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    Care of the Lupus Patient

    General Manifestations of SLE continued...

    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

    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.

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