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27NURSING CARE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATO
Denisa Veseli (BEGO),
PhD.
Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania
Zamira Imeraj, PhD.
Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania
Alma Imami Lelca,
PhD.
Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania
Gazmira Mici,
Service of Infectious Diseases, University Hospital Center, Tirana,Albania
Suzana Sinakolli
Service of Infectious Diseases, University Hospital Center, Tirana,Albania
Abstract
Systemic Lupus Erythematosus (SLE) is a chronic inflammatory disease of the connective tissue, often febrile, multi systemic, with frequent relapses, which is mainly characterized by damage to the skin, joints, kidneys and serous membranes.
Keywords: SLE, clinical signs, nursing care
Methods: The study was developed within a period of 1 years in the city of Tirana. This is a retrospective study, in which cases with systemic lupus erythematosus and nursing care in these patients were studied. The data collection was made from the statistics of the University Hospital "Mother Teresa" Tirana for patients registered in 2020 and 2021 with the diagnosis of SLE.
Results: Patients with the diagnosis of systemic lupus erythematosus, from the demographic distribution of patients with SLE, patients from the districts with 51% and from Tirana 49% of them. From the evaluation of the gender of patients with SLE, we have women with 87% of patients. From the age group 2130 years 26.7%, the age group 41-50 years occupy 19.8% and 51-60 years 18.8%. In the relationship between age and gender we see that we have women in the age group 21-30 years with 22 ,8%, also the 41-50 age group accounts for 17.8% and 51-60 years 16.8%.
Conclusions: From the results we see that we have a predominance of female patients with SLE, this coincides with the data of the literature, patients from the districts in our study dominate, in terms of age groups we see that the highest percentage of patients are in young ages and in differences between age and gender, we see that women aged 21-30 years prevail.
Entry
Lupus is a chronic, long-term disease that causes inflammation and pain in every part of the body. It is an autoimmune disease, which means that the immune system, which fights infections in our body, fights healthy tissue instead. It most often affects the joints, skin, internal organs such as kidneys and heart.(1,2,3)
The history of lupus
The history of lupus can be divided into three periods: classical, neoclassical and modern.
1. Lupus in the classical period (1230-1856)
The history of lupus during the classical period was reviewed by Smith and Cyr in 1988. The word 'lupus' (Latin for 'wolf') is attributed to the thirteenth-century physician Rogerius, who used it to describe pinkish facial lesions reminiscent of bites of a wolf. The classic descriptions of the distinct dermatological features of lupus were made by Thomas Bateman, a student of the British dermatologist Robert William, in the early 19 century; Casenave, a student of the French dermatologist Laurent Biett, in the mid/ 19 century; and Moriz Kaposi (born Moriz Kohn), student and son-in-law of Austrian dermatologist Ferdinand von Hebra, in the late 19 century. (1,2,3)
2. Lupus in the neoclassical period (1872-1948)
The neoclassical era of lupus history began in
1872 when Kaposi first described the systemic nature of this disorder: "... experience has shown that lupus erythematosus ... may be followed by completely more severe pathological changes, even by constitutional symptoms of dangerous. It may be intimately connected with the process in question, and that death may result from conditions which must be regarded as arising from local disease."
3. Lupus in the modern era (1948-present)
The event that heralded the modern era was the discovery of the LE cell by Hargraves and colleagues in 1948. Investigators observed these cells in the bone marrow of individuals with acute disseminated lupus erythematosus and postulated that the cell "... is the result of ... phagocytosis of of free nuclear material with a resulting round vacuole containing this partially dissolved and lysed nuclear material..."
This discovery ushered in the current era of applying immunology to the study of lupus erythematosus; it also allowed the diagnosis of individuals with much milder forms of the disease. This possibility, coupled with the discovery of cortisone as a treatment, changed the natural history of lupus as it was known before that time. (1,2,3)
Nursing care in patients with SLE
Nursing goals for a systemic lupus erythematosus (SLE) client may include relieving pain and discomfort, relieving fatigue, maintaining skin integrity, complying with prescribed medications, and increasing knowledge about the disease and the absence of complications. (3,4,5)
• Here are 4 diagnosis and nursing care plans (NCP) for Systemic Lupus Erythematosus (SLE):
J Nursing Care Plans
J Impaired skin integrity
J Acute pain
J Fatigue
1 Little knowledge
Assess the skin for integrity. Small lesions may develop on the mucous membrane of the mouth and nose. Unpleasant lesions that appear as a dense macu-lopapular rash may occur on the client's face or chest.(3,4,5)
Assess for an erythematous rash, which may be present on the face, neck, or extremities. The classic "butterfly" blush can appear across the bridge of the nose and on the cheeks and typically appears in a butterfly configuration. This is evident in about 50% of clients.
