Systemic_lupus_erythmatosus

Nursing Care of the Client with Connective Tissue Disease Systemic

Lupus Systemic Sclerosis Polymyositis

Systemic Lupus Erythmatosus Multisystem Inflammatory Disease

Etiology and Pathophysiology 

Etiology – unknown  Genetic

predisposition  Hormones  Environmental factors  Triggers: Infection  Certain medications 

Overaggressive Antibody Response 

Immune complexes deposited in basement membranes of capillaries:  Kidneys  Heart  Skin  Brain  Joints

* Specific symptoms of SLE depend on which cells or organs are involved

Manifestations & Complications   

Variable depending on severity Any organ(s) may be affected Most commonly affected:  Skin  Muscle  Lungs  Heart  Nervous  Kidneys

system

Manifestations & Complications 

Skin   

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Musculoskeletal  

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Butterfly rash – 50% of patients Ulcers – mouth or nose Alopecia Polyarthralgia – 90% of patients Non-erosive arthritis

Cardiopulmonary   

Tachypnea & cough Arrhythmias Accelerates CAD

Manifestations & Complications 

Renal problems – 50% of clients within one year 

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Mild proteinuria to glomerulonephritis

Nervous system      

Seizures Disordered thought processes Disorientation Memory deficits Depression Psychosis

Manifestations & Complications 

Hematological problems  Anemia  Mild

leukopenia  Thrombocytopenia 

Infection  Immunosuppresive

effect of anti-

inflammatory drugs  Defects in ability to phagocytize invading bacteria

Diagnosis of SLE  

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No specific diagnostic test Four or more of criteria are present serially or simultaneously Presence of criteria are not definitive for diagnosis “rule-out” other disease processes

Drug Therapy   

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NSAID’s hydroxychloroquine (Plaquenil) corticosteroids – especially during severe exacerbations of polyarthritis methotrexate azathioprine (Imuran)

Nursing Care 

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Assess severity of symptoms: fever, joint pain and limitations of movement, fatigability Weight and I&O – risk of fluid overload:  renal

failure  corticosteroid therapy

Nursing Care 

Observe S/S bleeding     

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Changes in vital signs Bruising Petechiae Tarry stools Pallor

Assess neuro status    

Visual disturbances Mental status Seizures Numbness, tingling, weakness of extremities

Patient Education 

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Avoid triggers: sun, infections, emotional stress, etc. Pre-conception counseling Correct use of medication(s) and importance of compliance Disease complications are “hidden”; physical limitations are not obvious

Patient Education Web site co-sponsored by NIH and National Institute of Arthritis and Musculoskeletal and Skin Diseases

http://www.niams.nih.gov/hi/topics/lupus

Systemic Sclerosis    

Fibrotic, degenerative changes Skin thickening/tightening Localized vs. systemic Causes:  Immune

dysfunction  Vascular abnormalities  Environmental exposure

Systemic Sclerosis  

Collagen is over produced CREST syndrome:  Calcinosis  Raynaud’s

phenomenon  Esophageal dysfunction  Sclerodactyly  Telangiectasia

Systemic Sclerosis 

Internal organ involvement  Esophageal

fibrosis  Lung involvement  Heart disease (CHF)  Kidney disease with malignant hypertension

Nursing and Collaborative Care 

Goal of medical regimen:  Prevent

complications of involved

organs  Medications:

Corticosteroids  Vasodilators (Raynaud’s, hypertension)  H2 receptor blocker or proton pump inhibitor (GI symptoms) 

 

Physical therapy Nursing care

Nursing Care 

Assessment:  Joint

ROM  Respiratory function  Nutrition: swallowing, weight, I&O  Circulation: Raynaud’s  Body image

Nursing Care 

Nursing Interventions:  ROM

exercises, mouth excursion  Moist heat/parafifin  Protect hands and feet: Keep warm  Gloves  No finger-stick blood testing  No smoking – vasoconstriction  Inspect for injury/infection 

Nursing Care  

Special attention to oral care Nutrition and hydration  Small,

frequent meals  Carefull/complete chewing  Dysphagia precautions Thickened liquids  High fowlers 2 hours after eating 

 Antacids

45 minutes after eating if gastric reflux

Resources for clients and health professionals http://www.scleroderma.org/

Polymyositis 

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Diffuse, inflammatory myopathies of striated muscle Relatively rare Produces bilateral weakness of shoulders, legs, arms and pelvic girdle Joint pain, reddness, inflammation

Collaborative Care 

Patient teaching:      

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Prescribed therapies Tests Importance of follow-up care Delay in response to therapy Patient safety Paced activity

Physical therapy High-dose corticosteroids Immunosuppressive drugs 

methotrexate