ATI Systemic Lupus Erythematosus

1. A nurse is reviewing the plan of care for a client who has systemic lupus erythematosus (SLE). The client reports fatigue, joint tenderness, swelling, and difficulty urinating. Which of the following laboratory findings should the nurse anticipate ? (Select all that apply.) A. Positive ANA B. Increased hemoglobin C. 2+ urine protein D. Increased serum C3 and C4 complement E. Elevated BUN

1. A. CORRECT: A positive antinuclear antibody (ANA) titer is an expected finding in a client who has SLE. The ANA test identifies the presence of antibody produced against the client's own DNA. B. INCORRECT: Increased hemoglobin is not an expected finding in a client who has SLE. C. CORRECT: Increased urine protein is an expected finding due to renal involvement as a result of SLE. D. INCORRECT: Increased serum C3 and C4 are not expected findings in a client who has SLE. Findings would be decreased. E. CORRECT: Elevated BUN is an expected finding due to renal involvement in a client who has SLE.

2. A nurse is providing teaching about self-care to a client who has SLE. Which of the following statements by the client indicates a need for further teaching? A. "I should avoid sun exposure." B. "I will apply powder to any skin rash." C. "I should use a mild hair shampoo." D. "I will call my doctor if I have a cough."

2. A. INCORRECT: A client who has SLE should avoid sun exposure. B. CORRECT: This statement requires further teaching because the client should apply steroid-based creams to skin rashes. C. INCORRECT: A client who has SLE should use a mild hair shampoo that does not irritate the scalp. D. INCORRECT: A client who has SLE should notify the provider about a cough due to the increased risk of infection while being immunocompromised.

Assessment ●● Risk Factors ◯◯ Females between the ages of __ and __ ◯◯ African American, Asian, or Native American descent ◯◯ The incidence of lupus declines in women following __ but remains steady in men.

20 40 menopause

◯◯ Laboratory Tests ■■ Autoantibodies ☐☐ Antinuclear antibody (ANA) titer (antibody produced against one's own DNA) - positive ANA titer in 90% of clients who have lupus (expected finding is negative ANA titer at 1:20 dilution) ■■ __ __ - positive (not specific for SLE but positive in the vast majority of clients who have SLE)

Anti-DNA

●● Subjective Data ◯◯ __/__ ◯◯ __ ◯◯ __ __ ◯◯ __ ◯◯ __ __ ◯◯ __/__ __ ◯◯ __ ◯◯ Joint pain, swelling, tenderness

Fatigue malaise Alopecia Blurred vision Malaise Pleuritic pain Anorexia weight loss Depression

●● Objective Data ◯◯ Physical Assessment Findings ■■ __ (also a major symptom of exacerbation) ■■ __ ■■ __ ■■ __ (presence of a cardiac friction rub or pleural friction rub) ■■ __ __ (arteriolar vasospasm in response to cold/stress) ■■ Findings consistent with organ involvement (kidney, heart, lungs, and vasculature) ■■ Butterfly rash on face

Fever Anemia Lymphadenopathy Pericarditis Raynaud's phenomenon

Complications ●● __ __ (renal failure/glomerulonephritis) ◯◯ Clients whose SLE is unable to be managed with immunosuppressants and corticosteroids may experience renal failure secondary to glomerulonephritis. This is a major cause of death, and a renal transplant may be necessary. ◯◯ Nursing Actions - Monitor for __ and lower extremity __ and __. Monitor the client's renal status (creatinine, BUN). ◯◯ Client Education ■■ Teach the client the importance of taking immunosuppressants and corticosteroids as prescribed. ■■ Teach the client the importance of avoiding __ and __.

Lupus nephritis periorbital swelling hypertension stress illness

●● __ and __ (instruct the client to report chest pain) ◯◯ Inflammation of the heart, its vessels, and the surrounding sac can occur secondary to SLE. ◯◯ Nursing Actions - Monitor for chest pain, fatigue, arrhythmias, and fever. ◯◯ Client Education ■■ Take immunosuppressants and corticosteroids as prescribed. ■■ Avoid stress and illness. ■■ Report chest pain to the provider.

