Care of the Lupus Patient
Lupus symptoms tend to present themselves
according to the body system affected. These symptoms vary over time in
intensity and duration for each patient as well as from patient to patient. To
effectively care for a lupus patient, the nurse or other health professional
needs an up-to-date knowledge and understanding of the disease, its many
manifestations, and its changing and often unpredictable course.
This article provides an
overview of general and system-specific lupus manifestations and identifies
potential problems. Suggested health care interventions for the nonhospitalized
lupus patient are given. Many of these interventions can be modified for the
hospitalized patient. The information and nursing interventions described in
this article are not meant to be inclusive, but to provide the practitioner
with guidelines for developing a care plan specific to the needs of each lupus
As a care plan is developed,
the health professional should keep in mind the importance of frequently
reassessing the patient's status over time and adjusting treatment to
accommodate the variability of SLE manifestations. An additional and very
important element of working with the lupus patient is to incorporate the
patient's needs and routines in the plan of care. Adjusting nursing
interventions and medical protocols to the patient's needs not only recognizes
the value of the patient as an authority on her or his own illness but also can
improve patient compliance and result in an improved quality of
Working together, the care
provider and the patient have much to offer each other. The rewards are
tremendous for the patient and family as independence is gained and the trust
in the ability to care for oneself is strengthened.
Systemic Lupus Erythematosus
psychological and emotional effects.
Dermatologic: Butterfly rash, photosensitivity, DLE, subcutaneous
LE, mucosal ulcers, alopecia, pain and discomfort, pruritus,
Musculoskeletal: Arthralgias, arthritis, other joint
Hematologic: Anemia, decreased WBC count, thrombocytopenia,
lupus anticoagulants, false-positive VDRL, elevated ESR.
Cardiopulmonary: Pericarditis, myocarditis, myocardial infarction,
vasculitis, pleurisy, valvular heart disease.
Renal: Asymptomatic microscopic renal involvement, renal
failure, fluid and electrolyte imbalance, urinary tract infection.
Central Nervous System
(CNS): General CNS symptomology,
cranial neuropathies, cognitive impairment, mental changes,
Gastrointestinal: Anorexia, ascites, pancreatitis, mesenteric or
Ophthalmologic: Eyelid problems, conjunctivitis, cytoid bodies, dry
eyes, glaucoma, cataracts, retinal pigmentation.
Pregnancy: Lupus flare, miscarriage or stillbirth,
pregnancy-induced hypertension, neonatal lupus.
Infection: Increased risk of respiratory tract, urinary tract,
and skin infections; opportunistic infections.
Nutrition: Weight changes; poor diet; appetite loss; problems
with taking medications; increased risk of cardiovascular disease, diabetes,
osteoporosis, and kidney disease.
Systems Potentially Affected by Lupus
General Manifestations of SLE
Fatigue is a nearly universal
complaint of patients with SLE even when no other manifestations of the disease
are present. The cause of this debilitating fatigue is not known. The patient
should be evaluated for factors that may exacerbate fatigue, such as
overexertion, insomnia, depression, stress, anemia, and other inflammatory
diseases. Fatigue in SLE patients may be lessened by adequate rest, healthful
diet, exercise, and attention to psychosocial factors.