Care of the Lupus Patient
General Manifestations of SLE continued...
Objective: Teach Patient to Recognize
Fever and Signs and Symptoms of Infection
Assess patient's prescription and
non-prescription drug regimen and dosages.
Monitor patient's WBC count.
Teach patient to monitor temperature
during a lupus flare.
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
Instruct patient to call physician if
signs and symptoms of an infection appear or if a fever is elevated above
Objective: Assist Patient in Adjusting
to Physical and Lifestyle Changes
Allow patient to express feelings and
Assess patient's usual coping
Acknowledge that feelings of denial and
anger are normal.
Explore with patient sources of potential
support and community resources.
Explore possible ways of concealing skin
lesions and hair loss.
Encourage patient to discuss interpersonal
and social conflicts that arise.
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
Assess patient for the major signs and
symptoms of depression.
Assess patient's interpersonal
and social support systems.
Encourage patient to express
Initiate a referral to a mental health
counselor or psychiatrist.
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.
(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