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    Care of the Lupus Patient

    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.
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