Systemic Lupus Erythematosus and Critical Illness.

Systemic lupus erythematosus is a chronic autoimmune disorder that causes a wide range of mild to life-threatening conditions that require hospitalization and critical care. The morbidity and mortality of systemic lupus erythematosus are associated with the organ system damage caused by intermittent or chronic disease activity and with the complications of long-term and toxic immunosuppressant medication regimens. This article reviews the epidemiologic, clinical, diagnostic, and therapeutic information essential for critical care clinicians who provide care to patients with systemic lupus erythematosus.

Effects of web-based education and counselling for patients with systemic lupus erythematosus: self-efficacy, fatigue and assessment of care.

OBJECTIVE: The aim of this study was to determine the effect of web-based education and counselling for patients with systemic lupus erythematosus on self-efficacy, fatigue and assessment of care. METHODS: The study was conducted as a randomized controlled trial. The study sample consisted of 80 patients divided into two groups: the experimental group (n = 40) and a control group (n = 40). Randomization was performed by simple random sampling. At the beginning of the study (month 0), data-collection forms were administered to both groups. Web-based education was carried out for the first three months, and counselling and information updates were given for the next three months for the experimental group. In the intervention process, the control group just received standard care. After six months, data-collection forms were administered to both groups again. RESULTS: The mean age of the participants in the experimental and control groups was 35.58 ± 8.40 years and 39.00 ± 12.71 years, respectively. In both groups, 95% of patients were women. Wilcoxon's test was used for within-group comparisons before and after the study. The Mann-Whitney U-test was used to evaluate the difference between the two groups before the intervention and between the two groups after the intervention. We found that there was a significant improvement in fatigue, self-efficacy and assessment of chronic illness care in the experimental group at the end of the study (p < 0.05). CONCLUSIONS: The intervention had a positive effect on self-efficacy, fatigue and satisfaction with chronic illness. In accordance with the results, similar studies should be conducted for different patient groups in order to strengthen the results.

El embarazo en mujeres con lupus eritematoso sistémico: una revisión integrativa / Pregnancy in women with systemic lupus erythematosus: an integrative review

INTRODUCCIÓN: En la actualidad, se conoce que el lupus eritematoso sistémico no afecta a la fertilidad; sin embargo, el embarazo en mujeres que lo padecen se asocia a riesgos, tanto maternos como fetales. OBJETIVO: Determinar las variables que intervienen en la preparación y control de la gestación en mujeres con lupus eritematoso sistémico, así como las medidas de enfermería más importantes. MATERIAL Y MÉTODO: Se ha realizado una revisión integrativa mediante una búsqueda en las bases de datos Proquest, Pubmed y Web of Science. Se incluyeron artículos científicos originales, observacionales y de revisión, en inglés y español, excluyendo aquellos artículos anteriores a 2009 o que no estuviesen en texto completo. RESULTADOS: Se han incluido 15 artículos publicados entre el año 2009 y 2019. El embarazo en pacientes con lupus eritematoso sistémico es complejo, ya que necesita de un control exhaustivo y continuo para conseguir buenos resultados. Un cambio de tratamiento, test de laboratorio cada cierto tiempo y la vigilancia de un equipo multidisciplinar, harán que la enfermedad se encuentre controlada y los riesgos de complicaciones maternas y fetales disminuyan. CONCLUSIONES: En la actualidad, la mayoría de las mujeres con lupus eritematoso sistémico pueden conseguir el objetivo de la maternidad, siempre y cuando la enfermedad se encuentre controlada al menos 6 meses antes de la concepción y durante todo el embarazo. Las variables más determinantes en el embarazo de la mujer con lupus eritematoso sistémico son la fertilidad, las complicaciones o el tratamiento, que influyen de forma directa sobre el embarazo

INTRODUCTION: At present, it is known that systemic lupus erythematosus does not affect fertility; however, pregnancy in these women is associated with risks, both maternal and fetal. OBJECTIVE: To determine the variables involved in the preparation and control of pregnancy in women with systemic lupus erythematosus, as well as the most important nursing actions. MATERIAL AND METHOD: An integrative review has been carried out through a search in the ProQuest, PubMed and Web of Science databases. Original, observational and review scientific articles were included, in English and Spanish, excluding those articles published before 2009 or that were not in full text in the databases. RESULTS: 15 articles published between 2009 and 2019 have been included. Pregnancy in patients with systemic lupus erythematosus is complex. Comprehensive and continuous control is required to achieve good results. A change of treatment, laboratory tests from time to time and the monitoring of a multidisciplinary team will control the disease and will reduce the risk of maternal and fetal complications. CONCLUSIONS: Currently, most women with systemic lupus erythematosus can achieve the goal of motherhood, if the disease is controlled at least 6 months before conception and throughout pregnancy. The most determinant variables in pregnancy of women with systemic lupus erythematosus are fertility, complications or treatment, which directly influence pregnancy

Immunosuppressive/Autoimmune Disorders.

