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Care of the Lupus Patient

Central Nervous System Manifestations continued...

Cranial or peripheral neuropathy occurs in 10-15% of patients; it is probably secondary to vasculitis in small arteries supplying nerves. Cerebrovascular accidents (strokes) are reported in approximately 15% of patients. Between 10 and 20% of patients experience seizures. Although cognitive impairment is believed to be very common, there are few measurements to document it.

Serious CNS involvement ranks behind only kidney disease and infection as a leading cause of death in lupus. However, the majority of SLE patients with CNS complications do not develop a life-threatening disease.

Potential Problems

  1. Alteration in mental status, cognition, and perception
  2. Altered ability to perform ADL and meet family responsibilities
  3. Potential for injury

Nursing Interventions

Objective: Develop Plan for Patient to Perform ADL Appropriately and Independently

Assess and document patient's mental status to determine her or his capabilities:

  • general appearance
  • unusual body movements
  • speech patterns and word use
  • alertness and orientation to time, place, and person
  • memory of remote and recent past
  • perception of self and environment
  • affect and emotional stability
  • ability to solve problems
  • presence of depression

Support patient's need to maintain some control over daily activities and decisions:

  • encourage patient to plan and participate in daily routines
  • set aside time to develop trust and rapport with patient, and be consistently truthful (patients are keenly aware of inconsistencies in information provided)

Potential CNS Manifestations

General CNS Lupus

  • Headaches
  • Fever
  • Confusion
  • Seizures
  • Psychosis

Cranial Neuropathies

  • Visual defects
  • Blindness
  • Nystagmus (involuntary movement of the eyeball)
  • Ptosis (paralytic drooping of the eyelid)
  • Papilledema (edema in the optic disk)
  • Tinnitus
  • Vertigo
  • Facial palsy

Cognitive Impairment

  • Confusion
  • Impaired long- and short-term memory
  • Difficulty in conceptualizing, abstracting, generalizing, organizing, and planning information for problem solving
  • Difficulties in personal and extrapersonal orientation
  • Altered visual-spatial abilities
  • Selective attention
  • Difficulties in pattern recognition, sound discrimination and analysis, and visual-motor integration

Mental Changes

  • Depression
  • Anxiety
  • Affective disorder
  • Mood swings
  • Hypomania or mania (especially with corticosteroid use)

Rare CNS Manifestations

  • Movement disorder
  • Aphasia
  • Coma

Encourage patient to discuss effects of SLE on her or his personal life and coping methods. Allow expressions of fear and anger.

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