SYSTEMIC LUPUS ERYTHEMATOSUS

(SLE)
 DEFINITION

Systemic lupus erythematosus (SLE) is a complex

autoimmune disease of the body’s connective tissues.
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.
 FOUR MAJOR TYPES OF LUPUS

 Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is the most common form of lupus. When people talk about lupus in general, this is the
type they’re most likely referring to. SLE affects many organs, especially skin, joints and kidneys.
 Drug-Induced Lupus Erythematosus
This type of lupus is separate from SLE and is caused by taking certain prescription drugs. The presentation of drug-induced
lupus is like SLE, including joints and inflammation around the lungs. The drugs most commonly connected with drug-
induced lupus include: Hydralazine, Procainamide, Isoniazid, Minocycline, Anti-TNF
 Neonatal Lupus Erythematosus
Neonatal lupus is a rare condition that affects babies of women who have anti-Ro and anti-La antibodies. These antibodies
from the mother act on the baby’s heart conduction system. At birth, the infant may have a skin rash, liver problems or low
blood cell count.
 Lupus of the Skin
Which are the Acute cutaneous lupus, Chronic cutaneous lupus erythematosus, or discoid lupus erythematosus (DLE),
Subacute cutaneous lupus erythematosus. A skin biopsy is sometimes necessary to diagnose these types of lupus, as each
has its own characteristic lesions and patterns.
 CLINICAL MANIFESTATION

DERMATOLOGIC
Oral/nasopharyngeal ulcers
Cutaneous vascular lesions
Alopecia
Butterfly rash
MUSCULOSKELETAL
Poly-arthralgia with morning
stiffness
Arthritis
Swan neck fingers
Ulnar deviation
Sub-luxation with hyperlaxity of
joints
 CLINICAL MANIFESTATION

CARDIOPULMONARY NERVOUS SYSTEM

Tachypnea Generalized/focal seizures
Pleurisy Peripheral neuropathy
Dysrhythmias Cognitive dysfunction
Accelerated CAD Disorientation
Pericarditis Memory deficits
Psychiatric symptoms
 CLINICAL MANIFESTATION

HEMATOLOGIC INFECTION
Formation of antibodies against blood 
Increased susceptibility to
cells infections
 Anemia Fever should be considered
Leukopenia serious
Thrombocytopenia Infections such as pneumonia are
Coagulopathy a common cause of death
Anti-phospholipid antibody
 PREVENTION

Although lupus is not preventable, people with lupus can take steps to manage their disease and prevent or
minimize lupus flares:
• It’s important for people with lupus to take their medications as directed by their health care providers. Taking
lupus medications as prescribed, even when someone with lupus doesn’t feel sick, will help prevent lupus flares
and minimize side effects.
• Exposure to UV rays from sunlight and other light sources can trigger flares in many people with lupus.
Applying sunscreen every day, and wearing sun-protective clothing can prevent UV rays from triggering a lupus
flare.
• Emotional stress and exhaustion can trigger flares. It is important for people with lupus to get plenty of sleep
and stay rested. Avoiding stress by planning ahead for activities and asking for help when needed can also
prevent flares.
• Although there is no special diet for people with lupus, it’s important to eat a variety of nutritious foods,
including fresh fruits and vegetables, whole grains, and moderate servings of lean protein such as meat, fish, and
beans. People with lupus should avoid eating alfalfa sprouts, because it has been associated with lupus flares.
 COMPLICATIONS

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.
 COMPLICATIONS
JOINTS
Arthritis is very common in people
who have lupus. It can cause pain,
with or without swelling. Stiffness
and pain may be worse in the
morning. Arthritis may be a problem
for only a few days or weeks, or it
may be permanent. It’s usually not
severe.
KIDNEYS
Up to half of people who have lupus
get kidney problems. They can be
dangerous. These problems are more
likely when you also have other lupus
symptoms, such as fatigue, arthritis,
rash, fever, and weight loss.
 COMPLICATIONS

BLOOD SKIN

People with lupus may have
dangerously low numbers of red
blood cells, white blood cells, or
platelets
Problems are common with lupus.
So are hair loss and mouth sores. If
you have a type called discoid
lupus, you get large, red, circular
rashes that may scar. Sunlight
usually irritates skin rashes
 MEDICAL /SURGICAL MANAGEMENT

 Rest. To relieve muscle and joint pains

 ROM exercise. To prevent contractures
 Prevent infection. The client is immunocompromised
 Avoid exposure to sunlight to prevent exacerbation of manifestations.
Pharmacotherapy ( these medications have anti-inflammatory effects)
 ASA
 NSAIDS
 Steroids
 Anti-malarial
 Cytotoxic Agents (Cyclophosphamide/Methotrexate)
Plasmapheresis. This is separation of antibodies from the plasma. It inhibits autoimmune
response
 MEDICAL /SURGICAL MANAGEMENT

The 3 types of major surgery that people with lupus most often undergo are:
Kidney transplant, in people with end-stage renal failure due to kidney
nephritis
Splenectomy (removal of the spleen), to reverse consistently low platelet count
(thrombocytopenia)
Joint replacement, especially hip replacement, to improve mobility and reduce
pain when lupus permanently damages the joints
Some surgeries are only performed when lupus has been in remission for a
certain amount of time to increase the chances of success.
 NURSING MANAGEMENT

 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. If the patient has nutrition-related
lupus complications, refer her or him to a registered dietitian for specialized counseling.
 Encourage exercise as tolerated.
 NURSING MANAGEMENT

 Instruct patient to weigh herself or himself at home once a week and record it.
 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.)
 Instruct patient to call physician if signs and symptoms of an infection appear or if a fever is elevated
above normal baseline.
 Explore possible ways of concealing skin lesions and hair loss.
 Allow patient to express feelings and needs.
 Assess patient’s usual coping mechanisms.
 Acknowledge that feelings of denial and anger are normal.
 TOP 5 NURSING PROBLEMS

1. Acute pain related to inflammatory process and inadequate comfort measures as

evidence by complaints of joint pain.
2. Fatigue related to chronic inflammation and altered immunity as evidence by lack
of energy, inability to maintain usual routine.
3. Impaired skin integrity related to photosensitivity, skin rash and alopecia as
evidenced by rash anywhere on body, butterfly rash on face, hair loss, areas of
ulceration on fingertips complaints of urticaria.
4. Deficient knowledge related to lack of exposure to an unfamiliarity with
information resources as evidence by questions about SLE.
5. Body image disturbance related to disease condition.