantibodies
This immunoregulatory disturbance is brought about by some combination of
genetic, hormonal (as evidenced by the usual onset during the childbearing
years), and environmental factors (sunlight, thermal burns )
Certain medications, such as hydralazine (Apresoline), procainamide (Pronestyl),
isoniazid (INH), chlorpromazine (Thorazine), and some antiseizure medications,
have been implicated in chemical or drug-induced SLE
In SLE, the increase in autoantibody production is thought to result from
abnormal suppressor T-cell function, leading to immune complex deposition and
tissue damage Inflammation stimulates antigens, which in turn stimulate
additional antibodies, and the cycle repeats That leads to tissue injuries, visceral
lesions which causes acute necrotising vasculitis

Risk factors

1 Female gender
2 Ages 15 to 44
3 Non-White population
4 Family history
5 Certain medications can lead to drug-induced lupus
6 Immune stimulation from Infections
7 Cigarette smoking

8 Crystalline silica exposure

Causes

1 Genes :
There is very little evidence that particular genes directly cause lupus, but
some genes seem to raise risk for the disease
2 Medications :
Some prescription medications such as hydralazine and procainamide can
cause lupus
The symptoms usually get better after stop taking the drug
3 Hormones (maybe) :
Women get lupus far more often than men
In addition, lupus symptoms seem to Increase before monthly periods and during
pregnancy when estrogen is higher
4 Environment :
It can be hard to figure out exactly whichh things act as causes of
lupus
This includes : Cigarette smoke, Mercury, Viruses, UV light and stress

Signs and symptoms

★ Symptoms vary from person to person, and may come and go

o Everyone with SLE has joint pain and swelling at some time
o Some develop arthritis
o SLE often affects the joints of the fingers, hands, wrists, and knees
★ Other common symptoms Include :
o Chest pain when taking a deep breath
o Fatigue
o Fever with no other cause
o General discomfort, uneasiness
o Hair loss
o Weight loss
o Mouth sores
o Sensitivity to sunligh
o Swollen lymph nodes
o A "butterfly" rash develops In about half the people with SLE The rash Is
mostly seen over the cheeks and bridge of the nose It can be widespread It
gets worse in sunlight

★ Other symptoms and signs depend on which part of the body is affected :
o Brain and nervous system :
Headaches, weakness, numbness, tingling, seizures, vision problems,
memory and personality changes
o Digestive tract :
Abdominal pain, nausea, and vomiting
o Heart :
Valve problems, inflammation of heart muscle or heart lining (pericardium)
o Lung :
Buildup of fluid In the pleural space, difficulty breathing, coughing up blood
o Skin :
Sores in the mouth
o Kidney :
Swelling in the legs
o Circulation :
Clots in veins or arteries, Inflammation of blood vessels, constriction of
blood vessels In response to cold (Raynaud phenomenon)
o Blood abnormalities :
including anemia, low white blood cell or platelet count
o Some people have only skin symptoms This Is called discoid lupus
Complications
1 The blood :
There may be changes In the blood cells, anemia, and changes to organs
related to circulation, such as the spleen or lymph nodes Some people with lupus
produce antibodies that attack certain blood-clotting factors, causing the blood
to clot too easily This can lead to mild or severe problems Some of these are
stroke, heart attack, deep vein thrombosis, miscarriage, and preeclampsia
2 The lungs :
Inflammation of the tissues around the lungs may cause no symptoms But
sometimes It can cause painful breathing, coughing, or chest pain
3 The heart :
Inflammation of the sac around the heart Is the most common lupus-related
heart problem There may also be hardening of the arteries and diseases of the
heart valves
4 The kidneys :
People who have lupus might notice swelling of the legs and ankles They
might have abnormal lab results when their urine is tested Some people develop
serious kidney disease
5 The nervous system and mental health :
Some of these problems include mild memory loss, headaches, problems with
vision, muscle weakness, and loss of feeling in the feet and hands Many people
who have lupus become anxious or depressed They might have delusions,
hallucinations, or episodes of manic behavior
Diagnosis
1_ Laboratory Examination :
 Antinuclear antibody (ANA)
 Complete blood count (CBC) with differential
 Serum creatinine
 Urinalysis
 Kidney function blood tests
 Liver function blood tests
 Tissue biopsy :
skin lesions can be biopsied and examined microscopically for signs of
Inflammation
 ESR : to detect systemic inflammation
2_ Radiology examination :
 X-Ray of affected joints : to see the condition
 Chest X-Ray : to find the systemic Involvement
 ECG : to determine extra- articular involvement / cardiac problems

Prevention

1_ Avoid sunlight
 Sun protection is Important for people with lupus, as UV exposure can
trigger symptoms
 Exposure to sunlight can lead to rashes and other symptoms In some
people with lupus, Including fatigue, and joint pain
 Photosensitivity is a common factor In cutaneous lupus erythematosus
 Not everyone with lupus has this sensitivity, but It is more common in
people with lupus than those wIthout the condition
 For people who have a sensitivity to ultraviolet (UV) light, staying out of the
sun can help reduce the risk of a flare-up
  If this is unavoidable, people should use a high-factor sunscreen of 50+ that
protects from both UVA and UVB, and wear clothes that cover the body