Autoimmune disorders are a category of diseases in which the immune system attacks healthy cells as a result of a dysfunction of the acquired immune system. Clinical presentation and diagnosis are disease specific and often correspond with the degree of inflammation, as well as the systems involved. Treatment varies based on the specific disease, its stage of presentation, and patient symptoms. The primary goal of treatment is to decrease inflammation, minimize symptoms, and lessen the potential for relapse. Graves disease, Hashimoto thyroiditis, rheumatoid arthritis, Crohn disease, ulcerative colitis, systemic lupus erythematosus, and multiple sclerosis are discussed in this article.

The management of lupus nephritis.

Lupus nephritis is one of the most devastating complications of systemic lupus erythematosus. New treatment approaches and recommendations aim to decrease mortality and improve quality of life and outcomes. The role of the primary care provider is essential to help manage complications of treatment and avoid organ damage.

Coping with SLE: just in case vs. just in time: nurse's perspective.

This paper considers the experiences of people with lupus in comparison with those with diabetes, and discusses the impact of lupus specialist nurses in information-giving and education under the guise of 'just in case' vs. 'just in time'. Now recognized as a difficult condition to diagnose, lupus can lead to significant worry and distress especially during delays to diagnosis and times of high disease activity. Providing appropriate, individualized information to people with lupus is embedded in specialist nursing practice and enables individuals to use the tools of self-management approaches in gaining control over everyday symptoms.

Systemic lupus erythmatosus.

Systemic lupus erythmatosus (SLE) presents many challenges in pregnancy for the midwife who is increasingly being relied upon to act as coordinator of care, guiding women with complex and high risk medical conditions through maternity pathways, as part of an integrated team. The disease and its pharmacological management are implicated in a range of complications. Primary care provision involves using skilful clinical observation of abnormal signs and symptoms and referring appropriately. The midwife plays a vital role in facilitating primary care provision and all the appropriate support, whilst ensuring that evidence based information is readily available. This enables the woman and her family to achieve the most desirable outcome.

The face of lupus.

Systemic lupus erythematosus--a chronic, complex autoimmune disease without a definitive diagnostic test--often requires burdensome procedures to confirm diagnosis. Nurse practitioners must understand lupus' clinical and serologic manifestations to make a diagnosis; some cases may not be identified using only the American College of Rheumatology's criteria.

Systemic lupus erythematosus: nurse and patient education.

Systemic lupus erythematosus (lupus) is an autoimmune disease in which the immune system attacks healthy cells, tissue and organs, including the skin, kidney, heart, lungs, brain, joints and blood vessels. Symptoms of lupus vary between patients. The most common symptoms include unexplained fever, skin rash, swollen or painful joints, fatigue and kidney problems. Lupus can be treated effectively, but there is presently no cure for the condition. People with lupus may experience periods of exacerbation of symptoms, which are termed 'flares', as well as periods of remission. Nurses need to have a good understanding of the disease to provide patients with appropriate support and advice about how to maintain wellbeing and lead active lives.

Occupational risk factors for systemic lupus erythematosus: a nationwide study based on hospitalizations in Sweden.

OBJECTIVE: To investigate possible associations between occupation and hospitalization for systemic lupus erythematosus (SLE) in a nationwide study. METHODS: A nationwide database was constructed in Sweden by linking the Swedish Census to the Hospital Discharge Register to obtain data on all first hospitalizations with a primary or secondary diagnosis of SLE in adults during the study period (1970 to 2008). Standardized incidence ratios (SIR) and 95% CI were calculated for different occupations. Two cohorts were defined based on occupational titles recorded in Swedish census data in 1970 and 1980. RESULTS: A total of 8921 male and 42290 female hospitalizations for SLE were retrieved in individuals aged over 15 years. High education (> 12 yrs) was associated with a lower risk of hospitalization for SLE among both women (SIR = 0.73) and men (SIR = 0.72). Among men with the same occupation in 2 consecutive censuses, increased risks (SIR) > 2.0 were present among artistic workers (2.52); shop managers and assistants (3.63); miners and quarry workers (6.04); shoe and leather workers (6.93); plumbers (2.21); other construction workers (2.08); glass, ceramic and tile workers (4.43); chimney sweeps (4.54); and military personnel (3.01). Among women with the same occupation in 2 consecutive censuses, no occupation was associated with SIR > 2.0. CONCLUSION: Occupation may carry significantly increased risk of hospital admission for SLE. Especially among men, several occupations were associated with increased risks for SLE.

