Care of the Lupus Patient
Dermatologic Manifestations continued...
Skin alterations in the lupus
patient, particularly those of DLE, can be disfiguring. As a result, patients
may experience fear of rejection by others, negative feelings about their body,
and depression. Changes in lifestyle and social involvement may
- Alteration in skin integrity
- Alteration in body image
Objective: Minimize Appearance of
- Document appearance and duration of
lesions and rashes.
- Teach patient to minimize direct exposure
to UV rays from sun and from fluorescent and halogen light bulbs. (Glass does
not provide complete protection from UV rays.)
- Instruct patient to use a sunscreen with
an SPF of 15 or greater and wear protective clothing. Patients who are allergic
to PABA will need to find a PABA-free sunscreen.
- Provide information on hypoallergenic
- Instruct patient to avoid topical
applications, such as hair dyes and skin creams, and the use of certain drugs
that may make her or him more sensitive to the sun.
- For patients with mouth lesions, suggest a
soft-food diet, lip balms, and warm saline rinses.
- Instruct patient to take medications that
may help to alleviate discomfort and itching as ordered. (The doctor may give
the patient intralesional steroid injections.)
- Suggest self-help measures for patients
with Raynaud's phenomenon, including: keep warm, particularly in cold weather;
use chemical warmers, gloves, socks, hats; avoid air conditioning; use
insulated drinking glasses for cold drinks; wear gloves when handling frozen or
refrigerated foods; quit smoking; control stress; and exercise as
Objective: Help Patients to Cope with
Potential Psychological Manifestations
See the nursing interventions
dealing with psychological issues under manifestions in this
Arthralgia or arthritis is
experienced by 95% of SLE patients at some time during the course of the
disease. Articular pain is the initial symptom in about one-half of patients
eventually diagnosed with SLE. Morning stiffness and joint and muscle aching
can also occur. Joint pain may be migratory; it is typically symmetric but is
asymmetric in many patients. Joints may become warm and swollen. X rays of the
joints usually do not show erosion or destruction of bone.
Unlike rheumatoid arthritis,
the arthritis of SLE tends to be transitory. Proliferation of the synovium is
more limited, and joint destruction is rare. The joints most commonly involved
are those of the fingers, wrists, and knees; less commonly involved are the
elbows, ankles, and shoulders.
Several joint complications
may occur in SLE patients, including Jaccoud's arthropathy and osteonecrosis.
Subcutaneous nodules, especially in the small joints of the hands, are seen in
about 5% of patients. Tendinitis, tendon rupture, and carpal tunnel syndrome
are seen occasionally.
- Morning stiffness and aching
- Joint pain
- Warm, swollen joints
- Ulnar deviation of the fingers with swan
neck deformities and subluxations
- Generalized myalgia and muscle tenderness,
especially in the upper arms and upper legs