Nursing Care of the Client with

Connective Tissue Disease

Systemic Lupus
Systemic Sclerosis

Polymyositis
Systemic Lupus Erythmatosus

Multisystem Inflammatory Disease

Etiology and Pathophysiology
 Etiology – unknown
 Genetic predisposition
 Hormones

 Environmental factors

 Triggers:
 Infection
 Certain medications
Overaggressive Antibody Response

 Immune complexes deposited in

basement membranes of capillaries:
 Kidneys

 Heart

 Skin

 Brain

 Joints

* Specific symptoms of SLE depend on

which cells or organs are involved
Manifestations & Complications
 Variable depending on severity
 Any organ(s) may be affected
 Most commonly affected:
 Skin
 Muscle
 Lungs
 Heart
 Nervous system
 Kidneys
Manifestations & Complications
 Skin
 Butterfly rash – 50% of patients
 Ulcers – mouth or nose
 Alopecia
 Musculoskeletal
 Polyarthralgia – 90% of patients
 Non-erosive arthritis
 Cardiopulmonary
 Tachypnea & cough
 Arrhythmias
 Accelerates CAD
Manifestations & Complications
 Renal problems – 50% of clients within
one year
 Mild proteinuria to glomerulonephritis
 Nervous system
 Seizures
 Disordered thought processes
 Disorientation
 Memory deficits
 Depression
 Psychosis
Manifestations & Complications
 Hematological problems
 Anemia

 Mildleukopenia
 Thrombocytopenia

 Infection
 Immunosuppresive effect of anti-
inflammatory drugs
 Defects in ability to phagocytize
invading bacteria
Diagnosis of SLE
 No specific diagnostic test
 Four or more of criteria are present
serially or simultaneously
 Presence of criteria are not
definitive for diagnosis
 “rule-out” other disease processes
Drug Therapy
 NSAID’s
 hydroxychloroquine (Plaquenil)
 corticosteroids – especially during
severe exacerbations of polyarthritis
 methotrexate
 azathioprine (Imuran)
Nursing Care
 Assess severity of symptoms: fever,
joint pain and limitations of
movement, fatigability
 Weight and I&O – risk of fluid
overload:
 renal failure
 corticosteroid therapy
Nursing Care
 Observe S/S bleeding
 Changes in vital signs
 Bruising
 Petechiae
 Tarry stools
 Pallor
 Assess neuro status
 Visual disturbances
 Mental status
 Seizures
 Numbness, tingling, weakness of extremities
Patient Education
 Avoid triggers: sun, infections,
emotional stress, etc.
 Pre-conception counseling
 Correct use of medication(s) and
importance of compliance
 Disease complications are “hidden”;
physical limitations are not obvious
Patient Education

Web site co-sponsored by NIH and

National Institute of Arthritis and
Musculoskeletal and Skin Diseases

http://www.niams.nih.gov/hi/topics/lupus
 Systemic Sclerosis
 Fibrotic, degenerative changes
 Skin thickening/tightening
 Localized vs. systemic
 Causes:
 Immune dysfunction
 Vascular abnormalities

 Environmental exposure
 Systemic Sclerosis
 Collagen is over produced
 CREST syndrome:
 Calcinosis

 Raynaud’s phenomenon
 Esophageal dysfunction

 Sclerodactyly

 Telangiectasia
 Systemic Sclerosis
 Internal organ involvement
 Esophageal fibrosis
 Lung involvement

 Heart disease (CHF)

 Kidney disease with malignant

hypertension
 Nursing and Collaborative Care
 Goal of medical regimen:
 Prevent complications of involved
organs
 Medications:
 Corticosteroids
 Vasodilators (Raynaud’s, hypertension)

 H2 receptor blocker or proton pump

inhibitor (GI symptoms)
 Physical therapy
 Nursing care
 Nursing Care
 Assessment:
 Joint ROM
 Respiratory function

 Nutrition: swallowing, weight, I&O

 Circulation: Raynaud’s

 Body image
 Nursing Care
 Nursing Interventions:
 ROM exercises, mouth excursion
 Moist heat/parafifin

 Protect hands and feet:

 Keep warm
 Gloves

 No finger-stick blood testing

 No smoking – vasoconstriction

 Inspect for injury/infection

 Nursing Care
 Special attention to oral care
 Nutrition and hydration
 Small, frequent meals
 Carefull/complete chewing

 Dysphagia precautions
 Thickened liquids
 High fowlers 2 hours after eating

 Antacids 45 minutes after eating if

gastric reflux
Resources for clients and
health professionals

http://www.scleroderma.org/
 Polymyositis
 Diffuse, inflammatory myopathies of
striated muscle
 Relatively rare
 Produces bilateral weakness of
shoulders, legs, arms and pelvic
girdle
 Joint pain, reddness, inflammation
 Collaborative Care
 Patient teaching:
 Prescribed therapies
 Tests
 Importance of follow-up care
 Delay in response to therapy
 Patient safety
 Paced activity
 Physical therapy
 High-dose corticosteroids
 Immunosuppressive drugs
 methotrexate