Assess for sensitivity to light. Clients may react violently to ultraviolet light or sunlight. Flares of illness or outbreaks of severe rash may occur in response to exposure.
Assess the extent to which symptoms interfere with the client's lifestyle and body image. A wide range of behaviors are associated with body image changes, ranging from complete ignorance of the change to preoccupation with it.
Instruct the patient to clean, dry, and moisturize intact skin; use warm (not hot) water, especially on bony prominences; use unscented lotion. Use a mild shampoo. Scented lotions may contain alcohol, which dries out the skin. The prescribed solutions reduce the dryness of the scalp and preserve the integrity of the skin.(1,2,3,4,5)
Assess the client's description of the pain.
Clients with SLE often experience arthralgia of many joints with morning stiffness. Joint stiffness associated with systemic lupus erythematosus (SLE) may not be related to overuse or activity; it's actually a response to immune complexes multiplying and setting up an inflammatory response in that particular part of the body. Patients with SLE may also have arthritis; thus stiffness and discomfort are very facto-rial.(5,6.7,8,9)
Assess the client's description of fatigue: time (afternoon or all day), relationship to activities, and aggravating and mitigating factors. This information can be useful in developing and organizing activity patterns that choose the time when the client has the greatest energy reserve.
Instruct lifestyle activities that can help reduce flare-ups such as:
• Eating a balanced diet of fruits, grains and vegetables.
• Regular exercise
• Avoiding sun exposure
• Adequate rest
A positive approach to helpful therapies allows the client to be an active partner in the treatment of this chronic condition.(5,6)
Diagnosis and plan of nursing interventions
Learning self-care for the SLE patient is an important aspect of nursing care, generating greater independence for the individual when dealing with changes related to treatment regimens, adverse drug reactions, and their safety at home. Diagnosis and treatment care should be directed towards providing information about the disease, day care and social support. (7,8,9)
The Purpose of the Study:
To get to know nursing care in patients with the diagnosis of Systemic Lupus Erythematosus
Objectives:
1. To estimate the number of patients with LES.
2. To assess the demographic distribution of patients with SLE.
3. To assess the distribution of patients by gender.
4. To evaluate the distribution of patients according to age group.
5. To evaluate the distribution of patients in relation to gender and age group.
Methodology:
The study was conducted within a 1year period in the city of Tirana. This is a retrospective study, in which cases with systemic lupus erythematosus and nursing care in these patients were studied. The data collection was made from the statistics of the University Hospital "Mother Teresa" Tirana for patients registered in 2020 and 2021 with the diagnosis of SLE.
Results of the study
The study included patients registered with the diagnosis of systemic lupus erythematosus in 2020 and 2021, 101 patients with SLE were included in the study, out of a total of 129 patients with discoid and systemic lupus registered.
Table 1.
Tirane City /localities
No. of patients 41 60
Discussion of Results
Chart 1.
It shows the distribution of patients diagnosed with systemic lupus erythematosus and discoid lupus.
DISTRIBUTION OF PATIENTS ACCORDING TO THE TYPE OF LUPUS
■ Lupus Eritematoz sistemik ■ Lupus dicoid
As can be seen from the graph: -78% of patients are diagnosed with SLE -22% of patients have discoid lupus
Table 2.
Lupus Eritematozsistemik Lupus dicoid
No. of patients 101 28
Chart 2.
Shows the demographic distribution of patients with SLE
As shown in the graph:
-59% of patients with LES are from the Districts -41% of patients with SLE are from
Table 3.
Woman Man
No. of patients 88 13
Chart 3.
Shows the distribution of patients with SLE by gender.
As shown in the graph: -87% of SLE patients are women -13% of SLE patients are male
Table 4.
