Systemic Lupus Erythematosus

The nurse is teaching a client with Systemic lupus erythematosus (SLE) about self care. Which of the following teaching points is most important for the nurse to review with the client? Encourage the client to apply suntan lotion SPF 8 and higher to skin before exposure. Encourage the client to verbalize feelings of anxiety related to the diagnosis. Encourage the client to perform good hand washing after using the bathroom and before eating. Encourage the client to utilize clean technique in caring for any wound care.

Encourage the client to perform good hand washing after using the bathroom and before eating. Rationale: # 1 is incorrect because suntan lotion of an SPF 15, 30 or higher should be used since sun exposure can bring on a flare. # 2 is incorrect because psychological needs do not precede physical needs. # 3 is correct. Hand washing is the most important client needs because hand washing reduces the risk of infection with endogenous organisms. # 4 is incorrect because clean technique is not indicated. The use of strict aseptic technique in caring for intravenous lines and indwelling urinary catheters or performing any wound care is indicated. Aseptic technique offers protection against external and resident host microorganisms.

The white blood cell (WBC) count of a client with systemic lupus erythematosus (SLE) shows a shift to the left. What is the highest priority nursing diagnosis for the nurse caring for this client? Impaired Skin Integrity Ineffective Individual Coping Ineffective Health Maintenance Ineffective Protection

Ineffective Protection Rationale: All of these diagnoses are appropriate for the client with SLE. However, the results of this client's WBC indicate that the client is at risk for infection due to the disease process or its treatments. Ineffective protection, then, is the highest priority of care for the nurse at this time.

The nurse should instruct a client that which of the following factors might increase the risk of developing an exacerbation of systemic lupus erythematosus (SLE)? GI upset Fever Hypotension Pregnancy

Pregnancy Rationale: Pregnancy can be associated with exacerbation because of increased estrogen levels. Hypotension, fever, and GI upset do not cause exacerbation of SLE.

Approximately 50% of people with SLE experience renal manifestations

Proteinuria, cellular casts, nephritic syndromes Up to 10% renal failure

The nurse would assess which of the following in a client who is being evaluated for systemic lupus erythematosus (SLE)? Fever Rash on the face across the nose Elevated red blood cell count Fatigue

Rash on the face across the nose Rationale: Rash on the face across the nose is the classic sign of SLE. Fever and fatigue are symptoms that occur during exacerbations. The client with SLE is apt to be anemic.

Systemic Lupus Erythematosus

SLE is a chronic inflammatory immune disorder affecting the skin and other body organs. Antibodies to DNA and RNA cause an autoimmune inflammatory response, resulting in swelling and pain. It is most common in young women, and has a strong genetic factor. The etiology is not known

SLE Triggers

While a person's genes may increase the chance that he or she will develop lupus, it takes some kind of environmental trigger to set off the illness or to bring on a flare. Examples include: • ultraviolet rays from the sun • ultraviolet rays from fluorescent light bulbs • sulfa drugs, which make a person more sensitive to the sun, such as: Bactrim® and Septra® (trimethoprim-sulfamethoxazole); sulfisoxazole (Gantrisin®); tolbutamide (Orinase®); sulfasalazine (Azulfidine®); diuretics • sun-sensitizing tetracycline drugs such as minocycline (Minocin®) • penicillin or other antibiotic drugs such as: amoxicillin (Amoxil®); ampicillin (Ampicillin Sodium ADD-Vantage®); cloxacillin (Cloxapen®) • an infection • a cold or a viral illness • exhaustion • an injury • emotional stress, such as a divorce, illness, death in the family, or other life complications • anything that causes stress to the body, such as surgery, physical harm, pregnancy, or giving birth Although many seemingly unrelated factors can trigger the onset of lupus in a susceptible person, scientists have noted some common features among many people who have lupus, including: • exposure to the sun • an infection • being pregnant • giving birth • a drug taken to treat an illness

Clients with active disease have an increased risk for

infections

Lung

o Pleurisy o Pleural effusion o pneumonitis o interstitial fibrosis

Diagnostic test

• Anti-DNA antibody testing • Erythrocyte sedimentation rate::Typically elevated • Serum complement levels::Usually decreased • CBC::Anemia, leukopenia, lymphocytopenia, thrmocytopenia • Urinalysis::Renal function: BUN, Serum Creatinine • Kidney biopsy

