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Care of the Lupus Patient

General Manifestations of SLE continued...

Many patients with SLE experience changes in weight. At least one-half of patients report weight loss before being diagnosed with SLE. Weight loss in SLE patients may be attributed to a decreased appetite, side effects of medications, gastrointestinal problems, or fever. Weight gain can occur in some patients and may be due in part to prescribed medications, especially corticosteroids, or fluid retention from kidney disease.

Episodic fever is experienced by more than 80% of SLE patients, and there is no particular fever pattern. Although high fevers can occur during a lupus flare, low-grade fevers are more frequently seen. A complicating infection is often the cause of an elevated temperature in a patient with SLE. The patient's WBC count may be normal to elevated with an infection, but low with SLE alone. However, certain medications, such as immunosuppressives, will suppress the WBC even in the presence of fever. Therefore, it is important to rule out other causes of a fever, including an infection or a drug reaction. Urinary and respiratory infections are common in SLE patients.

Psychological and emotional effects, such as grief, depression, and anger, are commonly experienced by lupus patients. These can be related to the outward changes, such as skin alterations, caused by the disease as well as by other aspects of the disease and its treatment. It is important for health professionals to be alert to potential psychological repercussions and to assist in alleviating them.

 

Potential Problems

  1. Inability to complete activities of daily living (ADL) because of fatigue, weakness, and psychological difficulties
  2. Changes in weight
  3. Fever

Nursing Interventions

Objective: Minimize Fatigue

  1. Assess patient's general fatigue level.
  2. Assess for the presence of depression, anxiety, and other stressors.
  3. Conduct assessment to determine patient's daily activities that contribute to fatigue.
  4. Help patient to develop an energy-conserving plan for completing daily and other activities and work.
  5. Suggest planning for rest periods as needed throughout the day to conserve energy.
  6. Encourage patient to get 8-10 hours of sleep at night.
  7. Encourage exercise as tolerated.

Objective: Maintain Weight at Optimal Range

  1. Assess patient's prescription and non-prescription drug regimen and dosages.
  2. Assess the patient's usual daily dietary intake by asking her or him to keep a food diary.
  3. Develop a dietary plan with the patient that encourages healthful eating. If the patient has nutrition-related lupus complications, refer her or him to a registered dietitian for specialized counseling.
  4. Encourage exercise as tolerated.
  5. Record patient's weight at each visit.
  6. Instruct patient to weigh herself or himself at home once a week and record it.

Potential Physiological Manifestations

  • Fatigue
  • Weight gain or loss
  • Fever -- increased temperature over normal baseline
  • Elevated WBC

Potential Psychological Manifestations

  • Lowered self-esteem
  • Negative feelings about body
  • Decreased confidence
  • Feelings of decreased self-worth
  • Depression
  • Feelings of sadness, hopelessness, helplessness
  • Difficulty in completing self-care activities, caring for children, maintaining a household, and other activities of daily living (ADL)
  • Inability to maintain full- or part-time employment
  • Decreased social activities
  • Lack of energy or ambition
  • Irritability
  • Impaired concentration
  • Crying
  • Insomnia
  • Suicidal thoughts

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