Systemic Lupus Erythematosus (SLE)

  1. General information
    1. Chronic connective tissue disease involving multiple organ systems
    2. Occurs most frequently in young women
    3. Cause unknown; immune, genetic, and viral factors have all been suggested
    4. Pathophysiology
      1. A defect in body's immunologic mechanisms produces autoantibodies in the serum directed against components of the client's own cell nuclei.
      2. Affects cells throughout the body resulting in involvement of many organs, including joints, skin, kidney, CNS, and cardiopulmonary system.
  2. Medical management
    1. Drug therapy
      1. Aspirin and NSAIDs to relieve mild symptoms such as fever and arthritis
      2. Corticosteroids to suppress the inflammatory response in acute exacerbations or severe disease
      3. Immunosuppressive agents such as azathioprine (Imuran), cyclophosphamide (Cytoxan) to suppress the immune response when client unresponsive to more conservative therapy
    2. Plasma exchange to provide temporary reduction in amount of circulating antibodies
    3. Supportive therapy as organ systems become involved
  3. Assessment findings
    1. Fatigue, fever, anorexia, weight loss, malaise, history of remissions and exacerbations
    2. Joint pain, morning stiffness
    3. Skin lesions
      1. Erythematous rash on face, neck, or extremities may occur
      2. Butterfly rash over bridge of nose and cheeks
      3. Photosensitivity with rash in areas exposed to sun
    4. Oral or nasopharyngeal ulcerations
    5. Alopecia
    6. Renal system involvement (proteinuria, hematuria, renal failure)
    7. CNS involvement (peripheral neuritis, seizures, organic brain syndrome, psychosis)
    8. Cardiopulmonary system involvement (pericarditis, pleurisy)
    9. Increase susceptibility to infection
    10. Diagnostic tests
      1. ESR elevated
      2. CBC; anemia; WBC and platelet counts decreased
      3. ANA positive
      4. LE prep positive
      5. Anti-DNA positive
      6. Chronic false-positive test for syphilis
  4. Nursing interventions
    1. Assess symptoms to determine systems involved.
    2. Monitor vital signs, I&O, daily weights.
    3. Administer medications as ordered.
    4. Institute seizure precautions and safety measures with CNS involvement.
    5. Provide psychologic support to client/significant others.
    6. Provide client teaching and discharge planning concerning
      1. Disease process and relationship to symptoms
      2. Medication regimen and side effects
      3. Importance of adequate rest
      4. Use of daily heat and exercises as prescribed for arthritis
      5. Need to avoid physical or emotional stress
      6. Maintenance of a well-balanced diet
      7. Need to avoid direct exposure to sunlight (wear hat and other protective clothing)
      8. Need to avoid exposure to persons with infections
      9. Importance of regular medical follow-up
      10. Availability of community agencies