Sle ppt

PRESENTED TO: PRESENTED BY:
Ms. SIMRANJIT KAUR AMANDEEP KAUR
ASSIT. PROFESSOR Msc. Nsg. 1st Year
(MED.-SURG. NURSING Roll No. 1915703

 The immune system is a complex system that
is responsible for protecting us against
infections and foreign substances.

 The immune system is closely tied to
 The lymphatic system,
With B and T lymphocytes within lymph
nodes.
 Tonsils and
 The thymus gland

THYMUS GLAND
 containing glandular tissue and producing several
hormones, is much more closely associated with
the immune system than with the endocrine
system.
 The thymus serves a vital role in the training and
development of T-lymphocytes, an extremely
important type of white blood cell.

 T-CELLS
(also known as Thymocytes cells) or T
lymphocytes are a type of lymphocyte (in turn, a
type of white blood cell) that play a central role in
cell-mediated immunity.
They are called T cells because they mature in the
thymus.

 B-CELLS
secreting antibodies

 BONE MARROW
In addition, the bone marrow contains
hematopoietic stem cells, which give rise to the
three classes of blood cells that are found in the
circulation:
 white blood cells (leukocytes),
 red blood cells (erythrocytes), and
 platelets (thrombocytes).

 SPLEEN
 It acts as a filter for blood as part of the
immune system.
 Old red blood cells are recycled in the spleen,
and
 platelets and white blood cells are stored there.
 The spleen also helps fight certain kinds of
bacteria that cause pneumonia and meningitis.

INTRODUCTION:
 The word “lupus” comes from the latin word “for
wolf” –means- “ to reflect the mask like
appearance”, that client have when they have a
lupus facial rash.
 The rash is red and thus the word erythematosus,
meaning reddened, was added to describe the
disease.

 “Chronic multisystem inflammatory disease.
Associated with abnormalities of immune system.
Results from interactions among genetic,
hormonal, environmental, and immunologic
factors”.

Affects the
 Skin
 Joints
 Serous membranes
 Renal system
 Hematologic system
 Neurologic system

 SLE affects 2 to 8 persons per 100,000 in United
States
 Most cases occur in women of childbearing years
 Women are 10 times more likely to develop SLE
than man.
 Most clients with lupus have the systemic type,
but a small percentage have the type that affect
only the skin , a condition called “DISCOID
LUPUS ERYTHEMATOSUS”.

 Discoid lupus is not life threatening.
 SLE can be life threatening -progressive
systemic inflammatory disease that can cause
major body organ and system failure.
 Although this definition seems similar to the
definition of rheumatoid arthritis; one
distinct difference exists, client with SLE
typically have more body organ development
earlier in their disease than the clients with
R.A.

 Etiology is unknown
 Most probable causes
 Genetic influence
 Hormones
 Environmental factors
 Certain medications

Immune system alteration
Antinuclear antibodies ,antibodies to
ribonucleoprotein (smith antigen)
Abnormalities in both B- cells and T-
cells(overactive).
Production of antibodies to self and non-self
antigen.

Tissue injuries.
Visceral lesions & antibodies against RBC.
Acute necrotizing vasculitis

Ranges from a relatively mild disorder to
rapidly progressing, affecting many body
systems
Most commonly affects the skin/muscles,
lining of lungs, heart, nervous tissue, and
kidneys

 DERMATOLOGIC
 Oral/nasopharyngeal ulcers
 Cutaneous vascular lesions
 Alopecia
 Butterfly rash

 MUSCULOSKELETAL
 Poly-arthralgia with morning stiffness
 Arthritis
 Swan neck fingers
 Ulnar deviation
 Sub-luxation with hyperlaxity of joints

POLY-ARTHRALGIA WITH
MORNING STIFFNESS

 flexion of the metacarpo-phalangeal and distal inter-
phalangeal joints and hyperextension of the proximal

Sub-luxation with
hyperlaxity of joints

Sub-luxation with hyperlaxity
of joints

 CARDIOPULMONARY
 Tachypnea
 Pleurisy
 Dysrhythmias
 Accelerated CAD
 Pericarditis

 RENAL
 Lupus nephritis
 Ranging from mild proteinuria to
glomerulonephritis

 NERVOUS SYSTEM
 Generalized/focal seizures
 Peripheral neuropathy
 Cognitive dysfunction
 Disorientation
 Memory deficits
 Psychiatric symptoms

 HEMATOLOGIC
 Formation of antibodies against blood cells
 Anemia
 Leukopenia(low white blood cells)
 Thrombocytopenia(low platelet count)
 Coagulopathy
 Anti-phospholipid antibody syndrome
(recurrent venous & aterial thrombosis)

 INFECTION
 Increased susceptibility to infections
 Fever should be considered serious
 Infections such as pneumonia are a common
cause of death

 No specific test
 SLE is diagnosed primarily on criteria relating
to patient
 history,
 physical examination,
 laboratory findings

 Tissue biopsy:- skin lesions can be biopsied
and examined microscopically for signs of
inflammation.
 ESR- to detect systemic inflammation.
 Antinuclear antibody titers- to detect the
presence of abnormal antibodies, sometimes
called LE cells.

