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Care of the Lupus Patient

Gastrointestinal Manifestations

Overview

Gastrointestinal (GI) problems are common and range from vague complaints of anorexia to life-threatening bowel perforation secondary to mesenteric arteritis. Anorexia, nausea, vomiting, and diarrhea may be related to the use of salicylates, NSAIDs, antimalarials, corticosteroids, and cytotoxic drugs.

SLE patients who present with acute abdominal pain and tenderness need immediate, aggressive, and comprehensive evaluation to rule out an intra-abdominal crisis. Ascites, an abnormal accumulation of fluid in the peritoneal cavity, is found in about 10% of SLE patients. Pancreatitis is a serious complication occurring in approximately 5% of SLE patients and is usually secondary to vasculitis.

Mesenteric or intestinal vasculitis are life-threatening conditions that may have complications of obstruction, perforation, or infarction. They are seen in more than 5% of patients with SLE. Abnormal liver enzyme levels are also found in about one-half of SLE patients (usually secondary to medications). Active liver disease is rarely found.

Potential Problems

  1. Alteration in GI function related to drug therapy or disease process
  2. Nutritional deficiencies

Nursing Interventions

Objective: Minimize Complications from GI Manifestations

  1. Assess patient for GI problems at each visit.
  2. Monitor laboratory results.
  3. Suggest measures that may increase comfort, such as throat lozenges, saline rinses, or small, frequent meals.
  4. Instruct patient to immediately report any sudden or severe abdominal pain, shortness of breath, or epigastric pain to physician.
  5. Refer patient to dietitian.

Potential GI Manifestations

General Manifestations

  • Persistent sore throat
  • Dry mouth (characteristic of patients with coexisting Sjogren's syndrome)
  • Anorexia
  • Nausea and vomiting
  • Diarrhea
  • Dysphagia (especially in association with Raynaud's phenomenon)

Pancreatitis

  • Mild nonspecific abdominal pain to severe epigastric pain radiating to the back
  • Nausea
  • Vomiting
  • Elevated serum amylase level
  • Dehydration

Ascites

  • Abdominal distention
  • Bulging flanks
  • Downward protruding umbilicus

Mesenteric and Intestinal Vasculitis

  • Cramping or constant abdominal pain
  • Vomiting
  • Fever
  • Diffuse direct and rebound abdominal tenderness

Ophthalmologic Manifestations

Overview

Visual impairment may be due to SLE or to drug treatment (corticosteroids or antimalarials), or it may be a separate problem (glaucoma or retinal detachment). Blindness due to SLE occurs, but is rare. Other visual problems may occur:

  • A lupus rash may develop on the eyelids.
  • Conjunctivitis occurs in 10% of SLE patients and is usually infectious. Kerato-conjunctivitis is usually mild.
  • Cytoid bodies are the most common retinal change in SLE. They reflect microangiopathy of the retinal capillaries and localized microinfarction of the superficial nerve fiber layers of the retina.
  • Sjogren's syndrome is an autoimmune condition manifest as excessive dryness of mucous membranes. Lupus patients with these symptoms require artifical tears to relieve dry eyes.
  • Glaucoma and cataracts may be caused by corticosteroids.
  • Antimalarials can damage the retina, which can impair vision (particularly color vision) or, rarely, cause blindness.

Potential Ophthalmologic Manifestations

  • A lupus rash on the eyelids
  • Red, sore, swollen eyes
  • Tearing
  • Mucus discharge from eyes, particularly upon awakening
  • Sensitivity to light
  • Change in vision
  • Blurred vision
  • Cloudy lens(es)
  • Dry eyes
  • Burning sensation in eyes

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

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