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Care of the Lupus Patient

Renal Manifestations continued...

Objective: Decrease Fluid Retention and Edema

  1. Monitor electrolyte values.
  2. Assess breath sounds and instruct patient to report shortness of breath or dyspnea.
  3. Teach patient to maintain balanced fluid intake and output. 
  4. Monitor patient for signs and symptoms of extracellular fluid overload.
  5. Instruct patient to weigh herself or himself daily to monitor fluid retention.
  6. Monitor patient's blood pressure and teach patient how to monitor it at home.

Objective: Minimize Risk of Infection

  1. Teach patient to watch for the signs and symptoms of urinary tract infection and to report them to the physician.
  2. Instruct patient that corticosteroid therapy may mask the usual symptoms of infection and that she or he may have an altered immune response because of medications used to control SLE.
  3. Teach patient to take antibiotics for urinary tract infection as prescribed.

Potential Renal Manifestations

SLE Nephropathy

Signs and Symptoms:

  • Hematuria (as few as 5 RBCs is significant)
  • Proteinuria (>1+ to 2+)
  • Abacterial pyuria
  • Elevated creatinine level (indicates loss of renal function)
  • Elevated blood urea nitrogen (BUN)
  • Markedly abnormal serologic tests, such as decreased complement or elevated anti-DNA values
  • Weight gain
  • Ankle edema
  • Hypertension

 

Signs and Symptoms Suggesting Renal Failure:

  • Nausea and vomiting
  • Anorexia
  • Anemia
  • Lethargy
  • Pruritus
  • Changing level of consciousness
  • Fluid and Electrolyte Imbalance (Excess Extracellular Fluid Volume)
  • Weight gain
  • Pitting edema of the lower extremities
  • Sacral edema
  • Bounding pulse, elevated blood pressure, S3 gallop
  • Engorgement of neck and hand veins
  • Dyspnea
  • Constant cough
  • Crackles in lungs
  • Cyanosis
  • Decreased hematocrit
  • Urine specific gravity <1.010
  • Variable serum sodium level (normal, high, or low), depending on the amount of sodium retention or water retention
  • Serum osmolality <275 mOsm/kg

 

Urinary Tract Infection

  • Dysuria: Frequent urination
  • Urgent need to urinate
  • Fever
  • Cloudy urine
  • Incomplete emptying of the bladder
  • Low back or suprapubic pain
  • Flank pain
  • Malaise
  • Nausea and vomiting

Central Nervous System Manifestations

Overview

Neurologic manifestations of SLE are common and vary from mild to severe. They can be difficult to diagnose and distinguish from other diseases. All portions of the nervous system may be affected, including the CNS. Definite diagnosis of CNS lupus may be difficult, as symptoms may be related to medications, other medical conditions, or to individual reactions to chronic illness.

Cranial or peripheral neuropathy occurs in 10-15% of patients; it is probably secondary to vasculitis in small arteries supplying nerves. Cerebrovascular accidents (strokes) are reported in approximately 15% of patients. Between 10 and 20% of patients experience seizures. Although cognitive impairment is believed to be very common, there are few measurements to document it.

Serious CNS involvement ranks behind only kidney disease and infection as a leading cause of death in lupus. However, the majority of SLE patients with CNS complications do not develop a life-threatening disease.

Potential Problems

  1. Alteration in mental status, cognition, and perception
  2. Altered ability to perform ADL and meet family responsibilities
  3. Potential for injury

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

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