Lewis Chapter 64 - Systemic Lupus Erythematosus (SLE)

A patient is suspected of having systemic lupus erythematosus (SLE). Which would be considered diagnostic for systemic lupus erythematosus? a. Anti-Smith antibody b. Positive lupus erythematosus cell prep c. Swan-neck deformity d. Raynaud's phenomenon

ANS: A Anti-Smith antibodies, swan-neck deformity, antinuclear antibodies, and Raynaud's phenomenon are all found in patients with systemic lupus erythematosus (SLE). Anti-Smith antibodies are present in 30 to 40 percent of patients with lupus and are almost always considered diagnostic of SLE. The lupus erythematosus cell prep test is nonspecific to SLE. Hence, it is not diagnostic of SLE. Swan-neck deformity is not specific to SLE. It is also found in patients with rheumatoid arthritis. Raynaud's phenomenon is also found in other diseases, such as scleroderma.

A 25-yr-old female patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I never leave my house because I hate the way I look." The nurse will plan interventions with the patient to address the nursing diagnosis of a. social isolation. b. impaired skin integrity. c. activity intolerance. d. impaired social interaction.

ANS: A The patient's statement about not going anywhere because of hating the way he or she looks expresses 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. The rash with SLE is nonpruritic and therefore does not impair skin integrity. There is no evidence of lack of social skills for this patient.

The nurse is educating a patient newly diagnosed with systemic lupus erythematosus (SLE). What should the nurse include in the education about things to avoid? Select all that apply. a. Drying soaps, powders, and household chemicals b. Exposure to individuals with infections c. Physical and emotional stress d. Nonsteroidal antiinflammatory medications e. Pregnancy

ANS: A, B, C Drying soaps, powder, and household chemicals will all exacerbate symptoms in the integumentary system. Exposure to individuals with infections should be limited, since those with SLE are often immunocompromised or taking immunosuppressant drugs. Avoidance of physical and emotional stress may help reduce SLE flares. Nonsteroidal antiinflammatory drugs are a mainstay of treatment for arthralgias in SLE. Pregnancy is safe for those with mild to moderate SLE but should be done in consultation with a physician.

A patient newly diagnosed with systemic lupus erythematosus (SLE) is setting care goals with the nurse. What are the most appropriate goals for this patient? Select all that apply. a. Adhere to the therapeutic regimen. b. Have satisfactory pain management. c. Maintain optimal role function and positive self-image. d. Prevent all infections by utilizing proper hand hygiene. e. Demonstrate awareness of an avoid activities that worsen the disease.

ANS: A, B, C, E Overall goals for the patient with SLE are that the patient will adhere to the therapeutic regimen to achieve maximum symptom management; have satisfactory pain management; maintain optimal role function and positive self-image; and demonstrate awareness of and avoid activities that worsen the disease. Proper hand hygiene is important, but it may not be possible to prevent all infections with this tactic alone or at all.

A nurse is caring for a patient with systemic lupus erythematosus (SLE) who is taking nonsteroidal antiinflammatory drugs (NSAIDs) for joint pain. Which adverse effects of NSAID therapy should the nurse educate the patient about? Select all that apply. a. Tarry stools b. Petechiae c. Tingling d. Pallor e. Fever

ANS: A, B, D Tarry stools are a sign of blood in the gastrointestinal tract, presence of petechiae is a sign of subcutaneous hemorrhage, and pallor may be a sign of decreased hematocrit, all of which can be caused by bleeding as a result of NSAID therapy. The patient with SLE should be educated about all of these possible drug adverse effects. Tingling is a symptom of peripheral neuropathy, which may be related to SLE itself or caused by irritated nerve endings in an acute flare. Fever is likely a sign of underlying infection. Neither of these manifestations is related to NSAID therapy.

A patient is admitted to the hospital for further management of a systemic lupus erythematosus (SLE) flare. What actions does the nurse anticipate performing in the care of this patient? Select all that apply. a. Administer 2 mg hydromorphone intravenously (IV) as needed for pain rated 7 to 10. b. Administer 125 mg methylprednisolone intravenously every six hours. c. Administer 2 L supplemental oxygen via nasal cannula. d. Observe and record intake and output. e. Obtain weight daily.

ANS: A, B, D, E Treatment of an acute flare primarily involves symptom relief. Pain is often associated with disease flares, particularly in the joints, and it may be treated with IV analgesics like hydromorphone. IV corticosteroids like methylprednisolone are often used to reduce inflammation and treat acute disease flares. Both accurate measurement of input/output and daily weights are important for the patient being treated with IV corticosteroids since there is a possibility of fluid retention and renal failure. Supplemental oxygen is not indicated solely on the basis of treating an SLE flare but could be indicated after further workup or if the patient becomes hypoxemic.

A patient is diagnosed with systemic lupus erythematosus (SLE). What neurologic manifestations should the nurse closely monitor for? Select all that apply. a. Stroke b. Seizures c. Alopecia d. Synovitis e. Psychosis

ANS: A, B, E Stroke, seizures, and psychosis are neurologic manifestations of SLE. Alopecia is an integumentary manifestation of SLE. Synovitis is a musculoskeletal manifestation of SLE.

