Systemic Lupus

Erythematosus
(SLE)
Dhea Natashia., S.Kep., Ns., M.Sc
Systemic Lupus
Erythematosus (SLE)
 Chronic multisystem inflammatory disease
 Associated with abnormalities of immune system
 Results from interactions among genetic, hormonal, environmental,
and immunologic factors
Systemic Lupus Erythematosus

 Affects the
 Skin
 Joints
 Serous membranes
 Renal system
 Hematologic system
 Neurologic system
Systemic Lupus Erythematosus

 A variable disease
 Chronic
 Unpredictable
 Characterized by exacerbations & remissions
Incidence

 SLE affects 2 to 8 persons per 100,000 in United States

 Most cases occur in women of childbearing years
 African, Asian, Hispanic, and Native Americans three times more
likely to develop than whites
Etiology

 Etiology is unknown
 Most probable causes
 Genetic influence
 Hormones
 Environmental factors
 Certain medications
Pathophysiology

 Autoimmune reactions directed against constituents of cell nucleus,

DNA
 Antibody response related to B and
T cell hyperactivity
Pathophysiology
Aktivasi pembentukan antibody oleh adanya ANTI
NUCLEAR ANTIGEN

Antibody mengikat antigen (Ab-Ag complex)

Terbentuknya deposit imun kompleks pada

dinding pembuluh darah

Aktivasi system komplemen

Vasculitis
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
Clinical Manifestations

Fig 65-9
Clinical Manifestations

 Dermatologic
 Cutaneous vascular lesions
 Butterfly rash
 Oral/nasopharyngeal ulcers
 Alopecia
Dermatologic Manifestations

Fig 65-10
Clinical Manifestations

 Musculoskeletal
Polyarthralgia with morning stiffness
Arthritis
Swan neck fingers
Ulnar deviation
Subluxation with hyperlaxity of joints
Swan Neck Deformity

Fig. 65-4 D
Clinical Manifestations

 Cardiopulmonary
 Tachypnea
 Pleurisy
 Dysrhythmias
 Accelerated CAD
 Pericarditis
Clinical Manifestations

 Renal
 Lupus nephritis
 Ranging from mild proteinuria to glomerulonephritis
 Primary goal in treatment is slowing the progression
Clinical Manifestations

 Nervous system
 Generalized/focal seizures
 Peripheral neuropathy
 Cognitive dysfunction
 Disorientation
 Memory deficits
 Psychiatric symptoms
Clinical Manifestations

 Hematologic
 Formation of antibodies against blood cells
 Anemia
 Leukopenia
Clinical Manifestations

 Hematologic (cont’d)
 Thrombocytopenia
 Coagulopathy
 Anti-phospholipid antibody syndrome
Clinical Manifestations

 Infection
 Increased susceptibility to infections
 Fever should be considered serious
 Infections such as pneumonia are a common cause of death
Diagnostic Studies

 No specific test
 SLE is diagnosed primarily on criteria relating to patient history,
physical examination, and laboratory findings
Diagnostic Studies
Diagnostic Studies

 Antinuclear antibodies
 ANA and other antibodies indicate
autoimmune disease
 Anti-DsDNA and anti-Smith antibody tests most
specific for SLE
 LE prep can be positive with other rheumatoid
diseases
 ESR & CRP are indicative of inflammatory
activity
Diagnostic Tests

 CBC for hematologic problems

 UA for lupus nephritis
 X-rays of affected joints
 Chest x-ray for pulmonary problems
 ECG for cardiac problems
Collaborative Care

 Prognosis is improved with

Earlier diagnosis
Earlier and better treatment regimens
Carefulmonitoring for organ
involvement
Collaborative Care

 Drug therapy
NSAIDs
Antimalarial drugs
Steroid-sparing drugs
Corticosteroids
Immunosuppressive drugs
Nursing Management
Nursing Assessment
 Assess
patient’s physical, psychologic, and
sociocultural problems with long-term
management of SLE
 Assess pain and fatigue daily
Nursing Management
Nursing Assessment

 Obtain subjective and objective data

 Educate and counsel on expected issues
Nursing Management
Nursing Diagnoses
 Fatigue
 Acute pain
 Impaired skin integrity
 Ineffective
therapeutic regimen
management
 Body image disturbance
Nursing Management
Planning
 Overall goals
Have satisfactory pain relief
Comply with therapeutic regimen to
achieve maximum symptom
management
Nursing Management
Planning
 Overall goals (cont’d)
Demonstrate awareness of, and avoid
activities that cause disease
exacerbation (triggers)
Maintain optimal role function and a
positive self-image
Nursing Management
Nursing Implementation

 Health promotion
Prevention of SLE is not possible
Promote early diagnosis and treatment
Nursing Management
Nursing Implementation
 Acute intervention
During
exacerbation, patient will
become abruptly, dramatically ill
Record severity of symptoms and
response to therapy
Nursing Management
Nursing Implementation
 Acute intervention (cont’d)
Observe for
Fever pattern
Joint inflammation
Limitation of motion
Location and degree of discomfort
Fatigability
Nursing Management
Nursing Implementation
 Acute intervention (cont’d)
Monitor weight and I&O
Collect 24-hour urine sample
Assess neurological status
Explain nature of disease
Provide support
Nursing Management
Nursing Implementation
 Ambulatory and home care
Reiteratethat adherence to treatment
does not necessarily halt progression
Minimize exposure to precipitating
factors – fatigue, sun, stress, infection,
drugs
Nursing Management
Nursing Implementation
 Ambulatory and home care
Teach energy conservation and
relaxation exercises
Forjoint problems, all the teaching for
RA related to joint protection, ROM, and
positioning to prevent contractures
Nursing Management
Nursing Implementation
Nursing Management
Nursing Implementation
 Lupus and pregnancy
 Infertility can result from SLE treatment
regimen
 SLE is associated with complications of
pregnancy
 Pregnancy & post partum can cause
exacerbations of SLE
 Women with serious SLE should be counseled
against pregnancy
Nursing Management
Nursing Implementation
 Psychosocial issues
Counselpatient and family that SLE has
good prognosis
Physical effects can lead to isolation,
self-esteem, and body image
disturbances
Assist patient in developing goals
Nursing Management
Evaluation
Expected outcomes
Completion of priority activities
Verbalization of having more
energy
Expression of satisfaction with pain
relief measures
Nursing Management
Evaluation
Expected outcomes (cont’d)
Performance of activities of daily
living without pain
Limitation of direct exposure to sun
and use of sunscreen
No open skin lesions
Nursing Management
Evaluation
 Expected outcomes (cont’d)
Expression of satisfaction with activity
level
Pacing of activities to match level of
tolerance
Expression of confidence in ability to
manage SLE over time and in home
environment