Pericarditis myocarditis

◯◯ Immunosuppressant agents - methotrexate and azathioprine (Imuran) ■■ Used to suppress the immune response. ■■ Nursing Considerations - Monitor for toxic effects (__ __ __, increased __ __).

bone marrow suppression liver enzymes

◯◯ Diagnosis of SLE may be delayed in older adult clients because many of the clinical manifestations mimic other disorders or may be associated with reports common to the normal aging process. ■■ Joint pain and swelling may significantly limit ADLs in older adult clients who have comorbidities. ■■ Older adult clients are at an increased risk for fractures if __ therapy is used.

corticosteroid

◯◯ Antimalarial - hydroxychloroquine (Plaquenil) ■■ Used for suppression of synovitis, fever, and fatigue. ■■ Nursing Considerations - Encourage frequent __ __.

eye examinations

●● Medications ◯◯ NSAIDs ■■ Used to reduce __ and __ __. ■■ Nursing Considerations ☐☐ NSAIDs are contraindicated for clients who have __ compromise. ☐☐ Monitor for NSAID-induced __.

inflammation arthritic pain renal hepatitis

●● SLE varies in severity and progression. It is generally characterized by periods of exacerbations (flares) and remissions. ●● SLE is classified as discoid or systemic. A temporary form of SLE may be __ __. ◯◯ Discoid SLE primarily affects the __. It is characterized by an __ __ rash over the nose and cheeks and is generally self-limiting. ◯◯ Systemic SLE affects the connective tissues of multiple organ systems and can lead to major __ __. ◯◯ Medication-induced SLE can be caused by medications (__, __, __). Findings resolve when the medication is discontinued, and it does not cause renal or neurologic disease.

medication-induced skin erythematosus butterfly organ failure procainamide hydralazine isoniazid

●● Care After Discharge ◯◯ Client Education ■■ Avoid UV and sun exposure. Use sunscreen when outside and exposed to sunlight. ■■ Use mild protein __ and avoid harsh __ treatments. ■■ Use __ creams for skin rash. ■■ Report peripheral and periorbital edema promptly. ■■ Report evidence of infection related to immunosuppression. ■■ Avoid crowds and individuals who are sick, because illness can precipitate an exacerbation. ■■ Educate client of childbearing age regarding risks of pregnancy with lupus and treatment medications.

shampoo hair steroid

◯◯ Provide __, __ meals if anorexia is a concern. Offer between-meal supplements. ◯◯ Encourage the client to limit __ __ for fluid retention secondary to steroid therapy. ◯◯ Provide emotional support to the client and family.

small frequent salt intake

4. A nurse is admitting a client who has suspected SLE. Which of the following clinical findings supports this diagnosis? A. Weight loss B. Petechiae on thighs C. Increased hair growth D. Alopecia

4. A. INCORRECT: Weight gain may occur in the client who has SLE and is being treated with corticosteroids. B. INCORRECT: A butterfly rash on the face is a clinical finding in a client who has SLE. C. INCORRECT: Alopecia is an expected clinical finding in a client who has SLE D. CORRECT: Areas of hair loss are an expected finding in a client who has SLE.

5. A nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. Which of the following clinical findings should the nurse anticipate? A. Swelling of joints of the fingers B. Pallor of toes with cold exposure C. Feet become reddened with ambulation D. Client report of intense feeling of heat in the fingers

5. A. INCORRECT: Swelling, pain, and joint tenderness are clinical findings in a client who has SLE and is not specific to an episode of Raynaud's phenomenon. B. CORRECT: Pallor of the extremities occurs in Raynaud's phenomenon in a client who has SLE and has been exposed to cold or stress. C. INCORRECT: The extremities becoming red, white, and blue when exposed to cold or stress is characteristic of an episode of Raynaud's phenomenon in a client who has SLE. D. INCORRECT: A client report of intense pain in the hands and feet is characteristic of an episode of Raynaud's phenomenon in a client who has SLE.

3. A nurse is providing teaching to a client who has a new prescription for prednisone (Deltasone). Which of the following should be included in the teaching? (Select all that apply.) A. Hypotension can occur. B. Weight gain is expected. C. Abdominal striae may appear. D. Loss of appetite may be present. E. Moon facies may be evident.

3. A. INCORRECT: Increased blood pressure is an adverse effect while taking this medication. B. CORRECT: Prednisone causes fluid retention which results in weight gain. C. CORRECT: Prednisone causes weight gain, especially in the abdomen, and can result in the appearance of abdominal striae. D. INCORRECT: An increase in appetite is an adverse effect while taking this medication. E. CORRECT: Moon facies (rounding of the face due to an accumulation of fatty tissue) is an adverse effect while taking this medication.