UNIT 5: Topic 3 SYSTEMIC LUPUS ERYTHEMATOSUS Pathophysio Autoimmune Dysfunction:

DEFn: Systemic lupus erythematosus (SLE) is an • SLE is characterized by an autoimmune

autoimmune disease. In this disease, the immune response where the body’s immune system
system of the body mistakenly attacks healthy tissue. mistakenly targets its own tissues and
It can affect the skin, joints, kidneys, brain, and other organs.
organs. • Autoantibodies, particularly antinuclear
Causes • Genetic factors: Having certain genetic antibodies (ANA), are produced,
mutations may make you more likely to contributing to immune complex
have lupus. formation.
• Hormones: Reactions to certain Immune Complex Deposition:
hormones in your body (especially • Immune complexes formed by the
estrogen) may make you more likely to interaction of antibodies and self-antigens
develop lupus. deposit in various tissues, triggering
• Environmental factors: Aspects about inflammation and tissue damage.
where you live and how much pollution or • These deposits can occur in the skin,
sunlight you’re exposed to might affect joints, kidneys, and other organs.
your lupus risk. Multi-Organ Involvement:
• Your health history: Smoking, your stress • SLE can affect multiple organs, leading to a
level and having certain other health wide range of clinical manifestations.
conditions (like other autoimmune • Commonly affected organs include the
diseases) might trigger lupus. skin, joints, kidneys, heart, lungs, blood
S/S • Chest pain when taking a deep breath. vessels, and the central nervous system.
• Fatigue. Inflammatory Cascade Activation:
• Fever with no other cause. • The immune complexes and inflammatory
• General discomfort, uneasiness, or ill mediators activate a cascade of
feeling (malaise). inflammatory responses, leading to tissue
• Hair loss. injury and damage.
• Weight loss. • Chronic inflammation contributes to the
• Mouth sores. development of characteristic symptoms
• Sensitivity to sunlight. 0073uch as joint pain, rashes, and organ
Hallmark sign: Skin rash -- A "butterfly" rash develops dysfunction.
in about half the people with SLE. The rash is mostly Episodic Flares and Remissions:
seen over the cheeks and bridge of the nose. It can be • SLE often follows a pattern of episodic
widespread. It gets worse in sunlight. flares and remissions, with periods of
• Swollen lymph nodes. increased disease activity and symptom
Other symptoms and signs depend on which part of exacerbation followed by periods of
the body is affected: relative stability.
• Brain and nervous system -- Headaches, • The unpredictable nature of flares makes
weakness, numbness, tingling, seizures, long-term management and monitoring
vision problems, memory and personality crucial.
changes
• Digestive tract -- Abdominal pain, nausea,
and vomiting
• Heart -- Valve problems, inflammation of
heart muscle or heart lining (pericardium)
• Lung -- Buildup of fluid in the pleural space,
difficulty breathing, coughing up blood
• Skin -- Sores in the mouth
• Kidney -- Swelling in the legs
• Circulation -- Clots in veins or arteries,
inflammation of blood vessels, Diagnostic • Blood tests to see how well your immune
constriction of arteries in response to cold Tests system is working and to check for
(Raynaud phenomenon) infections or other issues like anemia or
• Blood abnormalities including anemia, low blood cell counts.
low white blood cell or platelet count • Urinalysis to check your pee for signs of
Some people have only skin symptoms. This is called infections or other health conditions.
discoid lupus. • An antinuclear antibody (ANA) test looks
Types 1. Cutaneous lupus erythematous: Lupus for antibodies (protein markers that show a
that only affects your skin. history of your body fighting off infections).
2. Drug-induced lupus: Some medications People who have lupus usually have
trigger lupus symptoms as a side effect. It’s certain antibodies that show their immune
usually temporary and might go away after system has been overly active.
you stop taking the medication that caused • A biopsy of your skin or kidney tissue can
it. show if your immune system has damaged
3. Neonatal lupus: Babies are sometimes them.
born with lupus. Babies born to biological Medical • Hydroxychloroquine: is a disease-
parents with lupus aren’t certain to have Managemen modifying antirheumatic drug (DMARD)
lupus, but they might have an increased t that can relieve lupus symptoms and slow
risk.

