this topic describes indetail regarding the SYSTEMIC LUPUS ERYTHAMETOSUS (SLE) and its management

1. Systemic Lupus
Erythematosus (SLE)
By:
Mr. M. Sivananda Reddy

3. Incidence
• About 90% of all cases occur in women
• Most cases occur in women of childbearing years
• At the age of 30 years the ratio of women to men is
10:1
• African, Asian, Hispanic, and Native Americans
three times more likely to develop than whites

4. Etiology
• Auto immune
• Etiology is unknown
• Most probable causes:
– Genetic influence
– Hormones
– Environmental factors- UV B rays, infections with
CMV, HCV, smoking
– Certain medications- Trimethoprim,
Sulphamethaxozole

5. Pathophysiology
• Autoimmune reactions directed against constituents of
cell nucleus, DNA
• Antibody response related to B and
T cell hyperactivity which is stimulated by the Estrogen
• The antigen antibody complexes that are developed will
be in the circulation and blocks the microvasculature
and the spaces

6. Clinical Manifestations
• Ranges from a relatively mild disorder to rapidly
progressing, affecting many body systems
• Most commonly affects the skin/muscles, lining
of lungs, heart, nervous tissue, and kidneys

8. • Dermatologic:
– Cutaneous vascular lesions
– Butterfly rash
– Oral/nasopharyngeal ulcers
– Alopecia

9. Butterfly Rash / Malar Rash

10. • Musculoskeletal
–Polyarthralgia with morning stiffness
–Arthritis
• Swan neck fingers
• Ulnar deviation
• Subluxation with hyperlaxity of joints

11. Swan Neck Deformity

12. Ulnar deviation:

13. • Cardiopulmonary
– Tachypnea
– Pleuritis
– Dysrhythmias
– Accelerated CAD
– Pericarditis

14. • Renal
– Lupus nephritis
• Ranging from mild proteinuria to glomerulonephritis

15. • Nervous system
– Generalized/focal seizures
– Peripheral neuropathy
– Cognitive dysfunction
• Disorientation
• Memory deficits
• Psychiatric symptoms

16. • Hematologic
– Formation of antibodies against blood cells
– Anemia
– Leukopenia
– Thrombocytopenia
– Coagulopathy
– Anti-phospholipid antibody syndrome

17. • Infection
– Increased susceptibility to infections
– Fever should be considered serious
– Infections such as pneumonia are a common cause
of death

18. Diagnostic Studies

19. • Antinuclear antibodies
– ANA and other antibodies indicate autoimmune
disease
– Anti-DNA and anti-Smith antibody tests most
specific for SLE
– ESR & CRP are indicative of inflammatory
activity.

20. • CBC for hematologic problems
• Ultrasound Abdomen for lupus nephritis
• X-rays of affected joints
• Chest x-ray for pulmonary problems
• ECG for cardiac problems

21. Treatment
• Drug therapy
–NSAIDs- Acetaminophen
–Antimalarial drugs- Hydroxychloroquine
–Corticosteroids- Prednisone
–Immunosuppressive drugs

22. Nursing Management
Nursing Diagnoses
• Fatigue
• Acute pain
• Impaired skin integrity
• Ineffective therapeutic regimen management
• Body image disturbance

23. Nursing Interventions
– Observe for
• Fever pattern
• Joint inflammation
• Limitation of motion
• Location and degree of discomfort
• Fatigability

24. – Monitor weight and I&O
– Collect 24-hour urine sample
– Assess neurological status
– Explain nature of disease
– Provide support

25. • Ambulatory and home care
– Reiterate that adherence to treatment does not
necessarily halt progression
– Minimize exposure to precipitating factors –
fatigue, sun, stress, infection, drugs
– Teach energy conservation and relaxation exercises
– Teach regarding ROM to prevent contractures

26. • Psychosocial issues
– Counsel patient and family that SLE has good
prognosis
– Physical effects can lead to isolation, self-esteem,
and body image disturbances
– Assist patient in developing goals