NUR 265 EXAM 4 STUDY GUIDE

NUR 265 EXAM 4 STUDY GUIDE. This is a complete and an all-inclusive guide to NUR 265 EXAM 4 STUDY GUIDE. Systemic Lupus Erythematosus (313-317) ***TEMPERATURE***  Chronic, progressive, inflammatory connective tissue disorder that affects multiple body systems &organs o REMISSIONS/EXACCERBATIONS (can end up in the ICU) - Autoimmune o Attracted to KIDNEY’s—Lupus Nephritis is leading cause of death; this is direct damage to the kidneys  Poor survival associated with high creatinine, low hematocrit, proteinuria o Young Women of child bearing age 20-40 Y (primary AA women) o SLE & DLE both share a disfiguring and embarrassing rash!!  Clinical manifestations o Malar rash – red flat or raised rash over cheeks sparing nasolabial folds “butterfly rash” o Discoid rash – Red raised patches with scaling follicle plugging o Photosensitivity– discoid skin rash from sun exposure - pt should wear sunscreen or protective clothing o Oral ulcers–usually painless o Polyarthritis-multiple joints affected  Small joints and knees inflamed  Osteonecrosis from chronic steroid use (5y+) o Pleuritis with pleural effusion or pericarditis o Fever is the major sign of exacerbation o Generalized weakness, fatigue, anorexia, weight loss o Renal disorders–proteinuria, cellular casts o Neurologic disorders – seizures, psychosis and also peripheral neuropathies o Raynaud’s phenomena  Exposure to cold or extreme stress – red, white, blue & pain of digits o Alopecia or hair loss common  Diagnostic Tests o ANA most sensitive but antinuclear antibodies not specific to SLE o C reactive protein can help differentiate SLE flare from an infection (remains normal if SLE flare) o CBC shows pancytopenia (a decrease in all cell types)  Medical Management o Topical steroids for skin lesions o Acetaminophen or NSAIDS (caution with kidneys) – tx joint & muscle pain & inflammation o Hydroxychloroquine (anti-malarial agent) – dec absorption of ultraviolet light by skin, dec skin lesions  Frequent eye exams – b4 starting and q 6 mon o Glucocorticoids – Chronic steroid therapy  Take in the am b4 breakfast  Take Ca to prevent osteoporosis  Maintain skin integrity o Immunosuppressants – methotrexate, azathioprine o Belimumab – do not receive live vaccines for 30 days b4 tx  Teaching  Protect the skin o Limit sun/ultraviolet light exposure to prevent exacerbation (fluorescent light too)  Long sleeves, lg-brimmed hat, SPF 30+ o Clean skin with mild soap, pat dry and apply lotion o Cosmetics ok w/ moisturizers and sun protection, no excess powder or drying substances  Monitor temperature – first sign of exacerbation  Avoid large crowds and people who are ill, bc immunosuppressed  Avoid harsh hair tx (permanents or highlights)  Pregnancy can cause exacerbation Systemic Sclerosis (Scleroderma) ***SWALOWING PROBLEM***  Uncommon, chronic, inflammatory, autoimmune connective tissue disease.  Similar to SLE, but w/a higher mortality rate  Doesn’t respond to steroids or immunosuppressants, why mortality higher than SLE  Inflamed tissue becomes fibrotic and then sclerotic (hard) – renal involvement leading cause of death  Women 25-55, most in 40s  Diffuse cutaneous *Major organ problems o First sx – hand and forearm edema w/ or w/o bilateral carpal tunnel syndrome o Skin thickening on trunk, face, and proximal and distal extremities (most of the body) o Painless symmetric pitting edema of hands & fingers (sausage like fingers) o Changes of pigmentation with loss of skin folds & face can become mask like o Develop early problems w/ GI tract (GERD to dysphagia), heart(myocardial fibrosis), lungs (fibrosis & PAH), & kidneys (malignant HTN) o Complications can be rapid  Limited cutaneous *Esophagus o Skin thickening limited to sites distal to face, neck and distal extremities o Organ changes rare or late o CREST Syndrome  Calcinosis – calcium deposits in tissues  Raynaud’s Phenomenon – intermittent vasospasm of finger tips - first CREST symptom that develops  Esophageal dysmotility - **Dysphagia**  Sclerodactyly – scleroderma of digits – fingers stiff, shiny, and no skin folds  Telangiectasia – capillary dilations that form vascular lesions on face, lips & fingers  Medical Management