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 down how they progress (change or get • Apply warm/cool compresses to painful
worse). joints
• NSAIDs: OTC NSAIDs relieve pain and • Recommend non-pharmacological
reduce inflammation. Your provider will tell alternatives
you which type of NSAID will work best for - Inflammation and SLE related arthritis
you, and how often you should take it. Don’t can cause significant pain and
take NSAIDs for more than 10 days in a row stiffness of joints; Medication may be
without talking to your provider. necessary, but encourage other
• Corticosteroids: are prescription alternatives as well.
medications that reduce inflammation. Encourage deep breathing exercises to promote
Prednisone is a common corticosteroid adequate gas exchange and prevent lung diseases
providers use to manage lupus. Your • Splinting
provider might prescribe you pills you take • Incentive spirometer
by mouth or inject a corticosteroid directly • Relaxation
into one of your joints. - Patients may report chest pain with
• Immunosuppressants: are medications deep breathing. Encourage breathing
that hold back your immune system and exercises to open airways, reduce
stop it from being active. They can help pain and relieve anxiety. Incentive
prevent tissue damage and inflammation. spirometers and splinting with pillows
Prevention You can’t prevent lupus because experts aren’t sure may be beneficial.
what causes it. Talk to a healthcare provider about Cluster care and schedule activity
your risk if one of your biological parents has lupus. • Fatigue is a common complaint for patients
You might be able to prevent and reduce lupus flare- with lupus. Encourage activity as tolerated
ups by avoiding activities that trigger your symptoms, but discourage patients from overexertion.
including: Cluster care to reduce fatigue and
• Avoiding sun exposure: Spending too conserve energy.
much time in the sun can trigger lupus Administer medications appropriately
symptoms in some people. Try to avoid • Medications are often given to suppress
going outside when the sun is brightest immune system, treat existing
(usually between 10 am - 4 pm). Wear long inflammation and manage symptoms such
sleeves, a hat or sun-protective clothing. as pain. Monitor for GI discomfort or
Use sunscreen that’s at least SPF 50. irritation when giving medications; prevent
• Staying active: Joint pain can make it hard constipation if opioids are given.
or painful to move. But moving and gently Nutrition and lifestyle education
using your joints can be the best way to • Healthy diet (fruits, grains, vegetables)
relieve symptoms like pain and stiffness. • Regular exercise
Walking, biking, swimming, yoga and tai chi • Avoid sun exposure
are all great ways to move your body • Adequate rest
without putting too much stress on your
joints. Ask your healthcare provider which
types of activities are safest for you. UNIT 5: Topic 4 PSORIASIS
• Getting enough sleep and protecting DEFn: Psoriasis is a skin disease that causes a rash with
your mental health: Living with lupus can itchy, scaly patches, most commonly on the knees,
be frustrating. Getting the right amount of elbows, trunk and scalp.
sleep (seven to nine hours for adults) and
reducing your stress can help prevent flare- Psoriasis is a common, long-term (chronic) disease
ups for some people. A psychologist or with no cure. It can be painful, interfere with sleep and
other mental health professional can help make it hard to concentrate. The condition tends to go
you develop healthy coping mechanisms. through cycles, flaring for a few weeks or months,
There’s currently no cure for lupus. Your healthcare then subsiding for a while. Common triggers in people
provider will help you find a combination of with a genetic predisposition to psoriasis include
treatments to manage your symptoms and hopefully infections, cuts or burns, and certain medications.
put lupus into remission (long periods of time with no
symptoms or flare-ups). Psoriasis can be classified into:
Nursing Assess and monitor skin for rash • Mild. Less than 5% of your body is affected.
Managemen • The hallmark sign of SLE is a malar butterfly • Moderate. Five to 10% of your body is
t rash across the cheeks and bridge of the affected.
nose; rash may develop on the face, neck, • Severe. More than 10% of your body is
chest or extremities affected.
