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Care of the Lupus Patient

Potential Hematologic Manifestations

Anemia

  • Decreased hemoglobin and hematocrit values
  • Positive Coombs' test (hemolytic anemia)
  • Tachycardia
  • Palpitations
  • Dizziness
  • Sensitivity to cold
  • Chronic fatigue, lethargy, and malaise
  • Pallor
  • Weakness
  • Dyspnea on exertion
  • Headache

Thrombocytopenia

  • Petechiae
  • Excessive bruising of skin
  • Bleeding from gums, nose
  • Blood in stool

Nursing Interventions

Objective: Minimize Fatigue

  1. Refer to the nursing interventions for fatigue in this article.

Objective: Recognize Anemia and Develop Plan of Care

  1. Monitor patient for signs and symptoms of anemia and for altered laboratory values.
  2. Develop a plan with patient to conserve energy.
  3. Teach patient the basics of good nutrition.
  4. Instruct patient to take iron preparation medications as prescribed.

Objective: Minimize Episodes of Bleeding

  1. Assess patient for signs and symptoms of bleeding, such as petechiae, bruises, GI bleeding, blood in urine, ecchymoses, nose bleeds, bleeding from the gums, heavy menses, and bleeding between menstrual periods.
  2. Teach patient why she or he is at risk of bleeding (low platelet count, anemia, thrombocytopenia) and to report episodes to physician.
  3. Encourage patient to wear a medical alert bracelet or carry a card.
  4. Teach patient measures to prevent bleeding, such as use of a soft toothbrush or an electric shaver.

Objective: Decrease Risk of Infection

  1. See the nursing interventions for infection in this article.

Cardiopulmonary Manifestations

Overview

Cardiac abnormalities contribute significantly to morbidity and mortality in SLE and are one of the most important clinical manifestations of the disease. In addition, involvement of the lungs and pleurae is common. Pericarditis, an inflammation of the pericardium, is the most common cardiac abnormality in SLE. Myocarditis, an inflammation of the heart muscle, may also occur, but is rare. Myocardial infarction, caused by atherosclerosis, has been reported in SLE patients below the age of 35 years.

Vasculitis (inflammation of the blood vessels) and serositis (inflammation of serous membranes) are frequently part of the autoimmune pathology of SLE. These conditions respond well to corticosteroids. Vasculitis may cause many different symptoms, depending on the system(s) most affected. Serositis most commonly presents as pleurisy or pericarditis. Pleuritic chest pain is common. Pleurisy is the most common respiratory manifestation in SLE. Attacks of pleuritic pain can also be associated with pleural effusions. Many patients complain of chest pain, but pericardial changes are not often demonstrated on clinical evaluation.

Potential Problems

  • Alterations in cardiac function
  • Potential for impaired gas exchange and ineffective breathing patterns
  • Alteration in tissue perfusion

Nursing Interventions

Objective: Detect Changes in Cardiac Function

  1. Assess patient for signs and symptoms of potential cardiac problems.
  2. Teach patient signs and symptoms of cardiac problems, including warning signs of a heart attack; reinforce the importance of reporting them to the physician.
  3. Educate patient about medications.
  4. Educate patient about a healthful diet and regular exercise as tolerated.

Objective: Maintain Adequate Gas Exchange and Effective Breathing Patterns

  1. Assess quality and depth of respirations; auscultate breath sounds.
  2. Suggest measures to relieve pain, such as relaxation techniques, biofeedback, rest, and pain medications as ordered.
  3. Encourage patients who smoke to quit.

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