SLE english version

STUDY MATERIAL
A. The basic concept of SLE
1. Meaning
SLE (Systemisc lupus erythematosus) is an autoimmune disease in which the organs and cells suffer damage caused by tissue-binding autoantibody and immune complexes, which give rise to inflammation and can attack various organ systems but is not known for certain, the course of the disease that may be acute and fulminant or chronic, there is remission and exacerbation accompanied by the availability of a wide range of autoantibody in the body. In each patient, inflammation and organ are on different networks. Severity of disease vary from mild to illness illness that raises defects, depending on the amount and type of antibodies that appear and organs affected.

2. Etiology
Until now the cause of SLE is unknown. Unexpected genetic factors, infection and environment play a role in the pathophysiology of SLE follow.
protracted.
Mechanism or cause of autoimmune diseases is not fully understood but involve unforeseen environmental and hereditary factors. Several environmental factors can trigger the onset of lupus:
• Infections
• Antibiotics (especially the sulfa and penicillin)
• ultraviolet rays
• Excessive Stress
• Certain Drugs
• Hormone.
Although lupus is known is a hereditary disease, but the cause is unknown genes. Final findings mentioned the genes from chromosome 1. Only 10% of patients who have a relative (parent or sibling) who has or will suffer from lupus. Statistics show that only about 5% of children who are suffering from lupus patients with this disease.
Lupus is often referred to as a disease of women though can also be suffered by men. Lupus can strike regardless of age, both in men and women, although 10-15 times more often found in women. Hormonal factors may explain why lupus can strike women more often. Increasing symptoms of the disease at the time before menstruation and / or during pregnancy supports the belief that hormones (especially estrogen) may play a role in the onset of this disease. However, a definite cause of high rates of incidents over the woman and the pre-menstrual period, is not yet known.

Risk factors occurrence of SLE
1. Genetic Factors
 Gender, frequency in adult women 8 times more often than adult men
 age, usually more common in the 20-40 year age
 Ethnic, hereditary factors, with a frequency 20 times more often in family members with the disease there
2. Risk factors Hormones
Add to the risk of SLE estrogen, whereas androgens reduce this risk.
3. UV rays
Ultra violet rays reducing immune supresi until therapy becomes less effective, so SLE relapsed or heavier. This is because the skin cells produce cytokines and prostaglandins which results in the inflammation as well as systemic blood through the circulatory pebuluh
4. Immunity
In patients with SLE, there is hyperactivity of B cells or T cells intolerance
5. Drug
Specific medication in small a percentage of all the particular patient and drink in a certain period can trigger lupus drug (Drug Induced Lupus Erythematosus or widened). Types of drugs that can cause Lupus Drug is:
• Drugs that cause lupus drug identified: Kloropromazin, metildopa, hidralasin, prokainamid, and isoniazid
• Drugs that may cause lupus drugs: Dilantin, penisilamin, and kuinidin
• Relationship outstanding: gold salts, some types of antibiotics and griseofurvin
6. Infection
SLE patients tend prone to infection and sometimes this relapse of disease after infection
7. Stress
Heavy stress can trigger lupus in patients who already have the disease inclining.

3. Pathophysiology
The immune system loses the ability to distinguish between antigens from the body's own cells and tissues. Deviation immunological reaction will produce antibodies continuously. These antibodies also play a role in the formation of immune complexes to trigger immune inflammatory systemic disease with multiorgan mischief. Under normal circumstances, the immune system functions operate in the body's defense against infection. In lupus and other autoimmune diseases, the body's immune system turns against the body, which produced antibodies to attack its own body cells. These antibodies attack the blood cells, organs and body tissues, which results in disease

4. Diagnosis
The criteria for classification of SLE of the American Rheumatism Association (ARA, 1992). A patient suffering from SLE classified as fulfilling at least 4 of 11 criteria details below:
1. Arthritis, arthritis nonerosif on two or more peripheral joints accompanied by pain, swelling, or effusion in which the bones around the joints do not suffer damage
2. ANA test above normal titer = number of abnormal ANA found with immunofluoroscence or similar inspection if there is no known drug administration may trigger previously ANA
3. Constant spotting / Malar Rash (Butterfly Rash) = There is strictly delimited erythema, flat, or berelevasi on cheeks around the nose region (constant region)
4. Photosensitive reaction sun spots = sensitive to UV light / sun, causing the formation of a skin rash or more stunting
5. = Discoid rash spots on the skin
6. One of the blood Variants;
- Hemolytic anemia,
- Leukocytes <4000/mm ³,
- Lymphocytes <1500/mm ³,
- Platelets <100.000/mm ³
7. One of the Kidney Variants;
- Proteinuria> 0.5 g / 24 hours
- = Availability of mobile sediment in the water bladder abnormal elements derived from red blood cells / white or renal tubular cells
8. One of Serositis:
- Pleuritis,
- Pericarditis
9. One of Neurological abnormality;
- Convulsion / seizure,
- Psychosis
10. Mouth ulcers, Including oral and nasopharyngeal ulcers that can be found
11. One of Immunology Variants
- LE + cells
- Anti-dsDNA titers above normal
- Anti-Sm (Smith) above normal titer
- Exams false positive syphilis serology

