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Care of the Lupus Patient

General Manifestations of SLE continued...

 

Objective: Teach Patient to Recognize Fever and Signs and Symptoms of Infection

  1. Assess patient's prescription and non-prescription drug regimen and dosages.
  2. Monitor patient's WBC count.
  3. Teach patient to monitor temperature during a lupus flare.
  4. Teach patient to look for signs and symptoms of infection, particularly urinary and respiratory infections. (Note: The cardinal signs of infection may be masked because of corticosteroids and antipyretic medications.)
  5. Instruct patient to call physician if signs and symptoms of an infection appear or if a fever is elevated above normal baseline.

Objective: Assist Patient in Adjusting to Physical and Lifestyle Changes

  1. Allow patient to express feelings and needs.
  2. Assess patient's usual coping mechanisms.
  3. Acknowledge that feelings of denial and anger are normal.
  4. Explore with patient sources of potential support and community resources.
  5. Explore possible ways of concealing skin lesions and hair loss.
  6. Encourage patient to discuss interpersonal and social conflicts that arise.
  7. Encourage patient to accept help from others, such as counseling or a support group.

Objective: Recognize The Signs and Symptoms of Depression and Initiate a Plan of Care

  1. Assess patient for the major signs and symptoms of depression.
  2. Assess patient's interpersonal and social support systems.

  3. Encourage patient to express feelings.
  4. Initiate a referral to a mental health counselor or psychiatrist.

Dermatologic Manifestations

Overview

Approximately 80% of patients with SLE have skin manifestations and often suffer from itching, pain, and disfigurement. The classic sign of SLE is the "butterfly" rash extending over the cheeks (malar area) and bridge of the nose. This rash ranges from a faint blush to a severe eruption with scaling. It is photosensitive, and it may be transitory or fixed. Between 55 and 85% of patients develop this rash at some time in the course of the disease.

Other rashes may occur elsewhere on the face and ears, upper arms, shoulders, chest, and hands. DLE is seen in 15-30% of patients with SLE. Subacute cutaneous LE, seen in about 10% of SLE patients, produces highly photosensitive papules that itch and burn. Skin changes, especially the butterfly rash and subacute cutaneous LE, can be precipitated by sunlight.

Some patients may develop mouth, vaginal, or nasal ulcers. Hair loss (alopecia) occurs in about one-half of SLE patients. Most hair loss is diffuse, but it may be patchy. It can be scarring or nonscarring. Alopecia may also be caused by corticosteroids, infection, or immunosuppressive drugs.

Raynaud's phenomenon (paroxysmal vasospasm of the fingers and toes) frequently occurs in patients with SLE. For most patients, Raynaud's phenomenon is mild. However, some SLE patients with severe Raynaud's phenomenon may develop painful skin ulcers or gangrene on the fingers or toes.

Varying levels of pain and discomfort due to skin alterations may occur. Pruritus accompanies many types of skin lesions. Attacks of Raynaud's phenomenon can cause a deep tingling feeling in the hands and feet that can be very uncomfortable. Both pain and itching may affect a patient's ability to carry out activities of daily living (ADL).

WebMD Public Information from the U.S. National Institutes of Health

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