Care of the Lupus Patient
Potential Hematologic Manifestations
- Decreased hemoglobin and hematocrit values
- Positive Coombs' test (hemolytic anemia)
- Sensitivity to cold
- Chronic fatigue, lethargy, and malaise
- Dyspnea on exertion
- Excessive bruising of skin
- Bleeding from gums, nose
- Blood in stool
Objective: Minimize Fatigue
- Refer to the nursing interventions for fatigue in this
Objective: Recognize Anemia and Develop Plan of
- Monitor patient for signs and symptoms of anemia and for
altered laboratory values.
- Develop a plan with patient to conserve energy.
- Teach patient the basics of good nutrition.
- Instruct patient to take iron preparation medications as
Objective: Minimize Episodes of Bleeding
- 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
- Teach patient why she or he is at risk of bleeding (low
platelet count, anemia, thrombocytopenia) and to report episodes to
- Encourage patient to wear a medical alert bracelet or carry
- Teach patient measures to prevent bleeding, such as use of a
soft toothbrush or an electric shaver.
Objective: Decrease Risk of Infection
- See the nursing interventions for infection in this
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
- Alterations in cardiac
- Potential for impaired gas exchange and
ineffective breathing patterns
- Alteration in tissue perfusion
Objective: Detect Changes in Cardiac
- Assess patient for signs and symptoms of
potential cardiac problems.
- Teach patient signs and symptoms of
cardiac problems, including warning signs of a heart attack; reinforce the
importance of reporting them to the physician.
- Educate patient about
- Educate patient about a healthful diet and
regular exercise as tolerated.
Objective: Maintain Adequate Gas
Exchange and Effective Breathing Patterns
- Assess quality and depth of respirations;
auscultate breath sounds.
- Suggest measures to relieve pain, such as
relaxation techniques, biofeedback, rest, and pain medications as
- Encourage patients who smoke to