Assess mucous membranes; encourage oral hygiene; Types 1. Plaque psoriasis. The most common type
rinse mouth with half-strength peroxide three times of psoriasis, plaque psoriasis causes dry,
per day itchy, raised skin patches (plaques)
• Oral lesions and ulcers are common covered with scales. There may be few or
symptoms; peroxide helps to keep oral many. They usually appear on the elbows,
lesions clean and promote healing knees, lower back and scalp. The patches
Assess and manage pain vary in color, depending on skin color. The
• Analgesics affected skin might heal with temporary
• AROM/PROM changes in color (post inflammatory
• Positioning for comfort and to prevent hyperpigmentation), particularly on brown
contractures or Black skin.
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 2. Nail psoriasis. Psoriasis can affect Pathophysio
fingernails and toenails, causing pitting,
abnormal nail growth and discoloration.
Psoriatic nails might loosen and separate
from the nail bed (onycholysis). Severe
disease may cause the nail to crumble.
3. Guttate psoriasis. Guttate psoriasis
primarily affects young adults and
Difference Psoriasis and eczema are two different skin
children. It's usually triggered by a bacterial
with eczema conditions. Both conditions cause similar symptoms
infection such as strep throat. It's marked
like discolored skin, a rash and itching. Psoriasis
by small, drop-shaped, scaling spots on
plaques cause areas of thick skin covered in scales.
the trunk, arms or legs.
Eczema causes a rash of dry and bumpy skin. Eczema
4. Inverse psoriasis. Inverse psoriasis mainly
also typically causes more intense itching than
affects the skin folds of the groin, buttocks
psoriasis.
and breasts. It causes smooth patches of
S/S In addition to skin plaques or a rash, you might have
inflamed skin that worsen with friction and
symptoms that include:
sweating. Fungal infections may trigger this
• Itchy skin.
type of psoriasis.
5. Pustular psoriasis. Pustular psoriasis, a • Cracked, dry skin.
rare type, causes clearly defined pus-filled • Skin pain.
blisters. It can occur in widespread • Nails that are pitted, cracked or crumbly.
patches or on small areas of the palms or • Joint pain.
soles. Psoriasis isn’t contagious. You can’t get psoriasis by
6. Erythrodermic psoriasis. The least encountering another person’s psoriasis skin rash.
common type of psoriasis, erythrodermic How to A healthcare provider or a dermatologist will diagnose
psoriasis can cover the entire body with a diagnose? psoriasis after a physical exam to look at your skin
peeling rash that can itch or burn intensely. and review your symptoms. They’ll ask you questions
It can be short-lived (acute) or long-term that could include:
(chronic). • Do you have a history of skin conditions in
Causes Psoriasis is thought to be an immune system problem your biological family?
that causes skin cells to grow faster than usual. In the • When did you first notice symptoms?
most common type of psoriasis, known as plaque • Have you tried any at-home remedies to
psoriasis, this rapid turnover of cells results in dry, treat your skin?
scaly patches. • Is this the first time you’ve had an outbreak
on your skin?
The cause of psoriasis isn't fully understood. It's • What types of soaps or shampoos do you
thought to be an immune system problem where use?
infection-fighting cells attack healthy skin cells by The appearance of a skin plaque leads to a psoriasis
mistake. Researchers believe that both genetics and diagnosis, but symptoms can relate to other similar
environmental factors play a role. The condition is not skin conditions, so your provider might offer a skin
contagious. biopsy test to confirm your diagnosis.
Psoriasis triggers Medical • Steroid creams.
Many people who are predisposed to psoriasis may be Management • Moisturizers for dry skin.
free of symptoms for years until the disease is • Medication to slow skin cell production
triggered by some environmental factor. Common (anthralin).
psoriasis triggers include: • Medicated lotions or shampoos.
• Infections, such as strep throat or skin • Vitamin D3 ointment.
infections • Vitamin A or retinoid creams.
• Weather, especially cold, dry conditions If your symptoms of psoriasis don’t improve after
• Injury to the skin, such as a cut or scrape, a treatment, or if you have large areas of involvement
bug bite, or a severe sunburn (10% of your skin or more), your healthcare provider
• Smoking and exposure to secondhand may recommend the following treatments:
smoke • Light therapy: LED lights at specific
• Heavy alcohol consumption wavelengths can decrease skin
• Certain medications — including lithium, inflammation and help slow your skin cell
high blood pressure drugs and antimalarial production.
drugs • PUVA: This treatment combines a
• Rapid withdrawal of oral or injected medication called psoralen with exposure
corticosteroids to a special form of ultraviolet light.
