immune last

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immune last
2015-10-11 14:22:50

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  1. Systemic Lupus Erthematosus (SLE)
    • Autioimmune
    • progressive
    • systemic
    • chronic
    • inflammation
    • vascular disease- affects the blood vessels
  2. SLE
    • chronic multisystem micro vascular inflammatory disease
    • unpredictable course with exacerbations and remissions
    • usually affects skin, joints, serous membranes and renal, neuro, hematology systems.
  3. causes/predisposing factors of SLE
    • Unknown
    • sex- usually females
    • hereditary
    • genetics
    • drugs
    • infectious agents
    • envi factors (ultraviolet)
  4. Patho SLE
    • etiology: not clearly known
    • disorder of immunoregulation
    • autoimmune reaction against contents of cell nucleus (DNA)
    • B and T cell hypersensitivity
    • end result is overproductionof autoantibodies
    • autoantibodies bind to antigen (immune complex)--activates complement--trigger inflammatory response
    • - Immune  complexes are deposited in basement membrane of capillaries, kidneys, heart, brain and joints leads to destruction of the vessels
    • Kidney crashes
    • brain- confusion
    • heart- trouble
  5. s/s of SLE
    • variable and no characteristic pattern
    • -any organ can be affected
    • generalized complaints often precede an excerbation of disease
    • - fatigue, fever, weight loss, arthalgia
  6. s/s dermatological
    • some pts, may be initial symptom before systemic reactions
    • Derm issue will worsen with UV/sunlight
    • - cutaneous vascular lesions esp in sun exposed areas
    • - cutaneous butterfly rash over the bridge of nose and cheeks (50%)
    • - cutaneous lupus erthematous can become chronic with papules, plaques, scaling, scarring and pigmentation changes
    • - photosensitivity
    • - ulcers in the mouth and nasopharyngeal membranes
    • - alopecia (temp and permant loss)
    • use sunblock 50 or higher
  7. s/s neurological
    • seizures (15%)- electrical activity of brain is messed up
    • headaches- will not go away no matter what u do
    • peripheral neuropathy (bc deposited in the capillary)
    • organic brain syndrome (lupus cerebritis)
    • - disorganized thought process, memory deficits, depression, mood changes, psychosis
    • also cause CVA (bc of blockage)
  8. s/s cardiopulmonary
    • pericarditis and pleuritis are most common
    • high risk arthrosclerosis and CAD
    • raynaud's dx- always cold
    • HTN- heart thickens and it is hard for blood to flow
    • arrhythmias (advance disease)
  9. s/s hematological
    • The formation of antibodies against blood cells
    • - anemia, leukopenia, thrombocytopenia
    • - increased risk to infection
    • - coagulopathy (either excessive bleeding or clotting)
    • -- normocysitic- acute blood loss or inflammation
  10. s/s renal
    • kidney inflam (lupus nephritis LN)
    • proteinuria, glomerulonephritis can lead to nephropathy
    • elevated BUN, creatinine, persistent proteinuria, urine positive for casts, fluid retention
    • can lead to HTN, renal failure
    • kidneys cant flush when it should
  11. s/s musculoskeletal
    • 90%: arthritis (non erosive and affects two or more joints, symmetric)
    • polyarthralgia with morning stiffiness***
    • muscle weakness and tenderness
    • diffuse swelling with joint and muscle pain
    • deformities: swan neck appearance, ulnar deviation and subluxation
  12. dx of SLE
    • PE- may not help alot
    • criteria for diagnoses SLE- see next
    • no specific lab for SLE
    • elevated ANA (antinuclear antibody)
    • - 95% of patients with SLE develop autoantibodies
    • - other rheumatological diseases are associated with ANA
  13. criteria for dx SLE
    • malar rash
    • discoid rash
    • photosensitivity
    • oral ulcers
    • arthritis
    • serositis
    • renal disorder
    • neurological disorder
    • hematogical disorder
    • immunological disorder
    • ana antibody
  14. other dx sle
    • CBC w/ diff- infection anemia
    • ACA- (Anticardiolipin antibody) and LE (lupus anticoagulant)
    • - phospholipid antibodies
    • - positive: increased risk of antiphospholipid antibody syndrome
    • ESR and C- reactive protein (inflammation)
    • BUN/cr  24 hour urine analysis for protein and creat clearance- renal
    • CXR- will tell what is going on in the heart which can possible lead to echo
  15. Tx for SLE
    • Goals
    • early dx and aggressive treatment
    • - preventing an exerabation- reduce stress
    • - treating flare ups, avoid sun exposure, maintain tissue perfusion (nx dx)
    • limiting complications
    • improve quality of life (dec inflammation and pain)
    • pt education- ie to avoid infection bc immune system is poor
    • kills is the complication
    • eat health
    • reduce salt
  16. Nx management SLE
    • rest and avoid stress- stress can trigger
    • stop smoking and limit alcohol
    • healthy balance diet- measure to reduce CV complication
    • any blood in urine indicates kidney is in trouble
  17. Nx management SLE 2
    • protect from UV light and sun exposure
    • wear cap, large brim hat, protective clothing
    • sunscreen with SPF 30 or higher (50)
    • can trigger flare or increase disease activity
    • management options, medications, side effects
    • immunization- flu, pneum
  18. Nx care SLE
    • recognize infection
    • - report sore throat (bc endocarditis- strep can cause this), fever, incr allergy s/s, sinuitis, thrush
    • - encourage good body/oral hygiene
    • recognize the symptoms of flare
    • - incre in fatigue, pain, headache, fever, general malaise, onset of new rash
  19. Nx management sle 3
    • support changes in appearance, fatigue
    • provide information of local support groups and national support resources
  20. medical treatment sle
    • NSAID's
    • corticosteriods
    • hydroxchloroquin (plaquenil) w/food milk to cover GI
    • cytotoxic drugs (close to RA meds)
  21. NX dx sle
    • altered tissue perfusion
    • pain
    • fluid overload
    • skin intergrity- rash
    • knowledge deficit
  22. antiphospholiod antibody syndrome
    • Immune disorder
    • - antiphospholipid syndrome is a disorder in which your immune system mistakenly produces antibodies against certain normal proteins in your blood
    • causing blood clots to form with the arteries/beins, pregnancy complications0 such as miscarriages/still births
    • most common cause SLE
    • rx heparin, coumadin, asa