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Care of the Lupus Patient

Musculoskeletal Manifestations continued...

Potential Dermatologic Manifestations

  • Butterfly rash on cheeks and bridge of nose
  • Scaly, disk-shaped scarring rash (DLE)
  • Erythematous, slightly scaly papules (subacute cutaneous LE)
  • Psoriasiform or arcuate (curved) lesions on the trunk of the body (subacute cutaneous LE)
  • Itching and burning
  • Ulcers in the mouth, vagina, or nasal septum
  • Atrophy (including striae or stretch marks)
  • Impaired wound healing
  • Easy bruising
  • Petechiae
  • Increased body hair (hirsutism)
  • Steroid-induced ecchymosis
  • Ulcers or gangrene on fingers or toes
  • Alopecia

Potential Problems

  1. Pain
  2. Alteration in joint function

Nursing Interventions

Objective: Minimize Pain from Joint and Muscle Complications

  1. Assess and document joint complaints and appearance. Changes may be transient.
  2. Assess patient's self-management techniques for controlling pain.
  3. Teach patient to apply heat or cold as appropriate.
  4. Instruct patient in use of prescription and nonprescription pain medications.
  5. If ordered by physician, teach patient to apply splints or braces.

Objective: Maintain Joint Function and Increase Muscle Strength

  1. Suggest warm showers or baths to lessen stiffness and pain.
  2. If indicated, refer patients with acutely inflamed joints to a physical therapist for passive range-of-motion (ROM) exercises. The physical therapist may train a family member to assist the patient with ROM exercises at home.
  3. Teach patient that an inflamed joint should not bear weight and suggest that patient avoid strenuous activity.
  4. If needed, assist patient to obtain crutches, a walker, or a cane.
  5. Assist patient in developing a regular exercise plan that can be carried out during periods of remission. This plan should include exercises that promote muscle tone and fitness, minimize fatigue, and increase well-being.
  6. Consider referring patient to an occupational therapist.

Hematologic Manifestations

Overview

Abnormal blood conditions are common in patients with SLE. Problems include anemia, thrombocytopenia, and other clotting disorders.

Anemia, which is common in SLE patients, reflects insufficient bone marrow activity, shortened RBC life span, or poor iron uptake. Aspirin, NSAIDs, and prednisone can cause stomach bleeding and exacerbate the condition. There is no specific therapy for this type of anemia. Immune-mediated anemia (or hemolytic anemia), which is due to antibodies directed at RBCs, is treated with corticosteroids.

Thrombocytopenia may occur and may respond to low-dose corticosteroids. Mild forms may not need to be treated, but a severe form requires high-dose corticosteroid or cytotoxic drugs. The major clinical features of APLs and APL syndrome are venous thrombosis, arterial thrombosis, and thrombocytopenia with a history of positive anticardiolipin antibody (ACL) tests.

Abnormal laboratory tests may include a false-positive VDRL test for syphilis. Fluorescent treponemal antibody absorption (FTA-ABS) and microhemagglutination-Treponema pallidum (MHA-TP) tests, which are more specific tests for syphilis, are almost always negative if the patient does not have syphilis. An elevated erythrocyte sedimentation rate (ESR) is a common finding in active SLE, but it does not always mirror disease activity.

Potential Problems

  1. Inability to complete ADL because of fatigue and weakness.
  2. Anemia
  3. Potential for hemorrhage
  4. Potential to develop venous or arterial thromboses
  5. Increased risk of infection
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13

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

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