Republic of the Philippines MARIANO MARCOS STATE UNIVERSITY

COLLEGE OF HEALTH SCIENCES Department of Nursing Batac City, Ilocos Norte

Systemic Lupus Erythematosus (SLE)

Submitted By:

Sales, Fatimah M. Salmasan, Florence Marie P.

Tubera, Jasrina F. Tunac, Maica Tricia N. Vidad, Jay Mark Leish

BSN III A

Submitted To:

Ms. Judith P. Valenzuela

I. DESCRIPTION

Systemic lupus erythematosus (SLE) is a heterogeneous, inflammatory, multisystem

autoimmune disease in which antinuclear antibodies occur (often years before clinical symptoms).

Lupus erythematosus describes the typical rash of SLE and the term systemic emphasizes the

potential for multi-organ involvement. The cause of SLE is unknown. Lupus is an autoimmune

disease. This means that the body's natural defense system (immune system) attacks healthy tissues

instead of attacking only things like bacteria and viruses. This causes inflammation.

II. PATHOPHYSIOLOGY

SLE is an autoimmune disorder characterized by multisystem inflammation with the

generation of autoantibodies. Although the specific cause of SLE is unknown, multiple factors are

associated with the development of the disease, including genetic, epigenetic, ethnic,

immunoregulatory, hormonal, and environmental factors. Many immune disturbances, both innate

and acquired.

It is an extremely complicated and multifactorial interaction among various genetic and

environmental factors is probably involved. Multiple genes contribute to disease susceptibility. The

interaction of sex, hormonal milieu, and the hypothalamo–pituitary–adrenal axis modifies this

susceptibility and the clinical expression of the disease. Defective immune regulatory mechanisms,

such as the clearance of apoptotic cells and immune complexes, are important contributors to the

development of SLE. The loss of immune tolerance, increased antigenic load, excess T cell help,

defective B cell suppression, and the shifting of T helper 1 (Th1) to Th2 immune responses leads to

B cell hyperactivity and the production of pathogenic autoantibodies.

RISK FACTORS

The chances of developing lupus are higher in people who:

Are female.

Are black.

Are between the ages of 15 and 45.

Have a family history of lupus.

Take medicines that are associated with drug-induced systemic lupus.

Exposure to ultraviolet light, usually from sunlight.

Smoking. Smoking also may make getting lupus more likely, and make it more severe.

Some medicines.

Some infections. Some people who have cytomegalovirus (CMV), parvovirus (such as

fifth disease), and hepatitis C infections eventually get lupus. The Epstein-Barr virus has

been linked to lupus in children.

Chemical exposure. Suspected chemical toxins include trichloroethylene in well water

and silica dust. Hair dyes and strengtheners, linked to lupus in the past, are no longer

thought to trigger lupus.

Race. Lupus is more common in African Americans, Hispanics and Asians.

MANIFESTATIONS

Symptoms vary from person to person, and may come and go. Almost everyone with SLE

has joint pain and swelling. Some develop arthritis. The joints of the fingers, hands, wrists, and

knees are often affected.

Other common symptoms include:

Chest pain when taking a deep breath

Fatigue

Fever with no other cause

General discomfort, uneasiness, or ill feeling (malaise)

Hair loss

Mouth sores

Sensitivity to sunlight

Skin rash -- a "butterfly" rash in about half people with SLE. The rash is most often seen

over the cheeks and bridge of the nose, but can be widespread. It gets worse in sunlight.

Swollen lymph nodes

Other symptoms depend on which part of the body is affected:

Brain and nervous system: headaches, numbness, tingling, seizures, vision problems,

personality changes

Digestive tract: abdominal pain, nausea, and vomiting

Heart: abnormal heart rhythms (arrhythmias)

Lung: coughing up blood and difficulty breathing

Skin: patchy skin color, fingers that change color when cold (Raynaud's phenomenon)

Some people have only skin symptoms. This is called discoid lupus.

III. MANAGEMENT

MEDICAL MANAGEMENT

No drug can cure SLE, but many different drugs can help control symptoms and relieve

discomfort.

NURSING MANAGEMENT

Assess patient’s physical, psychologic, and sociocultural problems with long-term

management of SLE

Assess pain and fatigue daily

Ambulatory and home care

Reiterate that adherence to treatment does not necessarily halt progression

Minimize exposure to precipitating factors – fatigue, sun, stress, infection, drugs.

DIAGNOSTIC

Complete blood count. This test measures the number of red blood cells, white blood

cells and platelets as well as the amount of hemoglobin, a protein in red blood cells.

Results may indicate you have anemia, which commonly occurs in lupus. A low white

blood cell or platelet count may occur in lupus as well.

