Med-Surg Immune System, part 5: Systemic Lupus Erythematosus

by Cathy Parkes September 30, 2020

In this video

What is systemic lupus erythematosus (SLE)?

Systemic vs. discoid lupus

Pathophysiology of SLE

Risk factors for SLE

Signs and symptoms of SLE

  • What is Reynaud’s syndrome?

Diagnosis of SLE & associated lab values 

  • What is an ANA titer?

SLE Treatment

  • NSAIDs
  • Immunosuppressants
    • Prednisone
    • Methotrexate
  • Hydroxychloroquine
  • Topical steroid cream

Nursing care for SLE

Patient teaching for SLE

Full Transcript

Alright, in this video, I'm going to talk about systemic lupus erythematosus, or SLE. So if you're following along with cards, I'm on card number 12.

SLE is a chronic inflammatory disorder of the connective tissue and it causes widespread inflammation as well as tissue damage.

Now, keep in mind as I go through this information, I'm talking about systemic lupus and not discoid lupus, which primarily just affects the skin.

So in terms of the pathophysiology behind this disorder, systemic lupus is an autoimmune disorder which results in the production of antinuclear antibodies, or ANA. And this results in inflammation and damage to many organs in the body, including the skin, the lungs, the kidneys, and the heart.

And just like other autoimmune disorders, lupus is characterized by periods of exacerbations as well as periods of remission.

In terms of the risk factors, women are much more likely to get lupus. Onset of the disease usually occurs between the ages of 20 and 40. And race also plays a role, so African Americans, Asians, and Native Americans are at higher risk for getting lupus.

Signs and symptoms of systemic lupus include fatigue, joint pain, fever, a butterfly rash across the face. So that's one of the hallmark symptoms of this disorder, as well as Raynaud's phenomenon. So with Raynaud's, you have vasospasming, so decreased blood flow to the extremities, to the fingers. So those fingers become pale, numb, and cold. So if you Google Raynaud's, you'll see lots of pictures of pale fingers and you can imagine that they're probably numb and cold, too.

Other symptoms include anemia, pericarditis, which is inflammation of the membrane that surrounds the heart, as well as lymphadenopathy, so enlarged lymph nodes.

In terms of the labs and how we would diagnose this condition, patients who have lupus will usually have a positive ANA titer.

And they will also have decreased serum complement, so decreased C3 and C4.

In addition, they'll have decreased red blood cells, white blood cells, and platelet counts.

And then, if their kidneys become involved at some point, then we would see an increase in BUN and creatinine as well.

In terms of treatment, NSAIDs can be used but we also usually provide immunosuppressants to patients with lupus because it is an autoimmune disorder and we're trying to suppress that immune system.

Medications that fall within this class include prednisone as well as methotrexate.

Hydroxychloroquine is also an effective medication for lupus. So hydroxychloroquine is actually a medication used for malaria but it is also used for autoimmune disorders such as lupus.

And then, the provider may also prescribe a topical steroid cream for the rash on the face, for that butterfly rash.

In terms of nursing care, in addition to providing these medications, you're going to really monitor for complications, including renal failure.

And then you're going to provide some important teaching to your patient.

So some of those key teaching points include avoiding UV and sun exposure to prevent skin damage.

Also, the patient needs to really prevent infection, so they should avoid sick people and really protect themselves from getting infection.

And then they need to take frequent rest periods as well because of that side effect of fatigue associated with systemic lupus.

Okay, so that's it for lupus. When I come back on my next video, we will talk about scleroderma. Thank you so much for watching!

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