Presentation on theme: "LUPUS ERYTHEMATOSIS In this online lecture you will learn about the two types of lupus, including treatments, and interventions. The two types are: Discoid."— Presentation transcript:
1LUPUS ERYTHEMATOSISIn this online lecture you will learn about the two types of lupus, including treatments, and interventions.The two types are:Discoid Lupus Erythematous (DLE)Systemic Lupus Erythematous (SLE)
2The readings that accompany this lecture are: Reading AssignmentIggy- pp
3Let's start by looking at Discoid LupusErythematosus
4What is Discoid Lupus Erythematous? A chronic skin condition of sores with inflammation and scarring favoring the face, ears, and scalp and at times on other body areas.These lesions develop as a red, inflamed patch with a scaling and crusty appearance. The center areas may appear lighter in color with a rim darker than the normal skin.
5What does DLE look like?a skin biopsy needs to be done to confirm the diagnosis because other conditions can look like discoid lupus erythematosus.Lesions are treated with topical cortisone, or cortisone injectionsIf the cortisone is ineffective the client maybe treated with Plaquenil (***please click on this link to learn more about the medication***)
6What causes DLE?The exact cause is unknown, but it is thought to be autoimmune with the body's immune system incorrectly attacking normal skin.This condition tends to run in families. Females out number males with this condition 3 to 1.In some patients with discoid lupus erythematosus, sunlight and cigarette smoking may make the lesions come out.
7What interventions will help with DLE? Patients whose condition is sensitive to sunlight need to wear a UVA blocking sunscreen daily and a hat while out doors.Follow-up with the doctor is important and necessary every six months to once a year to make sure the disease is not spreading to the internal organs and to minimize scarringIf the client is taking Plaquenil yearly eye exams are a must.
10What is Systemic Lupus Erythematosus (SLE)? SLE is a complex chronic connective-tissue disease.It affects almost all body systems.The manifestations are widely variable but they are thought to be the result of cell and tissue damage caused by the deposition of antigen-antibody complexes in connective tissues.SLE can range from a mild, episodic disorder to a rapidly fatal disease process.
11What is the epidemiology of SLE? Females are affected more than males in a ratio of 9:1The disease usually affects women of childbearing age, but can occur at any age.It is more common in African Americans, Hispanics, and Asians than it is in Caucasians.
12What is the etiology of SLE? The exact etiology is unknown.Genetic, environmental and hormonal factors play a role in its development.The above statements are idiopathic forms of SLE. It can also be drug induced by the following medications:ProcainamideIsoniazidHydralazineMinocyclinePhenytoinEthosuximideD-PenicillamineManifestations of drug induced lupus usually resolve when the medication is discontinued.Do you need a refresheron some of these medications?Click on them and follow the link.
13What are the initial symptoms of SLE? The initial manifestations of SLE are: fatigue, fever, malaise, weight loss, musculoskeletal manifestations similar to arthritis.SLE can affect multiple systems. Let’s take a look at each of those systems.
14What are the dermatological signs? The client may have Cutaneous Lupus ErythematosusMalar "butterfly" rashPhotosensitivityVasculitisAlopeciaOral UlcersSicca Syndrome
15What are the neurological symptoms? A client may have the following symptoms:Neuropathies (peripheral and central)SeizuresDepressionPsychosisA client may have the following complications from an exacerbation of SLE:CVAOrganic Brain SyndromeIntellectual impairmentMemory LossPersonality ChangesDisorientation
16What kinds of ocular changes can result from SLE? ConjunctivitisPhotophobiaRetinal vasculitis with transient blindnessCotton-wool spots on retinaCotton wool spots are small areas of yellowish white coloration in the retina. They occur because of swelling of the surface layer of the retina, which consists of nerve fibers. This swelling almost always occurs because the blood supply to that area has been impaired and in the absence of normal blood flow through the retinal vessels the nerve fibers are injured in a particular location resulting in swelling and the appearance of a "cotton wool spot. "
17What are the musculoskeletal changes with SLE? Morning StiffnessArthralgiasSymmetric PolyarthritisJoint Swelling and Effusion
18How can SLE effect the renal system? ProteinuriaCellular castsPotential complications resulting from SLE are:Nephrotic syndromeRenal failure
19How can SLE effect the GI system? HepatomegalyAnorexiaNauseaAbdominal PainDiarrhea
20How can SLE effect the Cardiovascular system? PericarditisMyocarditisEndocarditisVasculitisVenous or arterial thrombosis (anywhere in the body)
21How does SLE effect the hematologic system? AnemiaLeukopeniaThrombocytopeniaSplenomegaly
