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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 patient.

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 life.

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

General Manifestations

Fatigue, fever, psychological and emotional effects.

Specific Manifestations

Dermatologic: Butterfly rash, photosensitivity, DLE, subcutaneous LE, mucosal ulcers, alopecia, pain and discomfort, pruritus, bruising.

Musculoskeletal: Arthralgias, arthritis, other joint complications.

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, seizures.

Gastrointestinal: Anorexia, ascites, pancreatitis, mesenteric or intestinal vasculitis.

Ophthalmologic: Eyelid problems, conjunctivitis, cytoid bodies, dry eyes, glaucoma, cataracts, retinal pigmentation.

Other Key Issues

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

Care of the Lupus Patient

General Manifestations of SLE

Overview

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.

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WebMD Public Information from the U.S. National Institutes of Health

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