Care of the Lupus Patient
Dermatologic Manifestations continued...
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
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.