North Eastern University NRSG2312 Pathophysiology study guide on Lupus
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1. The current status information given for this patient includes a brief medical
history of an 18- year history of SLE, otherwise unremarkable, with no known
allergies. She denies history of or current alcohol/tobacco use. Medications:
naproxen prn (occasional) for joint pain and antacid (?type) for “heartburn”. She
denies taking other prescription or OTC medications. Demographics include she is
47-year old white female, married, homemaker & has two children.
Background demographic and medical history is relevant in providing an overall
health status picture. This can broadly illustrate how this patient does (or does
not) fit the prevalence profilefor the presenting condition, gives clues into
possible precipitants to presenting complaints andprovides insight into daily
routines/health habits she engages in or is likely to engage in.
Lifestyle, situational, and psychosocial factors gleaned from the health history
can be extremelyhelpful in understanding the patient’s current status, and a useful
platform for patient teaching. When assessing a patient with SLE, it is important
to differentiate between disease activity and disease damage-comorbid conditions
(infection, osteoporosis, CAD), drug side effects, and quality of life are factors to
consider (Lupus Foundation of Minnesota, 2013).
A.B. is a female of childbearing age which fits the typical profile. The majority of
cases occur inwomen with onset after menarche and before menopause•estrogens
appears to play a role and seem to favor development of SLE (Bruyere, 2009). She
has joint pain and some G.I. distress. 90% of those with SLE have
arthralgias/arthritis, and deposition of immune complexes containing antibody
against DNA produces tissue damage, including inflammatory lesions in the
North Eastern University NRSG2312 Pathophysiology study guide on Lupus
Frythematosu Latest updat
,North Eastern University NRSG2312 Pathophysiology study guide on Lupus
Frythematosu Latest updat
G.I. tract (the renal tubular basement membranes, brain, heart, spleen, lung, skin
and peritoneumas well) (McCance & Huether, 2014). Nausea and dyspepsia are
common with active SLE and are sometimes difficult to identify a direct cause,
however, peptic ulcer disease is a common complication, especially in SLE
patients treated with NSAIDs and glucocorticoids (Medscape, 2017-e). Asking for
smoking/alcohol history is part of assessing for environmental determinantswhich
can be triggers for SLE, such as sun exposure (Bruyere, 2009). A study and
metaanalysis done by Kiyohara, Washio, Horiuchi, Asami, Ide, Atsumi, & ...
Takahashi, H. (2012) found thatsmoking positively contributed to an increased
risk of SLE, where moderate alcohol consumption had either an inverse, or no risk
related to SLE.
2. Genetic predisposition for SLE is based on the increase incidence in twins and
the existence ofautoimmune disease in the families of those with SLE (McCance
& Huether, 2014). A.B. has an older sister with rheumatoid arthritis, an aunt with
pernicious anemia, and her late mother had Graves disease. Rheumatoid arthritis
(autoimmune disease R/T connective tissue in joints), pernicious anemia
(autoimmune disease R/T the hematologic system) and Graves disease
(autoimmune disease R/T the endocrine system) factor strongly in this case
(McCance & Huether, 2014). The significance of the patient’s family history is
that SLE and other autoimmune diseases carry genetic risk factors (Bruyere, 2009).
3. A.B is 5 feet, 5 inches tall and weighs 102 pounds, with a decrease of 23
pounds since her last
P.E nearly 1 year ago. BMI as calculated by weight(kg) divided by height
squared(m2), 45.9kg/2.64m=17 (Calculator.net, 2017). This is considered
underweight for adults her height (Centers for Disease Control and Prevention,
2017-a). It is unclear if weight loss was intentional,
North Eastern University NRSG2312 Pathophysiology study guide on Lupus
Frythematosu Latest updat
, North Eastern University NRSG2312 Pathophysiology study guide on Lupus
Frythematosu Latest updat
however it appears unlikely given the case scenario, and weight change/loss is a
constitutional manifestation of SLE (Medscape, 2017-e). Regardless, 23 pounds is a
significant weight loss thatbears further exploration.
4. Hair loss was experienced by this patient, and this is a clinical manifestation
of SLE. In theirstudy to examine the immunological features of this process,
Abreu-Velez, Girard & Howard (2009) concluded the following:
antigen presenting cells (APCs) and dendritic cells (DCs) are equipped with
Pattern Recognition Receptors (PRRs) to some hair follicular unit antigens;
that these innate sensors recognize conserved molecular patterns on self-
tissue, and play a significant rolein the pathophysiology of alopecia in SLE
patients (p. 205).
The ESR reference range for women under 50 years old is < 20 mm/hr (Medscape,
2017-f), therefore, the patient’s level was elevated. ESR is a biomarker specifically
for inflammation and a predictive lab test typically used to aid with diagnosis of
SLE (Lupus Foundation of Minnesota,2013).
5. Lack of energy and fatigue is a constitutional manifestation of SLE, but it can
also possibly indicate a hematologic manifestation (Medscape, 2017-e). It is the
autoantibodies that cause disease in SLE-hemolytic anemia, lymphopenia and
thrombocytopenia are also seen in SLE dueto specific autoantibodies that target
RBCs and lymphocytes (Lupus Foundation of Minnesota, 2013). Fatigue is
consistent with anemia because with anemia the red blood cell’s capacity to carry
oxygen throughout the body is reduced and poor, causing hypoxemia (McCance
& Huether, 2014). In this case acquired hemolytic anemia should be considered
North Eastern University NRSG2312 Pathophysiology study guide on Lupus
Frythematosu Latest updat
Frythematosu Latest updat
1. The current status information given for this patient includes a brief medical
history of an 18- year history of SLE, otherwise unremarkable, with no known
allergies. She denies history of or current alcohol/tobacco use. Medications:
naproxen prn (occasional) for joint pain and antacid (?type) for “heartburn”. She
denies taking other prescription or OTC medications. Demographics include she is
47-year old white female, married, homemaker & has two children.