Systemic lupus erythematosus: a genetic review for advanced practice nurses.

PURPOSE: To review the symptom presentation, genetic aspects, and available treatment options for individuals diagnosed with systemic lupus erythematosus (SLE). Primary care providers should be vigilant in identifying symptoms, which may be related to SLE, perform adequate assessment, and diagnostic testing in order to arrive at an early diagnosis. DATA SOURCES: Extensive literature review of textbook, clinical, medical, and nursing journals. CONCLUSIONS: Lupus is a multigenic autoimmune disease, which requires the clinician to be hypervigilant by collecting a thorough family history and performing a complete physical assessment of the patient. There is an array of treatment modalities, both experimental and proven therapies, which improve signs and symptoms associated with SLE. Numerous medications are available for symptom management: anti-inflammatory agents for patients with musculoskeletal presentation, and steroids or antimalarials for those with more extensive organ involvement. IMPLICATIONS FOR PRACTICE: In SLE, the overall aim of management is to determine the extent of disease and prevent extensive organ involvement. Therefore, when diagnosed in a timely manner, most patients will survive and are able to manage their disease.

The need for nursing instruction in patients receiving steroid pulse therapy for the treatment of autoimmune diseases and the effect of instruction on patient knowledge.

BACKGROUND: Many patients who receive steroid pulse therapy go home the same day or the day after steroid administration. Nursing instructions are important for improving patient knowledge related to their diseases and treatments, but the short hospital stay often prevents complete education and guidance regarding the given therapy. The purpose of this study was to investigate the need for nursing instruction in patients receiving steroid pulse therapy for the treatment of autoimmune diseases and the effect of instruction on patient knowledge of their disease and treatment. METHODS: Patients with systemic lupus erythematosus (SLE) and systemic sclerosis receiving steroid pulse therapy (N = 63) were recruited from a medical center in Taipei. A structured questionnaire was used for data collection before and after nursing instruction, and 1 week as well as 2 weeks after therapy. The need for nursing instruction and knowledge levels were validated using Cronbach's α reliability test. RESULTS: There was a significant difference (P < 0.001) in the need for nursing instruction among the 4 time points. There was a positive correlation between the need for nursing instruction and body weight change, frequency of treatment, and distress, but there was a negative correlation with knowledge level (ß = -0.012, P = 0.003) regarding symptoms. The knowledge level of subjects after nursing instruction was significantly higher than before nursing instruction (80 ± 14.31 vs. 70.06 ± 17.23, P < 0.001). CONCLUSIONS: This study indicates that nursing instruction is needed by patients receiving steroid pulse therapy, and that by designing and administering nursing instructions according to the priority of patient symptoms, nurses can improve patient knowledge related to their diseases and treatments. In addition, the need for nursing instruction can be affected by patient characteristics.

Uso de açúcar em úlcera venosa contaminada por Pseudomonas aeruginosa: um relato de experiência / El uso de azúcar em las úlceras venosas de infección por Pseudomonas aeruginosa: un relato de experiencia / The use of sugar in venous ulcers infected by Pseudomonas aeruginosa: an experience report

Relatar e verificar a atuação do açúcar refinado comercial como agente coadjuvante em tratamento de um cliente com lesões venosas em membro inferior contaminadas por Pseudomonas Aeruginosa, com mais de 40 anos, que apresentam diagnóstico de Lúpus Eritematoso Sistemico (LES). Método: Estudo de natureza qualitativa, exploratória, tipo estudo de caso. O cenário da pesquisa foi uma enfermaria de clínica médica em um hospital público do Rio de Janeiro. Resultados: Considerando se tratar de uma experiência primeira, encontramos evidências elementares de que o açúcar mostrou-se eficaz como coadjuvante, pelo menos no controle antimicrobiano e no debridamento do leito da lesão. Conclusão: Precisamos avançar em estudos com maior rigor metodológico, para definir melhor os protocolos de utilidade do açúcar como recurso terapêutico de baixo custo no tratamento de feridas.

Relater y verificar el desempeño del azúcar refinado comercial como agente coadjuvante em el tratamiento del cliente com lesiones venosas em los miembros inferiores infectados com Pseudomanas aeruginosa, com más de 40 años, que tienen un diagnóstico de Lupus Eritematosa Sistemico (LES). Método: Estudio de naturaleza cualitativo, tipo estúdio de caso exploratório. El ámbito del estudio fue una sala de medicina interna en un hospital público de Río de Janeiro. Resultados: Teniendo en cuenta esta es una primera experiencia, encontramos evidencia de que el azúcar de base fue eficaz como adyuvante, por lo menos encontrol de los antimicrobianos y el desbridamiento de la herida. Conclusión: Tenemos que avanzar en losestudios con mayor rigor metodológico, para definir mejor los protocolos para el uso del azúcar y la opción de bajo costo terapéutica para el tratamiento de heridas.

