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Systemic Lupus Erythematosus (SLE)

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Pathophysiology: Autoimmune disorder where systemic inflammation occurs. This effects multiple body systems and organ failure can occur.


Overview

  1. Progressive, autoimmune, systemic inflammatory disease

Nursing Points

General

  1. Can affect every system in the body
  2. May result in organ system failure
  3. No known cure

Assessment

  1. Symptoms will vary greatly between patients depending on body system(s) affected
  2. Classic = Butterfly Rash
    1. Redness on cheeks and bridge of nose
  3. Arthritis
  4. Weakness
  5. Photosensitivity – redness on skin when exposed to UV light
  6. ↑ ESR and CRP levels
    1. Indicates inflammation

Therapeutic Management

  1. Assess for precipitating factors (“triggers”) for a flare up
    1. UV light exposure
    2. Infection
      1. Ask about sick contacts
    3. Stress
  2. Assess respiratory status
  3. Assess end-organ function (kidney, liver, heart)
  4. Plan rest periods
  5. Refer to dietician for anti-inflammatory diet
  6. Medications
    1. Corticosteroids
    2. NSAIDs
    3. Cyclophosphamide (immunosuppressive agent)

Nursing Concepts

  1. Immunity
  2. Comfort

Patient Education

  1. Identify and avoid triggers
  2. Take medications as prescribed
  3. Small, frequent meals

Reference Links

Study Tools

Video Transcript

In this lesson we’re going to talk about Systemic Lupus Erythematosus, or SLE. You may also just hear it called “Lupus”. This is something you may or may not have heard of before, but it affects a lot of patients, so we want to give you the most important things you need to know.

Systemic lupus erythematosus or lupus for short is an autoimmune systemic inflammatory disease that is Progressive, meaning that it gets worse over time. So we see the body’s immune system actually attacking healthy tissues within the body. It can affect literally every body system and therefore patients are at risk for organ system failure as the disease progresses. Unfortunately there’s no known cure, but with medications and some Lifestyle Changes patients are able to manage pretty well. Now there are some precipitating factors, otherwise known as triggers, that could instigate a flare-up of lupus. One of those is exposure to UV light. This could be synthetic forms of UV light like tanning beds, but also simply being out in the sun can cause a lot of problems. The other is any kind of infection or exposure to infection because it initiates the immune response. Then that immune response goes haywire and causes inflammation in the system. So many times we will even ask patients if they have been in recent contact with anybody else who’s been sick. And then any kind of excessive stress can cause lupus to flare up.

Now, remember I said that Lupus can affect ANY body system, right? So what we see is that symptoms can vary widely from patient to patient depending on which body system is affected. So, no two patients will be alike. But, the one thing that is relatively constant is this classic symptom of a butterfly rash across their cheeks and nose like you see here. In some patients it’s just redness, in others they will actually have blistering and pustules. As far as other symptoms, just think inflammation and what that can cause – arthritis, weakness, fever, even inflammation around the heart and lungs luke pericarditis and pleuritis, and photosensitivity from sunlight. We’ll also draw two specific lab values, one is ESR or Erythrocyte Sedimentation Rate, the other is CRP or C-Reactive Protein – both of these indicate inflammation, so they will both be elevated in a patient with Lupus.

We want to prioritize assessing and monitoring their respiratory status as well as other end-organ function like kidneys, liver, and heart. We want to help the patient identify their triggers so they can avoid flare ups, and we want to provide frequent rest periods. There’s a lot of weakness and fatigue involved in Lupus, so we cluster our care and encourage patients to rest during the day. We can also refer them to a dietician. This will help them get the best quality foods in when they’re too tired to eat, but they can also help them learn foods that can help decrease inflammation – mostly that involves avoiding grains, gluten, and dairy. We will also put them on medications to decrease the inflammation. We’ll use corticosteroids and NSAIDs (Non-steroidal anti-inflammatory drugs), but remember that both of those can have a lot of complications if used long-term. Another option we have is a drug called cyclophosphamide, which is an immunosuppressive agent. If we can decrease that immune response and keep it from overreacting, that can help decrease this systemic inflammatory response.

So our priority nursing concepts for a patient with Lupus are immunity, comfort, and educating the patient to avoid their triggers. Check out the care plan attached to this lesson to see more detailed nursing interventions.

So let’s recap. Lupus is an autoimmune disease that involves progressive, systemic inflammation that can affect any body system. Because it could be anywhere, symptoms will absolutely vary between patients and no two patients will be exactly alike. But, most of them will have the classic symptom of a butterfly rash across their cheeks and nose. We give anti-inflammatory medications like corticosteroids and NSAIDs, we give immunosuppressants like cyclophosphamide to help decrease the immune response. We also encourage patients to make some dietary changes and avoid triggers. While they’re in the hospital, we want to monitor for any kind of organ dysfunction and try to promote optimal energy levels to help them overcome their fatigue.

So those are the basics of Lupus. Let us know if you have any questions. Now, go out and be your best self today. And, as always, happy nursing!

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