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PATIENT CARE PROCESS

Patient Care Process for the Management of Systemic Lupus Erythematosus

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Collect

  • Patient characteristics (e.g., age, race, sex, pregnancy status)

  • Patient history (past medical, pregnancies and outcomes, symptoms, family, social—dietary habits, alcohol and tobacco use)

  • Current medications and prior lupus medication use

  • Immunization history

  • Objective data (see Clinical Presentation and Table 87-1)

    • Blood pressure (BP), heart rate, height, weight, and BMI; other physical exam findings

    • Labs (metabolic panel, Scr, BUN, urinalysis, CBC, ANA, antiphospholipid antibodies, direct Coomb's test, other lupus-associated antibodies, complement, inflammatory markers (ESR, CRP)

    • Other diagnostic tests when indicated (e.g., ECG, CXR, skin or kidney biopsy)

Assess

  • Presence of cutaneous, renal, neurologic, hematologic, cardiac, or pleural manifestations of lupus

  • Evidence of antiphospholipid syndrome (thromboembolic events, miscarriages)

  • Current medications that could be associated with drug-induced lupus

  • Appropriateness and effectiveness of current lupus regimen (see Figures 87-2 and 87-3)

  • Psychological effects of lupus

Plan*

  • Goals of treatment

  • Tailored lifestyle modifications (e.g., diet, exercise, weight management, protection from sun, smoking cessation, keeping warm if Raynaud phenomenon occurs)

  • Drug therapy regimen including specific medications based on disease manifestations, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Figures 87-2 and 87-3 and Tables 87-2 and 87-3)

  • Monitoring parameters including efficacy (e.g., skin manifestations, cardiovascular events, thromboembolic events, miscarriages, kidney health, neurologic events), safety (medication-specific adverse effects), and timeframe

  • Patient education (e.g., purpose of treatment, dietary and lifestyle modifications, drug therapy, pregnancy considerations, osteoporosis prevention if taking corticosteroids)

  • Self-monitoring of skin and BP—where and how to record results

  • Immunizations as needed; consider timing of live vaccines with respect to immunosuppressive drug use

  • Referrals to other providers when appropriate (e.g., physician, dietician)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up based on severity of symptoms and stability

Follow-up: Monitor and Evaluate

  • Determine goal attainment based on disease manifestations

  • Presence of adverse effects

  • Occurrence of CV events and development/progression of kidney or other organ impairment

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Systemic lupus erythematosus (SLE) is considered a disease primarily of young women, but can occur in anyone. The prevalence and severity vary with sex, race, ethnicity, and socioeconomic factors.

  • Image not available. Understanding the etiology of SLE and environmental factors that can initiate or exacerbate the disease may make it possible to avoid those triggers.

  • Image not available. SLE is an autoimmune disease characterized by the presence of autoantibodies, some of which may play a role in the pathogenesis of the disease. An understanding of disease mechanisms can lead to targeted drug therapy.

  • Image not available. SLE is a multisystem disease that can involve almost any organ and may present in many different ways. Therapy is determined by the manifestations in each patient. These may change and fluctuate in severity over time.

  • Image not available. Lifestyle changes can modify risk ...

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