Risk Factors • Family history. The condition runs in • Retinoids: These vitamin A-related drugs
families. Having one parent with psoriasis can help your psoriasis symptoms but may
increases your risk of getting the disease. cause side effects, including birth defects.
And having two parents with psoriasis • Immune therapies: Newer immune
increases your risk even more. therapy medications (biologics and small
• Smoking. Smoking tobacco not only molecule inhibitors) work by blocking your
increases the risk of psoriasis but also may body’s immune system so it can’t cause an
increase the severity of the disease. autoimmune reaction.
• Methotrexate: Providers recommend this
medication for severe cases of psoriasis. It
may cause liver disease. If you take it, your
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 provider will monitor your progress with Risk Factors • Age. Sjogren's syndrome is usually
blood tests. You may need periodic liver diagnosed in people older than 40.
biopsies to check your liver health. • Sex. Women are much more likely to
• Cyclosporine: This medicine can help have Sjogren's syndrome.
severe psoriasis but it may cause high • Rheumatic disease. It's common for
blood pressure and kidney damage. people who have Sjogren's syndrome to
Nursing • Administer prescribed medications, which also have a rheumatic disease — such as
Management may include coal tar therapy, and topical rheumatoid arthritis or lupus.
corticosteroids. Types • Primary Sjögren’s syndrome develops
• Discuss and assist with the administration on its own, and isn’t caused by another
of additional medical treatments, which health condition.
may include coal tar shampoos, • Secondary Sjögren’s syndrome
intralesional therapy (i.e. injection of happens when another condition or issue
medication directly into lesion), systemic causes (triggers) Sjögren’s syndrome.
cytotoxic medication, Causes Sjögren’s syndrome is an autoimmune disease.
photochemotherapoy, occlusive dressing. Primary Sjögren’s syndrome happens with no known
• Enhance skin integrity trigger or cause. Other health conditions trigger
• Prevent infection. secondary Sjögren’s syndrome, especially other
• Provide client and family teaching. autoimmune diseases and some viral infections.
1. Advise the client receiving systemic • Hepatitis C.
cytotoxic (e.g. methotrexate) therapy, • Cytomegalovirus (CMV).
which inhibits deoxyribonucleic acid • Epstein-Barr virus.
synthesis in epidermal cells to speed the • Human T-lymphotropic virus 1 (HTLV).
replacement of psoriatic cells, to continue • COVID-19.
taking the medication even if nausea and Pathophysio
vomiting occur, to increase fluid intake to
prevent nephrotoxicity, and to avoid
alcoholic beverages.
2. Instruct the client to avoid sun exposure
during photochemotherapy. This regimen
of phototherapy with ultraviolet A (PUVA)
light decreases cellular proliferation. PUVA
therapy results in photosensitivity and the
client should avoid exposure to sunlight
during this time.
3. Be knowledgeable about treatment, and
give the client written instructions.
Diagnostic Tests used to help diagnose Sjögren's syndrome
Tests include:
UNIT 5: Topic 8 SJORGREN’S SYNDROME • blood tests
DEFn: Sjogren's (SHOW-grins) syndrome is a disorder of • eye tests
your immune system identified by its two most • a test where you spit or dribble into a
common symptoms — dry eyes and a dry mouth. container for 5 minutes to see how much
Sjögren's syndrome is a condition where the glands saliva you produce
that produce fluid, such as tears and spit (saliva), • an X-ray of your salivary glands to see if
stop working properly. they're blocked
• a lip biopsy where a small piece of skin
The condition often accompanies other immune that contains salivary glands is removed
system disorders, such as rheumatoid arthritis and from your lip and looked at under a
lupus. In Sjogren's syndrome, the mucous microscope
membranes and moisture-secreting glands of your Sometimes you may also have an ultrasound scan
eyes and mouth are usually affected first — or a urine test.
resulting in decreased tears and saliva. Complications Common
S/S The two main symptoms of Sjogren's syndrome are: • Dental cavities. Because saliva helps
• Dry eyes. Your eyes might burn, itch or protect the teeth from the bacteria that
feel gritty — as if there's sand in them. cause cavities, you're more prone to
• Dry mouth. Your mouth might feel like it's developing cavities if your mouth is dry.
full of cotton, making it difficult to • Yeast infections. People with Sjogren's
swallow or speak. syndrome are much more likely to
Some people with Sjogren's syndrome also have develop oral thrush, a yeast infection in
one or more of the following: the mouth.
