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Care of the Lupus Patient

Potential GI Manifestations

General Manifestations

  • Persistent sore throat
  • Dry mouth (characteristic of patients with coexisting Sjogren's syndrome)
  • Anorexia
  • Nausea and vomiting
  • Diarrhea
  • Dysphagia (especially in association with Raynaud's phenomenon)


  • Mild nonspecific abdominal pain to severe epigastric pain radiating to the back
  • Nausea
  • Vomiting
  • Elevated serum amylase level
  • Dehydration


  • Abdominal distention
  • Bulging flanks
  • Downward protruding umbilicus

Mesenteric and Intestinal Vasculitis

  • Cramping or constant abdominal pain
  • Vomiting
  • Fever
  • Diffuse direct and rebound abdominal tenderness

Ophthalmologic Manifestations


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
  • Tearing
  • Mucus discharge from eyes, particularly upon awakening
  • Sensitivity to light
  • Change in vision
  • Blurred vision
  • Cloudy lens(es)
  • Dry eyes
  • Burning sensation in eyes

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.
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