Background demographic and medical history is relevant in providing an overall
health status picture. This can broadly illustrate how this patient does (or does
not) fit the prevalence profilefor the presenting condition, gives clues into
possible precipitants to presenting complaints andprovides insight into daily
routines/health habits she engages in or is likely to engage in.
Lifestyle, situational, and psychosocial factors gleaned from the health history
can be extremelyhelpful in understanding the patient’s current status, and a useful
platform for patient teaching. When assessing a patient with SLE, it is important
to differentiate between disease activity and disease damage-comorbid conditions
(infection, osteoporosis, CAD), drug side effects, and quality of life are factors to
consider (Lupus Foundation of Minnesota, 2013).
A.B. is a female of childbearing age which fits the typical profile. The majority of
cases occur inwomen with onset after menarche and before menopause•estrogens
appears to play a role and seem to favor development of SLE (Bruyere, 2009). She
has joint pain and some G.I. distress. 90% of those with SLE have
arthralgias/arthritis, and deposition of immune complexes containing antibody
against DNA produces tissue damage, including inflammatory lesions in the
North Eastern University NRSG2312 Pathophysiology study guide on Lupus
Frythematosu Latest updat
,North Eastern University NRSG2312 Pathophysiology study guide on Lupus
Frythematosu Latest updat
G.I. tract (the renal tubular basement membranes, brain, heart, spleen, lung, skin
and peritoneumas well) (McCance & Huether, 2014). Nausea and dyspepsia are
common with active SLE and are sometimes difficult to identify a direct cause,
however, peptic ulcer disease is a common complication, especially in SLE
patients treated with NSAIDs and glucocorticoids (Medscape, 2017-e). Asking for
smoking/alcohol history is part of assessing for environmental determinantswhich
can be triggers for SLE, such as sun exposure (Bruyere, 2009). A study and
metaanalysis done by Kiyohara, Washio, Horiuchi, Asami, Ide, Atsumi, & ...
Takahashi, H. (2012) found thatsmoking positively contributed to an increased
risk of SLE, where moderate alcohol consumption had either an inverse, or no risk
related to SLE.
2. Genetic predisposition for SLE is based on the increase incidence in twins and
the existence ofautoimmune disease in the families of those with SLE (McCance
& Huether, 2014). A.B. has an older sister with rheumatoid arthritis, an aunt with
pernicious anemia, and her late mother had Graves disease. Rheumatoid arthritis
(autoimmune disease R/T connective tissue in joints), pernicious anemia
(autoimmune disease R/T the hematologic system) and Graves disease
(autoimmune disease R/T the endocrine system) factor strongly in this case
(McCance & Huether, 2014). The significance of the patient’s family history is
that SLE and other autoimmune diseases carry genetic risk factors (Bruyere, 2009).
3. A.B is 5 feet, 5 inches tall and weighs 102 pounds, with a decrease of 23
pounds since her last
P.E nearly 1 year ago. BMI as calculated by weight(kg) divided by height
squared(m2), 45.9kg/2.64m=17 (Calculator.net, 2017). This is considered
underweight for adults her height (Centers for Disease Control and Prevention,
2017-a). It is unclear if weight loss was intentional,
North Eastern University NRSG2312 Pathophysiology study guide on Lupus
Frythematosu Latest updat
, North Eastern University NRSG2312 Pathophysiology study guide on Lupus
Frythematosu Latest updat
however it appears unlikely given the case scenario, and weight change/loss is a
constitutional manifestation of SLE (Medscape, 2017-e). Regardless, 23 pounds is a
significant weight loss thatbears further exploration.
4. Hair loss was experienced by this patient, and this is a clinical manifestation
of SLE. In theirstudy to examine the immunological features of this process,
Abreu-Velez, Girard & Howard (2009) concluded the following:
antigen presenting cells (APCs) and dendritic cells (DCs) are equipped with
Pattern Recognition Receptors (PRRs) to some hair follicular unit antigens;
that these innate sensors recognize conserved molecular patterns on self-
tissue, and play a significant rolein the pathophysiology of alopecia in SLE
patients (p. 205).
The ESR reference range for women under 50 years old is < 20 mm/hr (Medscape,
2017-f), therefore, the patient’s level was elevated. ESR is a biomarker specifically
for inflammation and a predictive lab test typically used to aid with diagnosis of
SLE (Lupus Foundation of Minnesota,2013).
5. Lack of energy and fatigue is a constitutional manifestation of SLE, but it can
also possibly indicate a hematologic manifestation (Medscape, 2017-e). It is the
autoantibodies that cause disease in SLE-hemolytic anemia, lymphopenia and
thrombocytopenia are also seen in SLE dueto specific autoantibodies that target
RBCs and lymphocytes (Lupus Foundation of Minnesota, 2013). Fatigue is
consistent with anemia because with anemia the red blood cell’s capacity to carry
oxygen throughout the body is reduced and poor, causing hypoxemia (McCance
& Huether, 2014). In this case acquired hemolytic anemia should be considered
North Eastern University NRSG2312 Pathophysiology study guide on Lupus
Frythematosu Latest updat
