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Care of the Lupus Patient

Cardiopulmonary Manifestations continued...

Objective: Ensure Adequate Tissue Perfusion

  1. Assess skin color and temperature; check for lesions.
  2. Check capillary refill in the nailbeds.
  3. Assess for presence of edema and pain in the extremities.
  4. Stress the importance of not smoking.
  5. Teach patient the basics of good foot care.
  6. Teach patient to avoid cold temperatures and to keep the hands and feet warm, especially in winter months.
  7. Teach patient signs and symptoms of vascular impairment that need to be reported to the physician, including a change in skin color or sensation or appearance of lesions.

Objective: Recognize The Signs and Symptoms of Thromboses; Refer for Immediate Medical Attention

  1. Teach patient the signs and symptoms of potential venous or arterial thrombosis and reinforce the need to contact a physician immediately.

Potential Cardiopulmonary Manifestations

Pericarditis

  • Pain in the anterior chest, neck, back, or arms that is often relieved by sitting up
  • Shortness of breath
  • Swelling of legs and feet
  • Fever
  • Chills
  • Audible pericardial friction rub

Myocarditis

  • Chest pain
  • Shortness of breath
  • Fever
  • Fatigue
  • Palpitations

Atherosclerosis Leading to Myocardial Infarction

Warning signs of myocardial infarction:

  • Burning, choking, squeezing, or pressing chest pain that may radiate to left shoulder and arm
  • Shortness of breath
  • Weakness
  • Unrelieved indigestion
  • Nausea and vomiting

Pleurisy

  • Shortness of breath
  • Chest pain, especially with deep inspiration
  • Coughing up blood or thick mucus

Periungual Erythema

  • Redness in the nailbed

Livedo Reticularis

  • A reddish or cyanotic pattern seen on arms, legs, torso, especially in cold weather

Leukocytoclastic Vasculitis

  • Necrotic ulcerations, including raised hemorrhagic nodules (papule, purpura) that ulcerate, especially on the lower legs, ankles, and dorsa of the feet

Valvular Heart Disease (Libman-Sacks Lesions)

  • Lesions that may result in cardiac murmurs and valve dysfunction; associated with antiphospholipid antibodies

Venous Thrombosis

  • Positive Homans' sign
  • Pain, swelling, inflammation, redness, and warmth in the affected limb
  • Increased circumference of affected limb

Arterial Thrombosis

  • Pain or loss of sensation due to ischemia
  • Panesthesias and loss of position sense
  • Coldness
  • Pallor
  • Paralysis
  • No pulse

Renal Manifestations

Overview

Renal damage is one of the most serious complications of SLE. The majority of lupus patients have some degree of asymptomatic microscopic kidney damage. Less than 50% have clinical renal disease, and most of those with renal disease have one of the milder forms. Kidney damage may necessitate treatment with corticosteroids, cytotoxic agents, dialysis, or renal transplantation.

Renal biopsy can be helpful in making decisions about drug treatments and determining prognosis by assessing the presence of active renal disease versus scarring.

Potential Problems

  1. Impaired renal function
  2. Fluid and electrolyte imbalance
  3. Increased risk of infection

Nursing Interventions

Objective: Promptly Recognize Renal Involvement and Prevent Complications

  1. Document any patient complaints or assessment findings that may indicate renal involvement.
  2. Teach patient to watch for signs and symptoms of renal complications and report them promptly to the physician: headache, facial swelling, peripheral edema, dizziness, "foamy" urine (proteinuria), "coke-colored" urine (hematuria), or nocturia and urinary frequency.
  3. Assess patient for early signs of heart or liver failure.
  4. Refer patient to a dietitian for counseling on dietary changes to accommodate alterations in renal status.
  5. Teach patient to take prescribed medications as ordered.
  6. Stress the importance of referral and followup care with nephrologist if necessary.

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

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