All posts by : chebby

My topic is to review the cardiovascular complications of Systemic Lupus Erythematosus (SLE) .

Patients with SLE have a higher risk of stroke, heart attack, and thromboembolic disorders.  The relative risk of CVD is around 2.5 times normal due to SLE (Bello, 2022)

1. Describe the specific pathophysiological processes in SLE that lead to the manifestations observed in your assigned body system. How does SLE affect your assigned body system? 

SLE causes chronic inflammation in blood vessels throughout the body. High Blood Pressure (HTN) is common for people with SLE.  SLE Kidney damage also causes HTN. 

Vessel inflammation and HTN cause atherosclerosis of coronary arteries and heart attacks are more likely for SLE patients. 

An antibody that is a hallmark of SLE autoimmunity is called anti phospholipid antibody (APL).  This APL antibody can trigger clots, and it can start inflammation on the surface of blood vessels or cardiac tissue. 

Direct SLE inflammation of cardiac tissues is another burden for patients.  Pericarditis occurs in 25%, Endocarditis in 15% and Myocarditis in 10% of SLE patients.  The valve damage that happens in Lupus endocarditis is not from infection it is from immune complex deposits on the valve surface (Ibrahim, 2023).  Scars and hypertrophy impair the valve function. 

   2. Discuss the symptoms and clinical manifestations of SLE on your assigned body system. How do these symptoms impact the client’s function and quality of life? Can changes in your assigned body system affect or be affected by other body systems in clients with SLE? 

The presentation of CVD in SLE patients is not different than for other patients.  SLE patients have the typical signs and symptoms for HTN, heart attack, stroke, venous thrombosis, embolism and heart valve disease.  What is different is that these conditions occur earlier in life.  SLE is more common in women than men, so SLE is the cause of heart disease in women in their 30s and 40s.  Chest pain, shortness of breath are seen in SLE heart attack, endocarditis, pericarditis, and myocarditis. 

Heart disease can affect the function of all other organs.  Poor pump function (CHF) affects lung function, kidney, liver and brain function.  Clots can block blood flow where they form or travel and cause tissue damage.  It is possible for Lupus patients to have heart disease, kidney injury and vision loss all at the same time.

   3. Discuss the diagnostic tests used to diagnose SLE-related complications in your body system. What challenges are associated with diagnosing SLE if only looking at your assigned body system? 

If a person presents for care with signs and symptoms of a cardiac condition and we don’t know they have SLE, we would use the usual diagnosis tools for heart disease; EKG, echocardiogram, stress test or even cardiac cath.  We would also get blood tests to check for heart muscle damage, like troponins.  SLE patients have HTN and atherosclerosis like everyone else, but people with SLE get it younger and more severe.  The one heart condition that is more commonly seen in Lupus is valve damage.  This is diagnosed with an Echocardiogram.  This is one example of how a heart test might make the care team consider SLE. 

   4. Explore the current treatments for managing SLE symptoms associated with your assigned body system. What are the goals of these treatments and how effective are they in mitigating the impact of SLE on the body?  

Medications used for control of LUPUS inflammation include Hydroxychloroquine (HCQ) and corticosteroids.  HCQ is taken chronically.  Steroids are used to control flare ups.  Some patients get targeted auto immune therapy (Siegel, 2024). 

Suppression of Lupus activity with these drugs can delay the onset of organ damage.

The treatments for heart disease caused by SLE are the usual treatments.  Blocked arteries get stents or bypass surgery.  High blood pressure gets HTN medication.  Clots get blooder thinners.  Valves can be replaced if severely damaged.  Poor heart pumps get CHF medication.

     In summary, Lupus is a rough illness that causes damage to blood vessels and all organs.  Heart disease happens younger in SLE patients.  Suppression of Lupus and control of other CVD risk factors are goals of care.

Bello N, Meyers KJ, Workman J, Hartley L, McMahon M. Cardiovascular events and risk in patients with systemic lupus erythematosus: Systematic literature review and meta-analysis. Lupus. 2023 Mar;32(3):325-341. doi: 10.1177/09612033221147471. Epub 2022 Dec 22. PMID: 36547368; PMCID: PMC10012401.

Ibrahim AM, Siddique MS. Libman-Sacks Endocarditis. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532864/Links to an external site.

Siegel CH, Sammaritano LR. Systemic Lupus Erythematosus: A Review. JAMA. 2024;331(17):1480–1491. doi:10.1001/jama.2024.2315

Topic: ACA and Health-Care Outcomes & Costs

What components of the ACA do you think will have a positive effect on improving health care outcomes and decreasing costs? 

