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    Care of the Lupus Patient

    Central Nervous System Manifestations continued...

    Objective: Assist Patient in Identifying Family and Community Support Services

    1. Assess patient's support network. Discuss alternatives for strengthening supports.
    2. Anticipate family concerns. Seek out the family to answer their questions and to provide support. Include significant others in patient care as appropriate.
    3. Help family identify potential coping skills, environmental supports, and community services for dealing with chronically ill people.
    4. Encourage patient and family members to consider professional counseling.

    Objective: Minimize Potential for Injury

    1. Assist patient and family in identifying and removing potentially dangerous items in the environment.
    2. Involve family members in planning of patient's care and safety measures.
    3. Assess patient's ability to safely administer own medications.

    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.
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