Nursing Medical Surgical Topic

1. SYSTEMIC LUPUS
ERYTHEMATOSUS (SLE)

2. DEFINITION
SLE is an autoimmune disease in which the immune
system attacks its own tissues, causing widespread
inflammation and tissue damage in the affected
organs. It can affect the joints, skin, brain, lungs,
kidneys, and blood vessels.
Systemic lupus erythematosus (SLE) is a chronic
inflammatory disease that affects almost all body
systems, including the musculoskeletal system.

3. INCIDENCE
SLE is more common in women than men by nearly 10
to 1.
It may occur at any age. However, it appears most
often in young women between the ages of 15 and 44.
In the US, the disease affects more African Americans,
Asians, African Caribbeans, and Hispanic Americans
compared to Caucasians.

4. ETIOLOGY
The cause of SLE is not clearly known. It may be linked to
the following factors:
•Genetic
•Environmental-
•ultraviolet rays
•Viruses
•Physical or emotional stress
•Trauma
•Hormonal
•Certain medicines

5. CLINICAL MANIFESTATIONS
Lupus can affect almost any organ in the body.
Symptoms vary from person to person and may come
and go.
Everyone with SLE has joint pain and swelling at some
time. Some develop arthritis. SLE often affects the
joints of the fingers, hands, wrists, and knees.
Other common symptoms include:
•Chest pain when taking a deep breath, Fatigue.
•Fever with no other cause.

6. •General discomfort, uneasiness, or ill feeling
(malaise).
•Hair loss, Weight loss.
•Mouth sores.
•Sensitivity to sunlight.
•Skin rash -- A "butterfly" rash develops in about half
the people with SLE.
•Swollen lymph nodes.

7. Other symptoms and signs depend on which part of the
body is affected:
•Brain and nervous system - Headaches, weakness,
numbness, tingling, seizures, vision problems, memory
and personality changes.
•Digestive tract- Abdominal pain, nausea, and vomiting
•Heart- Valve problems, Myocarditis or Pericarditis
•Lung- Pleural Effusion , difficulty breathing, Hemoptysis
•Skin- Sores in the mouth
•Kidney- Swelling in the legs
•Circulation- Clots in veins or arteries, Thrombophlebitis ,
Vasoconstriction in response to cold (Raynaud
phenomenon)
•Blood abnormalities including anemia, low white blood

10. DIAGNOSTIC EVALUATIONS
Diagnosis of SLE is based on a complete history, physical
examination, and blood tests.
Typically, assessment reveals classic symptoms, including
fever, fatigue, weight loss, and possibly arthritis, pleurisy,
and pericarditis. The skin is inspected for erythematous
rashes.
Cardiovascular assessment includes auscultation for
pericardial friction rub, possibly associated with myocarditis
and accompanying pleural effusions.
Joint swelling, tenderness, warmth, pain on movement,
stiffness, and edema may be detected on physical
examination.
The neurologic assessment is directed at identifying and
describing any central nervous system changes.
No single laboratory test confirms SLE; rather, blood testing

11. OTHER DIAGNOSTIC TESTS
•Antibodies to double-stranded DNA
•Coombs test
•ESR and CRP
•Kidney function blood tests
•Liver function blood tests
•Rheumatoid factor
•Antiphospholipid antibodies and lupus anticoagulant
test
•Kidney biopsy
•Imaging tests of the heart, brain, lungs, joints,
muscles or intestines

12. MANAGEMENT
The goals of treatment include preventing
progressive loss of organ function, reducing the
likelihood of acute disease, minimizing disease-
related disabilities, and preventing complications
from therapy.
Mild forms of the disease may be treated with:
NSAIDs for joint symptoms.
Low doses of corticosteroids, such as prednisone,
for skin and arthritis symptoms.
Corticosteroid creams for skin rashes.
Antimalarial medications are effective for
managing cutaneous, musculoskeletal, and mild

13. Treatments for more severe SLE may include:
High-dose corticosteroids.
Immunosuppressive medicines (these medicines
suppress the immune system).
Anticoagulants for clotting disorders.

14. NURSING MANAGEMENT
1. Provide variety of comfort measures
a. Application of heat or cold
b. Massage, position changes, rest
c. Foam mattress, supportive pillow, splints
d. Relaxation techniques, diversional activities
2. Administer anti-inflammatory, analgesic, and slow-
acting antirheumatic medications as prescribed.
3. Individualize medication schedule to meet patient’s
need for pain management.
4. Encourage verbalization of feelings about pain and
chronicity of disease.
5. Teach pathophysiology

15. Encourage adherence to the treatment program.
Refer to and encourage a conditioning program.
Encourage adequate nutrition, including source of iron
from food and supplements.

16. PATIENT EDUCATION
•Wear protective clothing, sunglasses, and
sunscreen when in the sun.
•Get preventive heart care.
•Stay up-to-date with immunizations.
•Have tests to screen for osteoporosis.
•Avoid tobacco and drink minimal amounts of
alcohol.

17. COMPLICATIONS
•Lupus nephritis
•Blood clots in arteries of veins of the legs,
lungs, brain, or intestines
•Destruction of red blood cells or anemia of
long-term (chronic) disease
•Pericarditis, or myocarditis or endocarditis
•Fluid around the lungs and damage to lung
tissue
•Pregnancy problems, including miscarriage
•Stroke