• Joint pain, swelling and stiffness • Vision problems. Dry eyes can lead to
• Swollen salivary glands — particularly light sensitivity, blurred vision and
the set located behind your jaw and in corneal damage.
front of your ears Less common
• Skin rashes or dry skin • Lungs, kidneys or liver. Inflammation
• Vaginal dryness can cause pneumonia, bronchitis or
• Persistent dry cough other problems in your lungs; lead to
• Prolonged fatigue

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 problems with kidney function; and • Avoid shearing forces and encourage or
cause hepatitis or cirrhosis in your liver. perform frequent position changes.
• Lymph nodes. A small percentage of • Increase liquid intake with meals.
people with Sjogren's syndrome develop • Assist or instruct patient to avoid
cancer of the lymph nodes (lymphoma). choosing spicy or dry foods from menu
• Nerves. You might develop numbness, choices.
tingling and burning in your hands and • Suggest smaller, more frequent meals.
feet (peripheral neuropathy). • Weigh patients weekly and review diet
Medical • Artificial tears: Your eye care specialist history for basic nutrient deficiencies.
Management might suggest OTC eye drops, • Advise patient on proper use of water-
prescription drops or lubricants to keep soluble vaginal lubrication.
your eyes moist. • Suggest alternate positioning and
• Dry eye surgery (punctal plugs): An practices to prevent dyspareunia.
ophthalmologist (eye surgeon) can • Teach the patient to recognize and report
surgically close some or all of your tear symptoms of vaginitis because infection
ducts to keep your natural tears in your may result from altered mucosal barrier.
eyes for longer. • Advise patient of commercially available
• Saliva producers: Your dentist may artificial saliva preparations, artificial
suggest over-the-counter saliva (spit) tears, moisturizing nasal spray, and
supplements or prescriptions to help artificial vaginal moisturizers.
your body make more saliva. They might • Encourage frequent dental visits. Dental
suggest you chew gum, sip water cavities are more frequent in patients
throughout the day or suck on ice chips to with Sjogren’s syndrome.
help moisturize your mouth. • Advice patient to check with health care
• Special mouthwash or dental care provider before using any medications
products: People with Sjögren’s because many cause mouth dryness (eg,
syndrome have a higher risk of dental diuretics, tricyclic antidepressants,
health issues, so you may need more antihistamines).
frequent cleanings, special fluoride • Advice patient to wear protective
treatments or prescription toothpaste eyewear while outdoors.
and mouthwash.
• Vaginal moisturizers or lubricants: Your
provider will suggest over-the-counter or
prescription lubricants to add moisture
to your vagina every day or during sexual
intercourse.
• Hormone therapy: Some people need
hormone therapy (like supplemental
estrogen) to treat vaginal dryness caused
by a hormonal imbalance.
Treatments for pain and other symptoms can
include:
• OTC pain relievers: Over-the-counter
NSAIDs (nonsteroidal anti-inflammatory
drugs) or acetaminophen can relieve pain
and reduce swelling. Don’t take these
medications for more than 10 days in a
row without talking to your provider.
• Corticosteroids: Prescription anti-
inflammatory medications your provider
will give you as pills or injections.
• Immunosuppressants: Prescription
medications that calm your immune
system and reduce how active it is. Your
provider might recommend disease-
modifying antirheumatic drugs
(DMARDs).
Nursing • Inspect oral mucosa for oral Candida
Management infection, ulcers, saliva pools, and dental
hygiene.
• Instruct or assist patient in proper oral
hygiene.
• Encourage frequent intake of non-
caffeinated, non-sugar liquids.
• Instruct or assist patient in daily
inspection of skin for areas of trauma or
potential breakdown.
• Apply lubricants to skin daily.

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