5. Symptom
Symptoms of lupus:
- Fever
- Tired
- Not feeling well
- Weight loss
- Skin rash
- Butterfly rash
- Skin rash made worse by sunlight
- Sensitive to sunlight
- Swelling and joint pain
- Swelling of the glands
- Muscle pain
- Nausea and vomiting
- Chest pain pleuritik
- Cramps
- Psikosa.
- Hematuria (blood contain water bladder)
- Coughing up blood
- Nosebleed
- Swallowing disorders
- Mottled skin
- Red spots on the skin
- Changes color when pressed fingers
- Numbness and tingling
- Lesions in the mouth
- Hair loss
- Abdominal pain
- Visual disturbances.

6. COMPLICATIONS
The amount and type of antibodies in lupus, larger than the other diseases, and this antibody (together with other unknown factors) determine which symptoms will develop. Therefore, the symptoms and severity of disease, varies in each patient.
Course of the disease is variable, ranging from mild disease until severe disease.
Different symptoms in each patient, as well as free time marked by symptoms (remission) and the time of relapse (exacerbation). In early disease, lupus attack only one organ, but in
then the day will involve other organs.
• muscle and body frame
Almost all patients with lupus experience joint pain and many suffer from arthritis. The commonly affected joints are the joints of the fingers, hands, wrists and knees. Death scoring in the pelvis and shoulders are often the cause of pain in the area.
• Skin
In 50% of patients found the butterfly rash on the cheek bone and the base of the nose. The rash usually gets worse if exposed to the sun
• Kidney
Most of the patients showed the presence of protein accumulation in renal cells, but only 50% are suffering from lupus nephritis (kidney inflammation settled). In the end can happen to patients with kidney failure or pencangkokkan need menjalanidialis a kidney.
• Nervous System
Neurological abnormality was found in 25% of patients with lupus. Most often found in nature is mild mental dysfunction, but variations can occur on any part of the brain, spinal cord or nervous system. Cramps, psikosa, organic brain syndrome and headaches are some of the nervous system abnormality that can occur.
• Blood
Blood disorders can be found in 85% of patients with lupus. Blood clots can form in the veins or arteries, which can cause lung danemboli stroke. Platelet count decreases and the body develops antibodies against blood clotting factors, which could cause significant bleeding. Disease often develops anemia due to chronic.
• Heart
 Inflammation of various parts of the heart can occur, such as pericarditis, endocarditis or miokarditis. Chest pain and arrhythmias can occur as a result of the condition.
• Lung
In lupus can terjadipleuritis (inflammation of the lining of the lungs) and pleural effusion (fluid between the lung deposition and wrapping). As a result of these circumstances often arise chest pain and shortness of breath.
SLE complications in children include:
 Hypertension (41%)
 growth disorders (38%)
 chronic lung disorders (31%)
 eye abnormality (31%)
 Damage to permanent kidney (25%)
 neuropsychiatric symptoms (22%)
 Damage muskuloskeleta (9%)
 gonadal function disorders (3%

7. Supporting Inspections
In diagnostics, the most important antibodies to be detected by this screening is positive ANA in 95% of patients, usually at the onset of symptoms. In some patients the ANA to grow in 1 year after onset of symptoms, so that repeat screening is very useful ..
The large amount of dsDNA IgG (non-single-strand DNA) specific for SLE. ELISA and immunofluorosensi reactions in cells with the flagel dsDNA Crithidia luciliae has about 60% sensitivity for SLE; identification of high aviditas for anti-dsDNA in the Farr inspection insensitive but better connect with nephritis
Examination to determine the presence of SLE disease
• Blood tests
Blood examination showed the presence of antibodies can antinuklear, found in almost all patients with lupus. But this antibody can also be found in other diseases. Because if found antinuclear antibodies (ANA), should be done also for antibody screening of DNA double chain. The high rate of second antibody specific for lupus is almost, but not all people with lupus have these antibodies. Other hematologic abnormality that often occurs is mild to severe anemia, thrombocytopenia, and leukocytosis / lekopenia.
• Rontgen chest showing pleuritis or pericarditis
 Inspection chest with a stethoscope help indicate a pleural friction or heart
 water analysis showed the presence of blood or urinary protein
 Calculate blood type indicates a decline in some types of blood cells
 renal biopsy
 neurological examination.

