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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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