main problem: exaggerated production of autoantibodies as a result of disturbed immune regulation
pathophysiology: abnormal suppressor T-cell function -> immune complex depostion -> tissue damage -> inflammation -> antigens stimulated -> stimulation of more antibodies -> cycle repeats
OR
immune system attacks the body’s cells & tissue -> tissue damage -> inflammation
related to:
1.) genetic
2.) hormonal – onset during childbearing years
3.) drug-induced – antiseizure, hydralazine, isoniazid, chlorpromazine, procainamide
outstanding signs and symptons: malar rash (aka butterfly rash) across the bridge of the nose and cheeks
signs & symptoms: systemic manifestations
skin – alopecia, chronic rash that has erythematous papules or plaques & scaling, oral ulceration
cardio – inflammation of various parts of the heart
respi – pleurisy
musculoskeletal – joint swelling, stiffness, tenderness, warmth and pain movement
renal – painless hematuria, proteinuria, glomerulonephritis
neurologic – subtle changes in behaviour patterns or cognitive ability, seizure, chorea, depression, psychosis
hematologic – moderate to severe anemia, thrombocytopenia, leukocytosis or leukopenia
diagnostic tests:
(1) erythrocyte sedimentation rate (ESR) – elevated
(2) WBC and platelet – decreased
(3) Anti Nuclear Antibody Test , LE prep, anti DNA - positive
(4) chronic false (+) for syphyllis
classic signs & symptoms: fever, fatigue, weight loss, pleurisy, possible arthritis, pericarditis
medical management: goal is to prevent progressive loss of organ function
(1) treatment: management of acute and chronic diseases
(2) medicines:
(a) NSAIDS
(b) corticosteroids
(c) immunosuppressive agents
(d) antimalarial agents – for arthritis like symptoms
nursing management:
(1) do a thorough systemic physical assessment. inspect for erythematous rashes, cutaneous erythematous plaques with scale on scalp, face and neck
(2) note area of hyperpigmentation or depigmentation
(3) inspect scalp for alopecia and mouth and throat for ulceration
(4) provide appropriate oral care
(5) note pericardial friction rub and abnormal lung sounds
(6) observe for signs of musculosceletal involvement. note joint swelling, tenderness, warmth and pain on movemend and stiffness
(7) observe for signs indicative of renal involvement. note edema and hematuria
(8) do a direct neurological assessment. ask family members or signifcant other regarding behavioral changes
(9) note and report signs of depression, seizure and chorea