Age estimation of SLE patients___
Age 10-20 age 21-30 age 31-40 age 41-50 age 51-60 age 61-70 age
No of patients 12 27 14 20 19 9
Chart 4.
Shows the age distribution of SLE patients
As can be seen from the graph: - from the age group of 10-20 years are 11.9% of patients with SLE
-from the age group 21-30 years are 26.7% of patients with SLE
-from the 31-40 age group are 13.9% of patients with SLE
-from the 41-50 age group are 19.8% of patients with SLE
- from the group of 51-60 years old are 18.8% of patients with SLE
-from the 61-70 age group are 8.9% of patients with SLE
Distribution of SLE
)atients in relation to gender and age
Table 5.
Age group Woman Man
10- 20 age 11 1
21- 30 age 23 4
31-40 age 12 2
41- 50 age 18 2
51- 60 age 17 2
61- 70 age 5 4
Chart 5.
Shows the distribution of SLE patients in relation to gender and age.
Distribution of pationts with SLE in relation between gender and age
25,0% 20,0% 15,0% 10,0% 5,0% 0,0%
22,8
10,9%
1,0%
-17,8% 16,8%
11,9%
4,0% 5,°% 4,0%
^ 2,0% 2,0% 2,0% ^
As can be seen from the graph:
- from the age group of 10-20 years, 10.9% are women and 1% are men of patients with SLE
- from the 21-30 age group, 22.8% are women and 4% are men of SLE patients
- from the 31-40 age group, 11.9% are women and 2% are men of patients with SLE
-from the 41-50 age group, 17.8% are women and 2% are men of patients with SLE
-from the 51 -60 year old group, 16.8% are women and 2% are men of SLE patients
-from the 61-70 age group, 5% are women and 4% are men of patients with SLE
Conclusions
Analyzing the data of this study we can say that:
Patients diagnosed with systemic lupus erythema-tosuse are more numerous than patients with discoid lupus, they account for 78% of patients diagnosed with lupus.
From the demographic distribution of patients with LES, we see that patients from the districts dominate with 51% and from Tirana 49% of them.
From the assessment of the gender of patients with SLE, we see that women predominate with 87% of patients.
Assessing the age of patients diagnosed with SLE, we see that the highest percentage of patients is in the 21-30 age group with 26.7%, also the 41-50 age group is 19.8% and 51-60 years 18, 8%.
In the relationship between age and gender, we see that we have the highest percentages of women in the age group 21-30 years with 22.8%, also the age group 41-50 years occupy 17.8% and 51-60 years 16.8%.
Recommendation
Systemic lupus erythematosus is a universally spreading autoimmune disease. Its pathogenesis is unknown, therefore it is associated with a multifactorial origin where genetic, hormonal and environmental factors mainly intervene. There is no characteristic clinical picture or regularity in terms of presentation, as its involvement is systemic. There are general symptoms such as fever, loss of weight or appetite and fatigue, the latter being the most common, and disabilities. In addition, each patient may present different symptoms of
organic involvement, renal manifestations being the most severe.
Improved diagnosis in recent years allows treatment to be implemented as soon as possible. In this way, the prognosis of LES has been significantly improved, increasing the life expectancy of these patients.
It should be emphasized that the role of nursing is essential to improve the quality of life of these patients by providing care, information and a series of general recommendations such as sun protection, physical exercises, diet, smoking, educational pro-grams.(4,5,6,7,8,9,)
References:
1. Christie M Bartels, M. M. (2020, march 18). Pathophysiology. Retrieved from Medscape: https://emedicine.medscape.com/article/332244-overview#a3
2. Christie M Bartels, M. M., & Chief Editor: Herbert S Diamond. (2020, march 18). Systemic Lupus Erythematosus (SLE) Treatment & Management. Retrieved from Medscape.com: https://emedicine.medscape.com/article/332244-treatment
3. Christie M Bartels, M. M., & Diamond, C. E. (2020, march 18). Epidemiology of LES. Retrieved from Medscape.com:
https://emedicine.medscape.com/article/332244-overview#a5
4. Christie M Bartels, M. M., & Diamond, C. E. (2020, march 18). Systemic Lupus Erythematosus (SLE) Differential Diagnoses. Retrieved from Medscape .com:
https://emedicine.medscape.com/article/332244-differential
5. Etiology. (2020, March 18). Retrieved from Medscape :
https://emedicine.medscape.com/article/332244-overview#a4
6. OLIVEIRA, C. M. (2016, august 16). LUPUS ERITEMATOSO SISTEMICO: UN FALLIMENTO DEL SISTEMA IMMUNITARIO. Rivista scientifica multidisciplinare di nucleo di conoscenza. , Anno 1. Vol. 6, pp. 52-67.
