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
- Inability to complete activities of daily
living (ADL) because of fatigue, weakness, and psychological
- Changes in weight
- Assess patient's general fatigue
- Assess for the presence of depression,
anxiety, and other stressors.
- Conduct assessment to determine patient's
daily activities that contribute to fatigue.
- Help patient to develop an
energy-conserving plan for completing daily and other activities and
- Suggest planning for rest periods as
needed throughout the day to conserve energy.
- Encourage patient to get 8-10 hours of
sleep at night.
- Encourage exercise as
Objective: Maintain Weight at Optimal
- Assess patient's prescription and
non-prescription drug regimen and dosages.
- Assess the patient's usual daily dietary
intake by asking her or him to keep a food diary.
- 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
- Encourage exercise as
- Record patient's weight at each
- Instruct patient to weigh herself or
himself at home once a week and record it.
- Weight gain or loss
- Fever -- increased temperature over normal
- Elevated WBC
- Lowered self-esteem
- Negative feelings about body
- Decreased confidence
- Feelings of decreased
- Feelings of sadness, hopelessness,
- 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
- Decreased social activities
- Lack of energy or ambition
- Impaired concentration
- Suicidal thoughts