Lupus
By: Brianna Tate
NUR 234
Hem-Onc-Imm
Signs &
Symptoms
Treatments
Pathophysiology
•Silica dust and cigarette smoking
•Administration of estrogen to postmenopausal women
•Photosensitivity is clearly a precipitant of skin disease
•Ultraviolet light stimulates an increased autoantibody production
•Breastfeeding is associated with a decreased risk of developing SLE
Environmental & Exposure Causes
SLE is an autoimmune disorder characterized by multisystem inflammation with the generation of auto antibodies.
Antibodies may be present for many years before the onset of the first symptoms of SLE
Lupus is chronic and affects more than 1.5 Americans
More than 90% of lupus sufferers are women , mostly between the ages of 15 and 44
Women of color are two to three times more at risk for lupus
2 Major Types of Lupus
1. Discoid lupus erythematosus (DLE)
affects only the skin
2. Systemic lupus erythematosus (SLE)
affects the entire body especially major organs
Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there's no cure for lupus, treatments can help control symptoms
What is Lupus?
Lupus is a chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs.
The development of autoantibodies involves a defect in apoptosis that causes increased cell death and a disturbance in immune tolerance
Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Used to treat pain, swelling and fever associated with lupus.
- Asprin
- Motrin
- Toradol
Antimalarial Drugs
Side effects of NSAIDs include stomach bleeding, kidney problems and an increased risk of heart problems.
Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), also can help control lupus
Side effects can include stomach upset and, very rarely, damage to the retina of the eye.
Joint Pain
Alternative Medicine
Treatment for lupus depends on the presenting signs and symptoms
•Dehydroepiandrosterone (DHEA)-Supplements containing this hormone have been shown to reduce the dose of steroids needed to stabilize symptoms in some people who have lupus
•Fish oil- Fish oil supplements contain omega-3 fatty acids that may be beneficial for people with lupus. Side effects of fish oil supplements can include nausea, belching and a fishy taste in the mouth.
•Vitamin D-There is some evidence to suggest that people with lupus may benefit from supplemental vitamin D
Also including stiffness and swelling
- Headaches
- Confusion
- Memory Loss
Corticosteroids
Prednisone and other types of corticosteroids can counter the inflammation of lupus
Long-term side effects — including weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection
Nursing Plans & Interventions
Butterfly Rash
- Reinforce instruction for client to avoid prolonged exposure to the sun
- Reinforce instruction for client to clean the skin with mild soap
- Monitor and collaborate with R to develop a teaching plan for client/family about administration of steroids
Immunosuppressants
Butterfly rash on the face that covers the cheeks and bridge of the nose
Raynaud's Phenomenon
Drugs that suppress the immune system may be helpful in serious cases of lupus
Examples include azathioprine (Imuran, Azasan), mycophenolate (CellCept), leflunomide (Arava) and methotrexate (Trexall)
Potential side effects= increased risk of infection, liver damage, decreased fertility and an increased risk of cancer.
Fingers and toes that turn white or blue when exposed to cold or during stressful periods
Skin Lesions
B. Raynauds Phenomenon
DeWit, S. (2013). Medical-surgical nursing: Concepts & practice (2nd ed.). St. Louis, Mo.: Elsevier Saunders.
Lupus Facts, Symptoms, Rash, Effects, Complications, and More. (n.d.). Retrieved December 8, 2014, from http://www.webmd.com/lupus/arthritis-lupus
Lupus. (n.d.). Retrieved December 8, 2014, from http://www.mayoclinic.org/diseases-conditions/ lupus/basics/definition/con-20019676
Skin lesions that appear or worsen with sun exposure
Your client has SLE. Your knowledge of this disease would tells you that symptoms such as the butterfly mask like rash and joint pain are associated with this disease. However, the client is complaining of having pale or purple fingers. What does this symptom indicate?
a. Discoid erythematosus
b. Raynauds Phenomenon
c. Scleradoma
d. Syncope
Biopsy
Lupus can harm the kidneys in many different ways, and treatments can vary, depending on the type of damage that occurs. In some cases, it's necessary to test a small sample of kidney tissue to determine what the best treatment might be
Diagnosis
Imaging Tests
•Chest X-ray- may reveal abnormal shadows that suggest fluid or inflammation in thelungs
•Echocardiogram- This test uses sound waves to produce real-time images of your beating heart. It can check for problems with the valves and other portions of the heart
Lab Tests
•Complete blood count- Results may indicate anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur
•Erythrocyte sedimentation rate- A faster than normal rate may indicate a systemic disease, such as lupus
•Kidney and liver assessment
•Urinalysis- Increased protein level or RBC's in the urine, which may occur if lupus has affected the kidneys
•Antinuclear antibody (ANA) test- A positive test for the presence of these antibodies which indicates a stimulated immune system