8. Codes of conduct
Teraphi purposes include efforts to
1. prevent the progressive loss of organ function
2. reduce the availability of acute illness
3. memimimalkan disabilitas relating to disease
4. prevent complications due to teraphi

To codes of conduct, SLE Patients were divided into:
• Light Group
Symptoms: Hot, arthritis, mild pericarditis, pleural effusion / perikard light,
fatigue, and headache
• Cluster weight
Symptoms: perikard massive pleural effusion, renal disease, hemolytic anemia, thrombocytopenia, cerebral lupus, acute vasculitis, miokarditis, lupus pneumonitis, and pulmonary hemorrhage.

General codes of conduct:
Fatigue can be due to pain or other illnesses, such as anemia, fever, infections, hormonal disorders, complications of treatment, or emotional stress. Disability reduce fatigue while medication is well rested, limitation of excessive activity, and are able to change their lifestyle such as:
 Avoid Smoking
 Avoid climate change as it affects the inflammatory process
 Avoid stress and physical trauma
 appropriate diet varieties, for example hyperkolestrolemia
 Avoid sun exposure, particularly in the UV at 10:00 until 15:00
 Avoid wearing kontrasespsi or other drugs that contain estrogen

Medikamentosa codes of conduct:
• For Mild degrees of SLE;
- Mild disease (rash, headache, fever, arthritis, pleuritis, pericarditis) just need a little therapy.
- To overcome arthritis and pleurisy given anti-inflammatory non-steroidal drugs
- To counter corticosteroid cream used skin rash.
- For skin and arthritis symptoms sometimes used antimalarial drugs (hydroxycloroquine)
- If you fail, you can add prednisone 2.5-5 mg / day.
- Dosage can be gradually every 1-2 weeks suited
- If the patient is very sensitive to sunlight, preferably on the go use sunscreen, long clothing or glasses

• For heavy degrees of SLE;
- Severe disease or life-threatening penderitanya (hemolytic anemia, heart or lung disease widespread, kidney disease, diseases of the central nervous system) to be addressed by members
- Provision of systemic steroids are the first choice of suitable varieties dose target organ affected.
- To handle the various manifestations of the disease can be severe immune system suppression drugs
- Some members give cytotoxic drugs (drugs that inhibit cell growth) in patients who do not respond well to corticosteroids or who depend on high doses of corticosteroids.


9. PROGNOSIS
The last few years getting better prognosis of lupus patients, many patients who show mild disease. Women who are pregnant lupus patients can survive in peace until normal babies, no kidney or heart disease found that the weight and the disease can be controlled. 10 year life expectancy increased to 85%. The worst prognosis was found in patients suffering from abnormality of brain, lung, heart and kidney weight
SLE have survival figures for the past 10 years as large 90%. Direct cause of death can be a result of lupus, namely due to renal failure, malignant hypertension, CNS damage, pericarditis, autoimmune sitopenia. Data from several studies in 1950-1960, showing a 5-year survival rates as large as 17.5% -69%. Whereas in 1980-1990, the 5-year survival rates as large as 83% -93%. Some researchers reported that 76% -85% of SLE patients can live for 10 years as big as 88% of patients experienced at least flawed in a number of body organs in the long term and settle down.

B. Nursing
a. Research
 Skin
 joint
 pain scale
 Inspection of the chest and heart
b. Nursing diagnosis
 Damage to skin integrity
 fatique (tiredness)
 The body image disorders
 Lack of knowledge
 Pain (acute / chronic)
c. Nursing plan
 Improve skin integrity
 Energy Management
 Improve citratubuh
 Management of pain
 Education and care at home
d. Execution / Implementation
e. Evaluation

C. HEALTH EDUCATION
D. Advocacy
E. LEGAL - ethics - MORAL
F. RELATED JOURNAL