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Care of the Lupus Patient

Pregnancy continued...

Potential Problems

  • Lupus flare
  • Increased risk of spontaneous abortion or stillbirth
  • Pregnancy-induced hypertension
  • Increased risk of prematurity
  • Neonatal lupus

Potential Lupus Complications During Pregnancy

Lupus flare

  • Increased pain
  • Morning stiffness
  • Fever
  • Development or worsening of a rash
  • Stomach discomfort
  • Headache
  • Dizziness

Miscarriage

  • Cramping
  • Vaginal bleeding (spotting to heavy bleeding)

Pregnancy-Induced Hypertension

Mild

  • Blood pressure 140/90 and over during the second half of pregnancy
  • Mild, generalized edema
  • Proteinuria

Pre-eclampsia

  • Blood pressure 140/90 and over during the second half of pregnancy
  • Proteinuria
  • Epigastric pain
  • Hyperreflexia
  • Edema, including face and hands
  • Headache

Eclampsia

  • All of the symptoms of preeclampsia
  • Seizures

Neonatal lupus

  • Transient rash
  • Transient blood count abnormalities
  • Heartblock

Nursing Interventions

Objective: Educate the Woman Regarding Birth Control Options and Risks of Pregnancy

  1. Encourage patient to plan pregnancy during remission and only after consulting with her doctor.
  2. Discuss birth control options:
    • Barrier Methods (diaphragm or condom with spermicidal foam) are the safest.
    • OIUDs are not recommended because of increased risk of infection.
    • Oral contraceptives may be appropriate.
  3. Discuss the potential risks of pregnancy and the importance of careful monitoring.

Objective: Ensure a Healthy, Full-Term Pregnancy

  1. Urge patient to keep appointments with her primary doctor and obstetrician.
  2. Instruct patient to observe for signs of complications or an impending flare.
  3. Monitor blood pressure and watch for signs of toxemia, which may be hard to distinguish from a lupus flare.

Infection

Overview

SLE affects the immune system, thus reducing the body's ability to prevent and fight infection. In addition, many of the drugs used to treat SLE also suppress the function of the immune system, thereby further depressing the ability to fight infection. The risk of infection parallels medication dosages and duration of treatment.

Patients with SLE who show signs and symptoms of infection need prompt therapy to prevent it from becoming life threatening. The most common infections involve the respiratory tract, urinary tract, and skin and do not require hospitalization if they are treated promptly. Other opportunistic infections, particularly Salmonella, herpes zoster, and Candida infections, are more common in patients with SLE because of altered immune status.

Potential Problems

  1. Increased risk of infection

Nursing Interventions

Objective: Minimize Incidence of Infection

  1. Assess patient's current medications, particularly those that promote susceptibility to infection such as corticosteroids and immunosuppressives.
  2. Teach patient to use good hand-washing and personal-hygiene techniques.
  3. Teach patient the signs and symptoms of infection and reinforce the importance of reporting them to the physician.
  4. Encourage patient to eat a balanced diet with adequate calories to help preserve the immune system.
  5. Teach patient to minimize exposure to crowds and people with infections or contagious illnesses.

Objective: Educate The Patient about Immunizations

  1. Check patient's current immunization status.
  2. Teach patient that infections can be minimized with immunizations.
  3. Encourage patient to consult her or his doctor before considering allergy shots or flu or pneumococcal vaccines; these medications may induce a lupus flare.

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