Risk for infection R/T compromised immune system

• Prophylactic antibiotics • Yearly influence vaccine • Hand hygine

GI

o Anorexia o Nausea o Abdominal pain o Diarrhea o hepatomegaly

Skin

o Butterfly rash on face o Photosensitivity o Maculopapular rash on expose body surfaces o Discoid lesions o Erythematous fingertip lesions o Splinter hemorrhages o Alopecia o Ulcers (lips, mouth, nose

Sensory System

o Conjunctivitis o Photophobia o Retinal vasculitis with transient blindness o Cotton-wool spots on retina

Brain

o Neuropathies o Seizures o Depression o Psychosis o Stroke

SLE characterized by periods of

remission and exacerbation

Prednisone prescribed because

the steroids will suppress tissue inflammation, which reduces damages to organs

A client with systemic lupus erythematosus (SLE) asks the nurse what medications are used to cure autoimmune diseases. The nurse should respond with which of the following? "The NSAIDS provide a cure for autoimmune diseases." "Antibiotics are used to treat autoimmune diseases." "Autoimmune diseases are not curable." "Autoimmune diseases are temporary and do not need medications."

"Autoimmune diseases are not curable." Rationale: The nurse should respond that autoimmune diseases are not curable by medications or by any other means. The client should be instructed on health promotion and management of symptoms with pharmacological and nonpharmacological methods. Antibiotics are used when the client with an autoimmune disease acquires an infection.

Hematologic abnormalities

Anemia, leukopenia, thrombocytopenia

Systemic Lupus

Systemic lupus is the most common form of lupus, and is what most people mean when they refer to "lupus." Systemic lupus can be mild or severe. Some of the more serious complications involving major organ systems are: inflammation of the kidneys (lupus nephritis), which can affect the body's ability to filter waste from the blood and can be so damaging that dialysis or kidney transplant may be needed an increase in blood pressure in the lungs (pulmonary hypertension) inflammation of the nervous system and brain, which can cause memory problems, confusion, headaches, and strokes

Cardiovascular

Pericarditis, vascultitis

the client diagnosed with SLE is being discharged from the medical unit. which discharge instructions are most important. select all: 1. use sunscreen of SPF 30 or greater 2. notify HCP of fever 3. some dyspnea is expected 4. the hands and feet may change color 5. clt can be cured

1-2-4

A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I look! I never go anyplace except here to the health clinic." An appropriate nursing diagnosis for the patient is a. activity intolerance related to fatigue and inactivity. b. impaired skin integrity related to itching and skin sloughing. c. social isolation related to embarrassment about the effects of SLE. d. impaired social interaction related to lack of social skills.

Answer: C Rationale: The patient's statement about not going anyplace because of hating the way he or she looks supports the diagnosis of social isolation because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for patients with SLE, but the information about this patient does not support this as a diagnosis. The rash with SLE is nonpruritic. There is no evidence of lack of social skills for this patient.

Many clients with SLE develop transient nervous system involvement

Decline in intellect, memory loss, disorientation Psychosis, seizures, depression, stroke

Low levels of WBC's and platelets?

Prednisone

The nurse, instructing a client with systemic lupus erythematosus (SLE) about the management of fatigue during an exacerbation, would determine that learning outcomes need reinforcement if the client states a plan to: Sit when possible. Take short rest periods. Engage in low-impact exercise when not fatigued. Take a hot bath before bed.

Take a hot bath before bed. Rationale: The nurse should instruct the client to avoid hot baths to help reduce fatigue; heat can cause an exacerbation. The client should be instructed that long periods of rest can promote joint stiffness. The nurse should encourage the client to sit when possible, and to engage in low-impact exercise when not fatigued.

SLE autoantibodies react with their corresponding antigen to form immune complexes, which are then deposited in the:

connective tissues of blood vessels, lymphatic vessels, and other tissues

Medications

hydroxychloroguine Aspirin Prednisone Immunosuppressive agents such as cyclophosphamide or azathiprine

autoantibody production results from

hyperreactivity of B cells(humoral immune response)

frequent site of complex deposition and damage occur in the

kidneys

The nurse, caring for a teen diagnosed with systemic lupus erythematosus (SLE), should instruct the family about which of the following challenges? Planning meals Planning family vacations Violence from the client Adherence to treatment

Adherence to treatment Rationale: Consistent with this developmental stage, the teen client is apt to rebel more strongly and deny the disease. Adherence to a plan of treatment, medications, and the fact that this will differentiate them from the peer group can cause nonadherence. Anger at having the disease could turn to violence, but this is not typical. Planning meals and vacations should not pose problems for the family.

A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue, acute hand and wrist pain, and proteinuria. The health care provider prescribes prednisone (Deltasone) 40 mg twice daily. Which nursing action should be included in the plan of care? a. Institute seizure precautions. b. Reorient to time and place PRN. c. Monitor intake and output. d. Place on cardiac monitor.

