Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient. Three (3) resources after 2008 are required along with APA format.
A 38 year female old med student goes to her physician with complaints of arthralgia and a new rash on her face bilaterally. The rash get worse when in the sun. When she is fatigued, she complains of a sharp pain in her chest when taking a deep breath. She has experienced this before, but this present episode has been the worst she has ever felt. An exam was completed and tests ordered. The following results are:
Physical:
Temperarture, respiratory rate, and BP normal, Heart rate regular and normal
Facial rash macular over the bridge of her nose and cheeks. Discoid scaling also noted on her extensor surfaces of her arms.
Joint pain and stiffness and pain in hands on active and passive motion
Pleural friction rub auscultated with deep respiration
Other systems examined normal.
Labs:
Serum electrolytes – normal
Hemoglibin and Hematocrit – low
Platelet count – slightly low
White blood cells – normal
BUN and Creatinine – elevated
Urine – Positive for Protein
CXR – Small pleural effusion noted
Antinuclear antibody (ANA) – positive
Anti-DNA antibodies – positive
Diagnosis: Systemic Lupus Erythematosus (SLE)
Questions:
- What is the common descriptive term for this patient’s facial rash and why?
- What does sunlight do to people with this disease that they are taught t avoid it?
- Which lab results indicate renal dysfunction. Is this dysfunction related to SLE? Why or why not?
- State the other signs and symptoms of SLE that are manifested in this patients physical exam and labs? Give the rationale for each.
- What is the pathophysiology behind SLE causing widespread tissue damage?
- What is discoid lupus and is it different from SLE?
- What type of teaching and management plan will be need to be devised by the APN for this patient?
- Common Descriptive Term for Facial Rash:
The common descriptive term for the facial rash seen in SLE patients is “butterfly rash” or “malar rash.” It is called so because of its characteristic appearance, resembling the shape of a butterfly, with a red or erythematous rash spreading over the bridge of the nose and cheeks.
- Impact of Sunlight on SLE:
Sunlight or ultraviolet (UV) radiation can exacerbate symptoms in individuals with SLE. This phenomenon is known as photosensitivity. Sunlight exposure can trigger or worsen the butterfly rash and lead to skin lesions. It is advised for SLE patients to avoid sunlight and use sunscreen because UV radiation can activate the immune response and worsen the underlying inflammatory processes in the skin and other organs.
- Lab Results Indicating Renal Dysfunction:
The elevated levels of BUN (Blood Urea Nitrogen) and Creatinine in the lab results indicate renal dysfunction. This dysfunction can be related to SLE as one of its complications. In SLE, immune complexes can deposit in the kidneys, leading to inflammation and damage to the renal tissues. This condition is known as lupus nephritis. The impaired kidney function can result in the elevated levels of BUN and Creatinine in the blood due to decreased filtration and excretion of waste products by the kidneys.
- Other Signs and Symptoms of SLE:
a. Joint Pain and Stiffness: This patient exhibits joint pain and stiffness, which is a common symptom of SLE. It occurs due to inflammation of the synovium in the joints.
b. Low Hemoglobin and Hematocrit: Anemia is common in SLE, and low hemoglobin and hematocrit levels can result from chronic inflammation or, in severe cases, due to autoimmune hemolytic anemia.
c. Pleural Friction Rub and Small Pleural Effusion: These findings indicate pleuritis, which is inflammation of the lining around the lungs. It’s a common manifestation of SLE.
d. Positive ANA and Anti-DNA Antibodies: These lab results are characteristic of SLE. ANA (Antinuclear Antibody) and anti-DNA antibodies are autoantibodies that target the body’s own cells and DNA, leading to tissue damage and inflammation.
- Pathophysiology of SLE Causing Tissue Damage:
SLE is an autoimmune disease where the immune system mistakenly attacks the body’s own cells and tissues. Immune complexes, formed by the interaction of antibodies with self-antigens, can deposit in various tissues, including the skin, joints, kidneys, and blood vessels. This deposition triggers inflammation and activates immune cells, leading to tissue damage. Chronic inflammation, cytokine release, and tissue destruction are key components of the pathophysiology, causing widespread tissue damage in multiple organs.
- Discoid Lupus vs. SLE:
Discoid lupus is a subtype of lupus that primarily affects the skin. It presents as skin lesions, such as red, scaly, and coin-shaped rashes, but does not involve multiple organ systems like SLE. However, some individuals with discoid lupus may later develop SLE.
- Teaching and Management Plan:
The Advanced Practice Nurse (APN) should devise a comprehensive plan, including:
- Education: Educate the patient about SLE, its triggers, and the importance of sun protection. Emphasize medication adherence and regular follow-up.
- Medication Management: Prescribe medications to manage symptoms and prevent disease flares, including non-steroidal anti-inflammatory drugs (NSAIDs), antimalarials, and immunosuppressive agents.
- Lifestyle Modifications: Encourage a balanced diet, regular exercise, and stress management to reduce disease activity. Advise on the importance of avoiding tobacco and excessive alcohol consumption.
- Monitoring: Schedule regular follow-up appointments to monitor disease progression, adjust medications, and assess renal function.
- Supportive Care: Refer the patient to support groups or counseling services for emotional and psychological support, as living with a chronic illness can be challenging.