Potential GI Manifestations
- Persistent sore throat
- Dry mouth (characteristic of patients with coexisting Sjogren's syndrome)
- Nausea and vomiting
- Dysphagia (especially in association with Raynaud's phenomenon)
- Mild nonspecific abdominal pain to severe epigastric pain radiating to the back
- Elevated serum amylase level
- Abdominal distention
- Bulging flanks
- Downward protruding umbilicus
Mesenteric and Intestinal Vasculitis
- Cramping or constant abdominal pain
- Diffuse direct and rebound abdominal tenderness
Visual impairment may be due to SLE or to drug treatment (corticosteroids or antimalarials), or it may be a separate problem (glaucoma or retinal detachment). Blindness due to SLE occurs, but is rare. Other visual problems may occur:
- A lupus rash may develop on the eyelids.
- Conjunctivitis occurs in 10% of SLE patients and is usually infectious. Kerato-conjunctivitis is usually mild.
- Cytoid bodies are the most common retinal change in SLE. They reflect microangiopathy of the retinal capillaries and localized microinfarction of the superficial nerve fiber layers of the retina.
- Sjogren's syndrome is an autoimmune condition manifest as excessive dryness of mucous membranes. Lupus patients with these symptoms require artifical tears to relieve dry eyes.
- Glaucoma and cataracts may be caused by corticosteroids.
- Antimalarials can damage the retina, which can impair vision (particularly color vision) or, rarely, cause blindness.
Potential Ophthalmologic Manifestations
- A lupus rash on the eyelids
- Red, sore, swollen eyes
- Mucus discharge from eyes, particularly upon awakening
- Sensitivity to light
- Change in vision
- Blurred vision
- Cloudy lens(es)
- Dry eyes
- Burning sensation in eyes
- Visual impairment
- Potential for injury
- Difficulty carrying out ADL
Objective: Minimize Discomfort
- Allow time for patient to express concerns and ask questions.
- Teach the patient how to apply artificial tears for dry eyes to increase comfort and prevent corneal abrasion.
- Teach patient the correct way to take prescribed medications, such as eye drops for glaucoma.
- Suggest warm, moist compresses, which may help ease discomfort and itching from conjunctivitis.
Objective: Minimize Potential for Serious Visual Impairment or Blindness
- Assess patient's vision changes and impairments.
- Reinforce the need to follow up with an ophthalmologist.
Objective: Develop a Plan for Patient to Perform ADL Appropriately and Independently
- Provide referrals to support groups and services for the visually impaired.