7. Tafaj, d. A. (2004). Reumatologjia . Tirane: albPAPER.
8. What are the types of lupus? (2021, may). Retrieved from lupus fondation of america:
https://www.lupus.org/resources/about-drug-induced-lupus
9. what is lupus. (2021, may). Retrieved from lupus fondation of america : http://www.lupus.org/resources
УДК: 616-006.61.616-07
PROBLEMS IN DIAGNOSING EARLY FORMS OF CERVICAL CANCER
Toktanalieva A.,
post-graduate student of KRSU, Bishkek, Kyrgyzstan,
Sultangazieva B., director of the NCOG, Bishkek, Kyrgyzstan,
Makimbetov E.
professor of KRSU, Bishkek, Kyrgyzstan
ПРОБЛЕМЫ ПРИ ДИАГНОСТИКЕ РАННИХ ФОРМ ЦЕРВИКАЛЬНОГО РАКА
Токтаналиева А.Н.
аспирант КРСУ, г. Бишкек, Кыргызстан, Султангазиева Б.Б. директор НЦОГ, г. Бишкек, Кыргызстан, Макимбетов Э.К. проф. КРСУ, г. Бишкек, Кыргызстан Национальный центр онкологии и гематологии МЗ КР, г. Бишкек
https://doi.org/10.5281/zenodo.7327055
Abstract
Cervical cancer (CQ is an urgent problem not only in oncogynecology, but also in all oncology. This is due to the fact that about one million women in the world initially registered with CC every year. About 85% of all cases of CC occur in undeveloped and developing countries of the world. Consequently, there is a significant variability in the distribution of CC. Approximately half of patients with cervical cancer dies from the number of initially registered cases. This is due to the lack of government programs for prevention, screening and early detection of CC. In Kyrgyzstan, there is also a high level of neglect of CC, a small percentage of early forms of the disease. The article highlights the problems in the diagnosis of early forms of CC.
Аннотация
Рак шейки матки (РШМ) является актуальной проблемой не только в онкогинекологии, но и всей онкологии. Это вызвано тем, что ежегодно в мире заболевает около одного миллиона женщин РШМ. Около 85% всех случаев РШМ приходится на неразвитые и развивающиеся страны мира. Следовательно, имеется значительная неравномерность в распространении РШМ. Примерно половина пациенток РШМ умирает из числа впервые зарегистрированных. Это обусловлено отсутствием государственных программ профилактики, скрининга и раннего выявления РШМ. В Кыргызстане также имеется высокая запущенность РШМ, малый процент ранних форм заболевания. В статье освещены проблемы при диагностике ранних форм РШМ.
Keywords: cervical cancer, incidence, early forms, cervical intraepithelial neoplasia, precancerous.
Ключевые слова: рак шейки матки, заболеваемость, ранние формы, цервикальная интраэпителиаль-ная неоплазия, предрак.
Введение. На региональном и глобальном уровнях существуют большие различия в распространенности и смертности от рака шейки матки (РШМ), отчасти из-за различий в обеспечении массового скрининга и первичной профилактики. Различные регионы мира, как внутри стран, так и между ними, различаются в плане доступа к профилактике и лечению [1,4].
Примерно 85% случаев РШМ происходит в менее развитых регионах мира (также известных как страны с низким и средним уровнем дохода), что
составляет 12% случаев рака у женщин в этих регионах. Восемьдесят семь процентов смертей от РШМ приходится на эти менее развитые регионы. Некоторые регионы мира с самыми высокими показателями смертности включают Юго-Восточную Азию и западную часть Тихого океана, за которыми следуют Индия и Африка [2].
В развитых странах создание национальных программ скрининга с популяционным приглашением подходящих женщин и системой отзыва положительных результатов скрининга привело к профилактике почти 70% случаев рака шейки матки.