Objectives: To describe and evaluate the action of refined commercial sugar as an adjuvant agent in a treatment of one client with lower limb venous lesions infected by Pseudomonas Aeruginosa, with more than 40 years, who have a diagnosis of Systemic Lupus Erythematosus (SLE). Method: It’s a qualitative and exploratory study, like acase study. The research scenario was an internal medicine ward in a public hospital in Rio de Janeiro. Results:Considering that this is a first experience, we found elementary evidences that the sugar was effective as an adjuvant, at least in antimicrobial control and in debridement of the lesion. Conclusion: We need to advance instudies with greater methodological rigor, to better define the utility protocols of sugar as a treatment method for low cost in the treatment of wounds.

Lupus eritematoso sistémico / Systemic lupus erythematosus

El lupus eritematoso sistémico es una enfermedad autoinmune, crónica,que afecta al tejido conectivo y cuya etiología es desconocida.Se caracteriza por la presencia de manifestaciones clínicas asociadasa la presencia de autoanticuerpos. Su prevalencia en España es de91 casos/100.000 habitantes. Es más frecuente en mujeres que enhombres en una relación 10:1.El propósito de este artículo, séptimo de una serie dirigida a los cuidadosenfermeros en reumatología, es presentar el lupus eritematososistémico, recorriendo generalidades de esta patología, sus manifestacionesclínicas, además del régimen terapéutico y la Educaciónpara la Salud dirigida a estos pacientes. Los cuidados enfermerosde las personas con esta patología tienen el objetivo de facilitar elautocuidado y el afrontamiento eficaz de la enfermedad, por lo quedeben incluir: recomendaciones higiénicas generales, recomendacionespara la reducción del riesgo cardiovascular y otras comorbilidades,enfatizar la importancia de la adherencia al tratamiento y elcumplimiento de las citas de revisión (AU)

Systemic lupus erythematosus is a chronic, autoimmune disease thataffects connective tissue and which aetiology is unknown. It is characterizedby clinical manifestations associated with the presence ofantibodies. Its prevalence in Spain is 91 cases/100,000 inhabitants.It is more frequent in women than men in a ratio of 10:1.The objective of this article, the seventh in a series aimed at nursingcare in rheumatology, is to present systemic lupus erythematosus,covering its general aspects, clinical manifestations, therapeuticregime and health education aimed at these patients. Nursing careof patients with this pathology aims to facilitate self-care and aneffective coping with the disease, thus making it necessary to include:general hygienic recommendations, recommendations forthe reduction of cardiovascular risk and other comorbidities, emphasison the importance of adherence to treatment and follow-upvisits (AU)

[Nursing care for a patient with lupus erythematosus systemic using ICNP]. / Assistência de enfermagem a paciente com lupus eritematoso sistêmico utilizando a CIPE.

It is a case study based on Horta's Theory of the Basic Human Needs and on the International Classification of the Nursing Practices (ICNP), aimed a systematizing Nursing Care for a patient with lupus erythematous systemic. This study was carried out at the Universidade da Paraíba University Hospital, a teaching hospital in the state of Paraíba, Brazil. Data collection was conducted through an instrument that fulfilled the psychobiologic, psychosocial, and psychospiritual needs based on Horta's theory. Nursing diagnoses were identified using ICNP Version Beta 2 establishing the expected outcomes and the nursing interventions, which were implemented and appraised. The results demonstrate that Systematization of the Nursing Care for this patient had the purpose of preventing disease complications and promoting the improvement of life quality.

Assistência de enfermagem a paciente com lupus eritematoso sistêmico utilizando a CIPE / Nursing care for a patient with lupus erythematosus sistemic using

Trata-se de um estudo de caso fundamentado na Teoria das Necessidades Humanas Básicas de Horta e na Classificação Internacional das Práticas de Enfermagem (CIPE), objetivando a sistematização da assistência de enfermagem a uma paciente portadora de Lupus Eritematoso Sistêmico. Foi desenvolvido no Hospital Universitário da Universidade da Paraíba. Para a coleta de dados, utilizou-se um insttrumento contemplando as necessidades psicobiológicas, psicossociaisituais baseadas na Teoria de Horta. Foram identidicados os diagnósticos de enfermagem utilizando a CIPE Versão Beta 2, estebelecendo-se os resultados esperados e as intervenções de enfermagem, que foram implementadas e avaliadas. Os resultados obtidos demonstram que a assistência de enfermagem a esta paciente foi direcionada para a prevenção de complicações decorrentes da doença e para a promoção da melhoria da qualidade de vida.