22How can SLE effect the Respiratory System? PleurisyPleural effusionPneumonitisInterstitial fibrosis
23What Lab Assessments help in the diagnosis? Initially and ANA titer is completed. *Please remember an ANA titer alone cannot be used to diagnose a disease, it must be used in combination with an evaluation of symptoms and other tests.Secondary testing if the ANA titer positiveComplete Blood Count *** pay particular attention to the WBC, Hgb & Plt counts**Coagulation factorsUrinalysisSerum CreatinineAntiphospholipid AntibodyDouble Stranded DNA Antibody (Anti-dsDNA)Smith Antibody (Anti-Smith or Anti-Sm)
24How is a diagnosis of SLE made? A diagnosis of SLE is made when a client has 4 of 11 following criteria:Malar RashDiscoid rashPhotosensitivityOral UlcersPolyarthritis involving more than 2 jointsPleuritis or PericarditisAntinuclear Antibody positive titerRenal diseaseNeurologic disorder (e.g. Seizures, Psychosis)Anemia, Neutropenia or ThrombocytopeniaAnti-dsDNA, Anti-Sm positive
25How is SLE treated?Part of the treatment of SLE involves the use of medicationsSalicylates and NSAIDsEnteric Coated ASA 650 mg PO every 4-6 hours prnIbuprofen mg PO tid-qid prnAnti-Malarial agentsHydroxychloroquine (Plaquenil) 400 mg/dayCorticosteroidsTopical CorticosteroidsSystemic Corticosteroids in severe exacerbationsPrednisone 0.5 to 1 mg/kg/day up to 4 weeks orSolu-medrol 15 mg/kg IV for 3 daysCytotoxic agents or antineoplastic drugs are effective immunosuppressive agents. **They act by decreasing the proliferation of cells within the immune system and are widely used to prevent rejection following a tissue of organ transplant. They are usually adminstered concurrently with corticosteriod therapy, allowing lower doses of both preparations, and resulting in fewer side effects.**Cyclophosphamide (cytoxen)Daily dosing: mg/kg/day orMonthly dosing: mg/kg IV every 4 weeksAzathioprine (Imuran) 2-3 mg/kg/day
26What else does a client with SLE need? A client with SLE also needs Opthamology exams with dilation upon starting steriods or plaquenil and yearly there after.Interventions to reduce fatigue.Sunscreen and other protection against photosensitivity.Interventions to prevent infection.Birth control is critical during exacerbations.
27How does a client diagnosed with SLE feel? Clients with SLE may have problems with the following:SELF ESTEEMWITHDRAWALDEPRESSIONPSYCHOSISHARDINESSMANAGEMENT OF A CHRONIC ILLNESS
28What are the outcomes?Although there is no cure for SLE, the 10 year survival rate is greater than 70% among clients with this disease, which once was considered fatal in most cases.Click on the following link to watch a video about Lupus and initiatives regarding the disease
29Great Job!!!Now that you know aboutDLE & SLE let'sapply it in a case study!!
30A Case StudyD.W. is a 23 year old married woman with 3 children under the age of 5. She presented to her physician 2 years ago with vague complaints of intermittent fatigue, joint pain, and low-grade fever. Her physician noted a scaly rash across her nose cheeks, back and chest at that time.
32What is the diagnosis: systemic lupus erythematosus or cutaneous lupus erythematosus? D.W. was diagnosed with systemic lupus erythematosus.The malar rashPolyarthritisAnemiaPositive ANA titer
33How does discoid lupus erythematosus differ from systemic lupus erythematosus? DLETopical skin disorderAn autoimmune disorder attacking the skinSLEA systemic autoimmune multi-system disorderAn episodic disorderMay include DLE
34D. W. was subsequently diagnosed with systemic lupus erythematosus D.W. was subsequently diagnosed with systemic lupus erythematosus. She was initially treated with Cyclophosphamide (cytoxen) 150mg PO every day and prednisone (Deltasone) 20 mg po every day, bedrest, ice packs, and aspirin to control discomfort.
35What priorities need to be addressed with D.W.? Monitor blood count with particular attention to WBC and platelet counts. Notify the physician if the WBC’s fall below 4000, or platelets below 75,000.Monitor renal & liver function studiesCytoxen should be administered with food to minimize gastrointestinal effectsMonitor for signs of abnormal bleedingUse meticulous hand washing and assess for signs of infectionEnsure adequate nutrient intake
36D.W. responded well to treatment and resumed her job in environmental services at a large geriatric facility. Eighteen months after diagnosis, D.W. developed puffy hands and feet and increased fatigue. D.W. reported that she had been working longer hours because of the absence of 2 of her fellow workers.
37Diagnostic Evaluation Revealed: BUN 29 mg/dLCreatinine 1.5 mg/dLUrinalysis+2 protien+1 RBC
38What are the significance of these findings? What is the relationship of such findings to D.W.’s diagnosis of SLE?How will D.W.’s treatment and nursing plan likely to change?(**Hint – This is a great place to apply your Renal Content****)
39Great Job!!There will be a pass session on Lupus to discuss and questions and talk about the case study. Hope to see you there.For any other questions please see Jean or her at