Care of the Lupus Patient
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.
Inability to complete ADL because of
fatigue and weakness.
Potential for hemorrhage
Potential to develop venous or arterial
Increased risk of infection
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