Answer: C Rationale: Lupus nephritis is a common complication of SLE, and when the patient is taking corticosteroids, it is especially important to monitor renal function. There is no indication that the patient is experiencing any nervous system or cardiac problems with the SLE.

Early manifestations include

Because lupus can affect so many different organs, a wide range of symptoms can occur. These symptoms may come and go, and different symptoms may appear at different times during the course of the disease. The most common symptoms of lupus, which are the same for females and males, are: • extreme fatigue (tiredness) • headaches • painful or swollen joints • fever • anemia (low numbers of red blood cells or hemoglobin, or low total blood volume) • swelling (edema) in feet, legs, hands, and/or around eyes • pain in chest on deep breathing (pleurisy) • butterfly-shaped rash across cheeks and nose • sun- or light-sensitivity (photosensitivity) • hair loss • abnormal blood clotting • fingers turning white and/or blue when cold (Raynaud's phenomenon) • mouth or nose ulcers

A 32-year-old female with systemic lupus erythematosus (SLE) complains that her hands become pale, blue, and painful when exposed to the cold. What disorder should the nurse cite as an explanation to these sign and symptoms? a) Buerger's disease occur as a result to cold exposure. b) Guillain Barre Syndrome results from very cold climate. c) Raynaud's disease results from reduced blood flow to the lower extremities when exposed to cold or stress. d) Multiple Sclerosis disease occur as a result to cold exposure.

C

Which of the following statements when made by the client with systemic lupus erythematosus (SLE) indicates the need for further teaching? a) I will wear long-sleeved clothings when I go walking in the morning b) I will walk in shaded areas only c) I will go sunbathing in summer d) I will wear wide-breamed hat when I go to the beach

C

The nurse is assigned to care for a client with systemic lupus erythematosus. The nurse plans care, knowing that this disorder is a(n): a) local rash that occurs as a result of allergy b) disease caused by overexposure to sunlight c) inflammatory disease of collagen contained in connective tissue d) disease caused by the continuous release of histamine in the body

C - Systemic lupus erythematosus is an inflammatory disease of collagen in connective tissue. Options A, B, and D are not associated with this disease.

The nurse is assigned to care for a client admitted to the hospital with a diagnosis of systemic lupus erythematosus. The nurse reviews the physician's orders, expecting to note that which type of medication is prescribed? a) antibiotic b) antidiarrheal c) corticosteroid d) opioid analgesic

C - Treatment of systemic lupus erythematosus is based on the systems involved and symptoms. Treatment normally consists of anti-inflammatory drugs, corticosteroids, and immunosuppressants. Options A, B, and D are not standard components of medication therapy.

A 26-year-old woman has been diagnosed with early systemic lupus erythematosus (SLE) involving her joints. In teaching the patient about the disease, the nurse includes the information that SLE is a(n) a. hereditary disorder of women but usually does not show clinical symptoms unless a woman becomes pregnant. b. autoimmune disease of women in which antibodies are formed that destroy all nucleated cells in the body. c. disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression. d. disease that causes production of antibodies that bind with cellular estrogen receptors, causing an inflammatory response.

Answer: C Rationale: SLE has an unpredictable course, even with appropriate treatment. Women are more at risk for SLE, but it is not confined exclusively to women. Clinical symptoms may worsen during pregnancy but are not confined to pregnancy or the perinatal period. All nucleated cells are not destroyed by the antinuclear antibodies. The inflammation in SLE is not caused by antibody binding to cellular estrogen receptors.

A laboratory test result that supports the diagnosis of SLE is: a. Leukocytosis, elevated BUN and CREA b. Pancytopenia, elevated antinuclear antibody (ANA) titer c. Thrombocytosis, elevated ESR d. None of these

B

A sign of neurologic involvement in SLE is manifested by: a. CVA b. Infection c. Psychosis d. Facial tic

B

The nurse, providing nutritional instruction for a client diagnosed with systemic lupus erythematosus (SLE), should teach the client to avoid which of the following foods? (Select all that apply.) Turkey Steak Broccoli Bacon Cantaloupe

Bacon Steak Rationale: The client with SLE is at risk for cardiovascular disorders. The client should be instructed on nutritional lifestyle changes to prevent these disorders. The client should be instructed to reduce fat (steak, bacon), salt (bacon), and to quit smoking. The other food choices are part of a healthy diet.