Submission Instructions:

• Post should be at least 500 words, formatted and cited in current APA style with support from at least 2 current academic sources within past 5 years

see attached

Describe the influence “levels of evidence” have on practice changes. Identify the most reliable level of evidence and provide an example of the type of practice change that could result from this level of evidence.

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.

Attached 

Need help with a question.

APA format

Minimum 1 paragraph per reply

Total of 2 replies

Due in 8 hrs

Statistical significance refers to the likelihood that the results of a study are not due to chance, while clinical significance refers to the practical importance of the results in terms of their impact on patient care. In other words, statistical significance is a measure of the strength of the evidence, while clinical significance is a measure of the relevance of the evidence to real-world situations.

Using a quantitative research article from one of the previous topics, analyze the p-value. What is it? Is it statistically significant? If your p-value is not statistically significant, what is the clinical significance? Generalizability of research depends on a variety of factors. List three factors of generalizability, and discuss whether this research article is generalizable to the nursing problem you are researching.

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.

For previous articles, check the attachments.

My assigned body system will be – Hematology System

1. Describe the specific pathophysiological processes in SLE that lead to the manifestations observed in your assigned body system. How does SLE affect your assigned body system?                          – Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of autoantibodies that target various tissues in the body. In the hematologic system, several specific pathophysiological processes occur: –
   • Autoantibody Production: SLE leads to the formation of autoantibodies, such as anti-nuclear antibodies (ANAs) and anti-dsDNA antibodies, which can bind to red blood cells, white blood cells, and platelets. 
   • Hemolytic Anemia: The binding of antibodies to red blood cells can lead to their destruction (hemolysis), resulting in hemolytic anemia, which is characterized by a decrease in red blood cell count. 
   • Thrombocytopenia: Autoantibodies may also target platelets, leading to thrombocytopenia (low platelet count), which increases the risk of bleeding and bruising. 
   • Leukopenia: SLE often causes a decrease in white blood cells (leukopenia), which impairs the immune response and increases susceptibility to infections. 
2. Discuss the symptoms and clinical manifestations of SLE on your assigned body system. How do these symptoms impact the client’s function and quality of life? Can changes in your assigned body system affect or be affected by other body systems in clients with SLE? – Symptoms and clinical manifestations of SLE affecting the hematologic system include:
   • Fatigue and weakness: Resulting from anemia. 
   • Pallor: Due to decreased red blood cell count. 
   • Easy bruising and bleeding: From thrombocytopenia. 
   • Frequent infections: Due to leukopenia.                                                                                                                                                                                                                                                                 -These symptoms can severely impact the client’s function and quality of life, leading to decreased physical activity, increased healthcare utilization, and emotional distress due to persistent fatigue and fear of bleeding or infections. The interconnectedness of body systems means that changes in the hematologic system can affect other systems, such as the immune system (increased susceptibility to infections) and the cardiovascular system (anemia can lead to cardiovascular strain). 
3. Discuss the diagnostic tests used to diagnose SLE-related complications in your body system. What challenges are associated with diagnosing SLE if only looking at your assigned body system? – Complete Blood Count (CBC): To assess for anemia, leukopenia, and thrombocytopenia.
   • Peripheral Blood Smear: To evaluate the morphology of blood cells and identify hemolysis signs. 
   • Direct Coombs Test: To determine if hemolytic anemia is present. 
   • Challenges: Diagnosing SLE can be difficult when only focusing on the hematologic system because these abnormalities can also be seen in other conditions, such as infections, malignancies, or other autoimmune diseases. This overlap can lead to misdiagnosis or delayed diagnosis. 
4. Explore the current treatments for managing SLE symptoms associated with your assigned body system. What are the goals of these treatments, and how effective are they in mitigating the impact of SLE on the body?  
   • Corticosteroids: to reduce inflammation and suppress the immune response in cases of severe anemia or thrombocytopenia. 
   • Immunosuppressants: azathioprine or mycophenolate mofetil, to manage autoimmune activity. 
   • Blood transfusions: for severe anemia. 
   • Erythropoietin-stimulating agents: to stimulate red blood cell production in chronic anemia. 
   •  Goals of Treatment
     – To reduce symptoms and improve blood counts.
     – To minimize the risk of complications, such as severe anemia or bleeding.
     – To enhance overall quality of life by managing fatigue and preventing infections.
     These treatments can effectively mitigate the impact of SLE on the hematologic system, though they may have side effects and require careful monitoring.                                                                The overall goal is to maintain a balance between managing SLE activity and minimizing treatment-related complications.