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Lupus Health Center

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Care of the Lupus Patient

Potential Ophthalmologic Manifestations continued...

Potential Problems

  • Discomfort
  • Visual impairment
  • Potential for injury
  • Difficulty carrying out ADL

Nursing Interventions

Objective: Minimize Discomfort

  1. Allow time for patient to express concerns and ask questions.
  2. Teach the patient how to apply artificial tears for dry eyes to increase comfort and prevent corneal abrasion.
  3. Teach patient the correct way to take prescribed medications, such as eye drops for glaucoma.
  4. Suggest warm, moist compresses, which may help ease discomfort and itching from conjunctivitis.

Objective: Minimize Potential for Serious Visual Impairment or Blindness

  1. Assess patient's vision changes and impairments.
  2. Reinforce the need to follow up with an ophthalmologist.

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

  1. Provide referrals to support groups and services for the visually impaired.

Pregnancy

Overview

Twenty years ago, women with lupus were counseled not to become pregnant because of the risk of a flare of the disease and an increased risk of miscarriage. Research and careful treatment have made it possible for more and more women with lupus to have successful pregnancies. Although a lupus pregnancy is still considered high risk, most women with lupus are able to carry their babies safely to term. Experts disagree on the exact numbers, but approximately 20-25% of lupus pregnancies end in miscarriage, compared with 10-15% of pregnancies in women without the disease. Pregnancy counseling and planning before pregnancy is important. Optimally, a woman should have no signs or symptoms of lupus before she becomes pregnant.

Researchers have now identified two closely related lupus autoantibodies, anticardiolipin antibody and lupus anticoagulant, that are associated with risk of miscarriage. One-third to one-half of women with lupus have these autoantibodies, which can be detected by blood tests. Identifying women with the autoantibodies early in the pregnancy may help physicians take steps to reduce the risk of miscarriage. Pregnant women who test positive for these autoantibodies and who have had previous miscarriages are generally treated with baby aspirin or heparin throughout their pregnancy.

Some women may experience a mild to moderate flare during or after their pregnancy; others may not. Pregnant women with lupus, especially those taking corticosteroids, are also likely to develop pregnancy-induced hypertension, diabetes, hyperglycemia, and kidney complications. About 25% of babies of women with lupus are born prematurely, but do not suffer from birth defects.

About 3% of babies born to mothers with SLE will have neonatal lupus, or specific antibodies called anti-Ro(SSA) and anti-La(SSB). This is not the same as SLE and is almost always temporary. The syndrome is thought to be caused by passive transfer of anti-Ro antibodies from the mother to the fetus. About one-third of women with SLE have this antibody. By 3-6 months of age, the rash and blood abnormalities associated with neonatal lupus disappear. Very rarely, babies with neonatal lupus will have a congenital complete heart block. This problem is permanent, but can be treated with a pacemaker.

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

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