 CBC :-(Hb., TLC, DLC,RFT,LFT, Platelets
count): to get valuable information of the
general state of health.
 Anti-DNA & Anti-smith antibodies: to detect
the titres of anti-(double standard) dsDNA
Antibodies. Increased level sugest SLE.
(ELISA- enzyme-linked immunosorbent
assay).

 Urinalysis: to check for protein & cells, signs of
possible kidney damage.
 X-Ray of affected joints: to see the condition.
 Chest X-Ray: to find the systemic involvement.
 ECG- to determine extra- articular involvement /
cardiac problems.

 Prognosis is improved with
 Earlier diagnosis
 Earlier and better treatment regimens
 Careful monitoring for organ involvement

DRUG THERAPY
 NSAIDs-
(diclofenac sodium, Naproxen and oxaprozin )
 Anti-malarial drugs-
(Chloroquine phosphate)
 Steroid-sparing drugs
(Cyclosporine,methotrexate).

 Corticosteroids/ immunosuppressive
drugs.
(Dexamethasone, hydrocortisone, prednisolone
 Cytotoxic agents:- if other drugs fail. i.e.-
cyclophosphamide.
 Ointments or skin creams for rash.

 No way to prevent lupus.
 But people who smoke may be more likely to
get lupus.
 Avoiding smoking and perhaps other tobacco
products may decrease the risk.

 Assess patient’s physical, psychologic, and
sociocultural problems with long-term
management of SLE.
 Assess pain and fatigue daily.
 Obtain subjective and objective data.

 Acute pain related to inflammatory process
and inadequate comfort measures as evidenced
by complaints of joint pain.
 Fatigue related to chronic inflammation and
altered immunity as evidenced by lack of
energy, inability to maintain usual routine.

 Impaired skin integrity related to
photosensitivity, skin rash and alopecia as
evidenced by rash anywhere on body, butterfly
rash on face, hair loss, areas of ulceration on
fingertips complaints of urticaria.
 Deficient knowledge related to lack of
exposure to an unfamiliarity with information
resources as evidenced by questions about
SLE.
 Body image disturbance related to disease
condition.

1) Uses energy conservation techniques.
2) Sets and complete priority activities.
3) Adapt lifestyle to energy level.
4) Avoid activities that cause disease
exacerbation (triggers).
5) Uses analgesics and non-pharmacologic
measures appropriately to control pain at an
acceptable level

 Health promotion
 Prevention of SLE is not possible
 Promote early diagnosis and treatment
 Acute intervention
 During exacerbation, patient will become
abruptly, dramatically ill
 Record severity of symptoms and response to
therapy

 Observe for
Fever pattern
Joint inflammation
Limitation of motion
Location and degree of discomfort
Fatigability

 Monitor weight and I&O
 Collect 24-hour urine sample
 Assess neurological status
 Explain nature of disease
 Provide support

 Ambulatory and home care
 Reiterate that adherence to treatment does not
necessarily halt progression
 Minimize exposure to precipitating factors –
fatigue, sun, stress, infection, drug.
 Teach energy conservation and relaxation
exercises
 For joint problems, all the teaching for RA
related to joint protection, ROM, and
positioning to prevent contractures

 Infertility can result from SLE treatment
regimen
 SLE is associated with complications of
pregnancy
 Pregnancy & post partum can cause
exacerbations of SLE
 Women with serious SLE should be
counseled against pregnancy.

 Counsel patient and family that SLE has
good prognosis
 Physical effects can lead to isolation, self-
esteem, and body image disturbances
 Assist patient in developing goals

 Expected outcomes
 Completion of priority activities
 Verbalization of having more energy
 Expression of satisfaction with pain relief
measures
 Performance of activities of daily living
without pain
 Limitation of direct exposure to sun and use
of sunscreen

 No open skin lesions
 Expression of satisfaction with activity level
 Pacing of activities to match level of
tolerance
 Expression of confidence in ability to manage
SLE over time and in home environment

Follow-up
Use of special cosmetics
Complementary or alternative therapies
should be discussed
Reproduction-avoid pregnancy

 Systemic Lupus Erythematosus (SLE) is a
chronic autoimmune disorder. It predominantly
affects younger women, but can occur in up to
20% of pts. 50 years of age or older. SLE
affects almost almost every system in the
body,with varying degrees of severity. The
mgt. is individualized and depends on
presenting symptoms.

BIBLIOGRAPHY
•Lippincott Manual of Nursing Practice. Of
Lippincott Williams & wilkins. Jaypee brothers
medical publishers (p) ltd. Edition-8th. P.1019-22.
•Brunner & suddarth’s text book of Medical-
Surgical Nursing.volume-3. By Janice L. Hinkle
& Kerry H. Cheever. Edition-13th. P.1070-1.
•INTERNET:-
www.ncbi.nlm.nih.gov>pubmedsystemiclupuseryt
hmatousus

 Make a nsg. Care plan on patient with systemic
lupus erythematousus with nsg. Diagnosis
prioritiwise.

Sle ppt

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Sle ppt