Erythrocyte sedimentation rate. This blood test determines the rate at which red blood

cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a

systemic disease, such as lupus. The sedimentation rate isn't specific for any one disease.

It may be elevated if you have lupus, another inflammatory condition, cancer or an

infection.

Kidney and liver assessment. Blood tests can assess how well your kidneys and liver

are functioning. Lupus can affect these organs.

Urinalysis. An examination of a sample of your urine may show an increased protein

level or red blood cells in the urine, which may occur if lupus has affected your kidneys.

Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies —

produced by your immune system — indicates a stimulated immune system. While most

people with lupus have a positive ANA test, most people with a positive ANA do not

have lupus. If you test positive for ANA, your doctor may advise more-specific antibody

testing.

Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or

inflammation in your lungs.

Echocardiogram. This test uses sound waves to produce real-time images of your

beating heart. It can check for problems with your valves and other portions of your

heart.

THERAPEUTIC MANAGEMENT

Mycophenolate mofetil

Mycophenolate mofetil selectively suppresses T and B lymphocyte proliferation by

inhibiting inosine monophosphate dehydrogenase, the enzyme involved in de novo purine

nucleotide synthesis.

B cell depletion therapy

While many facets of the immune system, including pathogenic T cells, cytokines and

autoantibodies, may play a role in the pathogenesis of SLE, it has been generally agreed that B

cell dysfunction is central to SLE pathogenesis, thus providing a rationale for trials to further

evaluate the anti-CD20 monoclonal antibody rituximab for treatment of SLE

Autologous haematopoietic stem cell transplant

Immunoablation followed by autologous haematopoietic stem cell transplant (HSCT) has

been explored in patients with severe systemic lupus who are unresponsive to conventional

therapies or suffer intolerable side-effects

DRUGS

Chlorpromazine Hydralazine Isoniazid

Methyldopa Procainamide Procaine

Other Medications

Barbiturates Phenytoin(Dilantin) Protamine Salicylates Diazepam (Valium)

Food Additives

Bisulfites Monosodium glutamate (MSG)

Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as

naproxen (Aleve) and ibuprofen (Advil, Motrin, others), may be used to treat pain, swelling

and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effects

of NSAIDs include stomach bleeding, kidney problems and an increased risk of heart

problems.

Antimalarial drugs. 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.

Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation

of lupus, but often produce long-term side effects — including weight gain, easy bruising,

thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection.

The risk of side effects increases with higher doses and longer term therapy.

Immune suppressants. Drugs that suppress the immune system may be helpful in serious

cases of lupus. Examples include cyclophosphamide (Cytoxan), azathioprine (Imuran,

Azasan), mycophenolate (Cellcept), leflunomide (Arava) and methotrexate (Trexall).

Potential side effects may include an increased risk of infection, liver damage, decreased

fertility and an increased risk of cancer. A newer medication, belimumab (Benlysta) also

reduces lupus symptoms in some people. Side effects include nausea, diarrhea and fever.

IV. NURSING DIAGNOSIS AND INTERVENTIONS

1. Disturbed body image related to presence of rash, lesions, alopecia, and loss of

strength

2. Acute Pain related to inflammation and tissue damage.

Goal: improvement in comfort level

Intervention:

1. Carry out a number of actions that provide comfort (heat / cold; massage, position

changes, break; foam mattresses, pillows buffer, splints; relaxation techniques,

activity that distracts)

2. Provide anti-inflammatory preparations, analgesics as recommended.

3. Adjust treatment schedule to meet the needs of patients to pain management.

4. Encourage the patient to express his feelings about the nature of chronic pain and

illness.

5. Describe the pathophysiology of pain and helping patients to realize that pain is

often brought him to the method of unproven therapies.

6. Assist in identifying a person's life that brings pain to the patient cases using

unproven therapies.

7. Perform an assessment of the subjective changes in pain.

3. Fatigue related to an increase in disease activity, pain, depression.

Goal: include action as part of the activities of daily living necessary for change.

Intervention:

1. Give an explanation of fatigue:

The relationship between disease activity and fatigue.

Explain the actions to provide comfort while executing.

Develop and maintain a sleep routine actions fatherly (warm water bathand

relaxation techniques that facilitate sleep).

Explaining the importance of rest to reduce systemic stress, articular and

emotional.

Explains how to use traditional techniques to save energy.

Identify the factors that lead to physical and emotional exhaustion.

2. Facilitating the development schedule of the activity / rest right.

3. Encourage patients' adherence to treatment programs.

4. Refer and thrust conditioning program.

5. Encourage adequate nutrition including iron from food sources and supplements.