Which hematologic disorders are frequently associated with systemic lupus erythematosus (SLE)? Select all that apply. a. Thrombocytopenia b. Hemolytic anemia c. Erythrocytosis d. Leukocytosis e. Leukopenia

ANS: A, B, E Thrombocytopenia, hemolytic anemia, and leukopenia are all associated with SLE. Erythrocytosis is a syndrome in which the blood has too many red blood cells; this is not associated with SLE. Leukocytosis is a syndrome in which there are an increased number of white blood cells, which often signifies infection.

A patient with systemic lupus erythematosus (SLE) returns to the clinic with worsening fatigue. On intake, the nurse notices that the patient has a sunburn and malar rash. What will the nurse document? Select all that apply. a. Impaired skin integrity related to photosensitivity and skin rash b. Impaired skin integrity related to medication usage c. Poor compliance related to knowledge deficit d. Fatigue related to chronic inflammation e. Fatigue related to active infection

ANS: A, D Impaired skin integrity related to photosensitivity and skin rash as well as fatigue related to chronic inflammation are two nursing diagnoses that pertain to this patient with SLE. Impaired skin integrity is evident, but the nurse cannot know without further assessment if it is related to medication therapy. Poor compliance is evident but may be caused by a variety of reasons; the knowledge deficit must first be assessed. The nurse cannot diagnose fatigue related to active infection without fully assessing the patient.

A patient is prescribed an antimalarial agent for the treatment of systemic lupus erythematosus (SLE) and states, "I don't have malaria. Why am I taking this" What is the best response by the nurse? Select all that apply. a. To treat fatigue b. To treat hypercoagulability c. To improve cutaneous lupus d. To treat exacerbations of polyarthritis e. To treat moderate skin and joints disease

ANS: A, E Antimalarial agents such as hydroxychloroquine and chloroquine are often used to treat fatigue and moderate skin and joints problems in SLE patients. In cases of hypercoagulability, an anticoagulant such as warfarin or heparin is used. For cutaneous lupus, high doses of corticosteroids or thalidomide are used. In order to treat exacerbations of polyarthritis, nonsteroidal antiinflammatory drugs are given.

Which result for a patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider? a. Decreased C-reactive protein (CRP) b. Elevated blood urea nitrogen (BUN) c. Positive antinuclear antibodies (ANA) d. Positive lupus erythematosus cell prep

ANS: B Elevated BUN and serum creatinine indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows decreased inflammation.

A patient has been taking an antimalarial drug prescribed for systemic lupus erythematosus (SLE) but is unable to tolerate the side effects. What medication does the nurse anticipate educating the patient about that would be an alternate? a. Uricosuric drug b. Antileprosy drug c. Steroid-sparing drug d. Antiinflammatory drug

ANS: B If the patient with SLE cannot tolerate an antimalarial agent, an antileprosy drug such as dapsone may be used. Uricosuric drugs are used to treat gout. Steroid-sparing drugs such as methotrexate are used in treating SLE, but not as an alternative to antimalarial drugs. These are given to decrease the side effects of corticosteroids. Antiinflammatory drugs are pain relievers and reduce inflammation.

The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question? a. Draw anti-DNA blood titer. b. Administer varicella vaccine. c. Naproxen (Aleve) 200 mg BID. d. Famotidine (Pepcid) 20 mg daily.

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

Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient has understood the nurse's teaching about the condition? a. "I will exercise even if I am tired." b. "I will use sunscreen when I am outside." c. "I should avoid nonsteroidal antiinflammatory drugs." d. "I should take birth control pills to avoid getting pregnant."

ANS: B Severe skin reactions can occur in patients with SLE who are exposed to the sun. Patients should avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal antiinflammatory drugs are used to treat the musculoskeletal manifestations of SLE.

A patient asks why they have to continue to take oral prednisone for the treatment of systemic lupus erythematosus (SLE). What is the best response by the nurse? Select all that apply. a. To treat fatigue b. To control seizures c. To treat lupus nephritis d. To manage polyarthralgia e. To treat hypercoagulability

ANS: B, C, D Prednisone is a corticosteroid drug. In patients with SLE, corticosteroids are given to treat seizures. Prednisone is also used in the treatment of lupus nephritis, especially when the cytotoxic drugs have not yet achieved therapeutic effectiveness. Antimalarials are often used to treat fatigue in SLE patients. Nonsteroidal antiinflammatory drugs are used in cases of polyarthralgias. Hypercoagulability is managed with the help of anticoagulants such as warfarin or heparin.

A patient's complex symptomatology over the past year has led to a diagnosis of systemic lupus erythematosus (SLE). Which statement demonstrates the patient's need for further teaching about the disease? a. "I'll try my best to stay out of the sun this summer." b. "I know that I probably have a high chance of getting arthritis." c. "I'm hoping that surgery will be an option for me in the future." d. "I understand that I'm going to be vulnerable to getting infections."

ANS: C Surgery is not a key treatment modality for SLE, so this indicates a need for further teaching. Immunosuppressive treatment for SLE carries an increased risk of infection. People with SLE have severe photosensitivity and are prone to sun damage. Arthritis occurs in up to 95% of patients with SLE.A patient is admitted to the hospital for further management of a systemic lupus erythematosus (SLE) flare. What actions does the nurse anticipate performing in the care of this patient? Select all that apply.

A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review? a. Rheumatoid factor (RF) b. Antinuclear antibody (ANA) c. Anti-Smith antibody (Anti-Sm) d. Lupus erythematosus (LE) cell prep

ANS: C 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.