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    Care of the Lupus Patient

    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.

    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.

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