Ocular

Conjunctivitis, photophobia, transient blindness due to retinal vasculitis

A patient is diagnosed with a systematic lupus erythematous (SLE). SLE primarily attacks which tissues? a. Heart b. Lung c. Nerve d. Connective

D

A client is suspected of having systemic lupus erythematosus. The nurse monitors the client, knowing that which of the following is one of the initial characteristic signs of systemic lupus erythematosus? a) weight gain b) subnormal temperature c) elevated red blood cell count d) rash on the face across the bridge of the nose and on the cheeks

D - Skin lesions or rash on the face across the bridge of the nose and on the cheeks is an initial characteristic sign of systemic lupus erythematosus (SLE). Fever and weight loss may also occur. Anemia is most likely to occur later in SLE.

A client with systemic lupus erythematosus (SLE) asks the nurse if getting a flu vaccine in the fall is important. The nurse responds with which of the following? "No, you could get the flu from the shot." "Yes, you should get the nasal flu vaccine." "Yes, flu vaccine is a priority every year." "No, you are not at risk for the flu."

"Yes, flu vaccine is a priority every year." Rationale: The client with SLE has a compromised immune system and should be protected from the flu with a shot every year. The flu shot is not a live virus. The nasal vaccine is a live virus and should not be used by a client with a compromised immune system. Immunization with a killed virus will not cause the disease.

the 26 year old female client is c/o low-grade fever, arthralgias, fatigue, and facial rash. which lab test should nurse expect HCP to order? 1. complete metabolic panel and LFTs 2. CBC and antinuclear antibody test 3. cholesterol and lipid profile 4. BUN and glomerular filtration test

2. CBC and antinuclear antibody test

the nurse is developing a care plan for a client diagnosed with SLE. which goal is priority? 1. maintain reproductive ability 2. verbalize feelings of body image 3. no deterioration of organ function 4. client's skin will remain intact

3. no deterioration of organ function

A classic sign of SLE is: a. Rashes over the cheeks and nose b. Weight loss c. Vomiting d. Difficulty urinating

A

The client had been diagnosed to have systemic lupus erythematosus (SLE). Which of the following assessment findings should the nurse watch out for? a) pericardial friction rub b) elevated blood pressure c) tachycardia d) hemoptysis

A

The nurse provides home care instructions to a client with systemic lupus erythematosus and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further instructions? a) I should take hot baths because they are relaxing b) I should sit whenever possible to conserve my energy c) I should avoid long periods of rest because it causes joint stiffness d) I should do some exercises, such as walking, when I am not fatigued

A - To help reduce fatigue in the client with systemic lupus erythematosus, the nurse should instruct the client to sit whenever possible, avoid hot baths (because they exacerbate fatigue), schedule moderate low-impact exercises when not fatigued, and maintain a balanced diet. The client is instructed to avoid long periods of rest because it promotes joint stiffness.

The nurse is caring for a client with systemic lupus erythematosis (SLE). The major complication associated with systemic lupus erythematosis is: a. Nephritis b. Cardiomegaly c. Desquamation d. Meningitis

Answer A is correct. The major complication of SLE is lupus nephritis, which results in end-stage renal disease. SLE affects the musculoskeletal, integumentary, renal, nervous, and cardiovascular systems, but the major complication is renal involvement; therefore, answers B and D are incorrect. Answer C is incorrect because the SLE produces a "butterfly" rash, not desquamation.

A 19-year-old patient who is taking azathioprine (Imuran) for systemic lupus erythematosus has a check-up before leaving home for college. The health care provider writes all of these orders. Which one should the nurse question? a. Naproxen (Aleve) 200 mg BID b. Give measles-mumps-rubella (MMR) immunization c. Draw anti-DNA titer d. Famotidine (Pepcid) 20 mg daily

Answer: B Rationale: Live virus vaccines, such as rubella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.

Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says, a. "I should expect to have a low fever all the time with this disease." b. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms." c. "I should try to ignore my symptoms as much as possible and have a positive outlook." d. "I can expect a temporary improvement in my symptoms if I become pregnant.

Answer: B Rationale: Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process. Symptoms may worsen during pregnancy and especially during the postpartum period.

A patient with polyarthralgia with joint swelling and pain is being evaluated for systemic lupus erythematosus (SLE). The nurse knows that the serum test result that is the most specific for SLE is the presence of a. rheumatoid factor. b. anti-Smith antibody (Anti-Sm). c. antinuclear antibody (ANA). d. lupus erythematosus (LE) cell prep.

Answer: B Rationale: The anti-Sm is antibody found almost exclusively in SLE. The other blood tests are also used in screening but are not as specific to SLE.