2_ Avoid some medications

 A number of prescription drugs can trigger symptoms, including : The sleep
aids melatonin and Rozerem, which mimics melatonin
 The antibiotics Bactrim (which combines sulfamethoxazole and
trimethoprim) and Septra (sulfamethoxazole and trimethoprim)

3_ Avoid certain foods

 For a person with an autoimmune condition, enhancing the immune system
can be a problem
 Foods such as garlic and alfalfa sprouts and supplements may have this
property
 People sometimes use such foods and supplements to prevent colds, but
people with lupus might find that they make symptoms worse

4_ Avoid toxins
 Cigarette smoke, alcohol, and some work-related and other chemicals
appear to trigger genetic changes that can lead to lupus

5_ Healthy lifestyle
 Increase exercise
 Get enough rest
 Eat well
 Avoid alcohol
 Don’t smoke
 Wear sunglasses, a hat, and sunscreen
Medical management
 Treatment will depend on several things, Including age, overall health,
medical history, which part of body Is affected, and severity of case
 Because lupus can change over time, It’s crucial to have regular visits with a
doctor, such as a specialist called a rheumatologist
 Some people with mild cases don’t need treatment Those who have more
serious symptoms such as kidney problems may need strong medications
Drugs that treat lupus include:
 Immune system ; It treats severe forms of lupus, such as those affecting
kidneys or brain

Pharmacological management
1 Imuran (azathioprine)
This treats serious symptoms of lupus It was originally used to prevent
rejection after an organ transplant
2 Plaquenil (hydroxychloroquine)
This medicine helps control mild lupus-related problems, such as skin and
joint disease It can also prevent symptom flares
3 Rheumatrex (methotrexate)
Anotherr chemotherapy drug that weakens immune system More doctors
are using It for skin disease, arthritis, and other conditions that don’t get
better with medications such as hydroxychloroquine or low doses of the
steroid prednisone
4 Rituxan (rituximab)
A biologic that treats lymphoma and rheumatoid arthritis You might take It
if you have serious symptoms that don’t go away with other treatments
5 Saphnelo (anifrolumab-fnia)
This newer Injectable immunosuppressant is for the treatment of adult
patients with moderate to severe (SLE) who are getting standard therapy
6 Steroids
You can put steroid creams directly on rashes They’re usually safe and
effective, especially for mild rashes Low doses of steroid creams or pills
can ease mild or moderate signs of lupus You can also take steroids In
higher doses If lupus is affecting your internal organs But high doses also
are most likely to have side effects

Nursing diagnosis

1 Acute pain related to Inflammatory process and Inadequate comfort

measures as evidenced by complaints of joint pain

2 Deficient knowledge related to lack of exposure to an unfamiliarity

with information on resources as evidenced by questions about

systemic lupus Erythematosus

3 Fatigue related to chronic inflammation and altered Immunity as

evidenced by lack of energy , Inability to maintain usual routine

4 High risk for Impaired skin Integrity related to photosensitivity, skin

rash and alopecia

5 Body image disturbance related to disease condition

Nursing care plan " Actual"

Nursing Expected outcomes Implementation Rationale

diagnosis
Acute pain Patient will report Encourage the client to These
related to pain or stiffness at a perform range-of- exercises help
inflammatory level less than 3 to 4 motion (ROM) exercises reduce
process and on a scale of 0 to 10 after the shower or stiffness and
inadequate bath, two repetitions per maintain joint
comfort Patient will implement joint mobility
measuresas a pain management
evidenced by plan that includes Encourage the client to
complaints of pharmacological and assume an anatomically Such measures
joint pain nonpharmacological correct position with all assist in
measures joints Suggest that the preventing the
client uses a small flat development of
pillow under the head contractures
and not use a knee
gatch or pillow to prop
the knee
Patient will be able to Remind the client to Activity is
participate in self- avoid prolonged periods required to
care activities of inactivity prevent further
stiffness and to
prevent joints
from freezing
and muscles
from becoming
atrophied
 Assess for the signs of Usual signs of
joint inflammation inflammation
(warmth, redness, may not be
swelling) or decreased present with
motion this disease

Nursing care plan " potential"

Nursing Expected Implementation Rationale
diagnosis outcomes

High risk for Patient will Encourage adequate These

Impaired skin identify measures nutrition and hydration measures
integrity related to cover scalp promote
to loss as required healthy skin
photosensitivity, by personal and healing in
skin rash and preference the presence
alopecia of wounds

Patient will Instruct the client to keep Skin is

maintain optimal ulcerated skin clean and necessary to
skin integrity, as dry prevent
evidenced by an infection and
Apply dressings as
absence of rashes promote
needed
and skin lesions healing

Client will Instruct the client that Hair will

verbalize ability to scalp hair loss may be regrow as the
cope with hair caused by high-dose dose
loss corticosteroids decreases
(prednisone) and
immunosuppressant drug
Summary
Systemic Lupus erythematous Is a complex, multisystem autoimmune disease It
is characterized by chronic Inflammation throughout the body, whichh can lead to
some long-term and serious complications
Lupus complications can occur within the blood, heart, lungs, kidneys, and
central nervous system It can also lead to mental health dIsturbances
References
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Nordin S Human leucocyte antigens profiling in Malay female patients with
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