Lupus symptoms tend to present themselves according to the body system affected. These symptoms vary over time in intensity and duration for each patient as well as from patient to patient. To care effectively for a lupus patient, the nurse or other health professional needs an up-to-date knowledge and understanding of the disease, its many manifestations, and its changing and often unpredictable course.

This chapter provides an overview of general and system-specific lupus manifestations and identifies potential problems. Suggested health care interventions for the nonhospitalized lupus patient are given. Many of these interventions can be modified for the hospitalized patient. The information and nursing interventions described in this chapter are not meant to be inclusive, but to provide the practitioner with guidelines for developing a care plan specific to the needs of each lupus patient.

As a care plan is developed, the health professional should keep in mind the importance of frequently reassessing the patient's status over time and adjusting treatment to accommodate the variability of systemic lupus erythematosus (SLE) manifestations. An additional and very important element of working with the lupus patient is to incorporate the patient's needs and routines in the plan of care. Adjusting nursing interventions and medical protocols to the patient's needs not only recognizes the value of the patient as an authority on her or his own illness, but also can improve patient compliance and result in an improved quality of life.

Working together, the care provider and the patient have much to offer each other. The rewards for patients and families are tremendous, as patients become more independent and gain confidence in being able to care for themselves.

General Manifestations

Fatigue, fever, psychological and emotional effects

Specific Manifestations

Dermatologic: butterfly rash, photosensitivity, Discoid LE, subcutaneous LE, mucosal ulcers, alopecia, bruising

Musculoskeletal: arthralgias, arthritis, other joint complications

Hematologic: anemia, decreased white blood cell (WBC) count, thrombocytopenia, lupus anticoagulants, false-positive venereal disease research laboratory test (VDRL), elevated erythrocyte sedimentation rate (ESR), lymphopenia

Cardiopulmonary: pericarditis, myocarditis, myocardial infarction, vasculitis, pleurisy, valvular heart disease

Renal: asymptomatic microscopic renal involvement, renal failure, fluid and electrolyte imbalance, edema

Central Nervous System (CNS): cranial neuropathies, cognitive impairment, mental changes, seizures, stroke, peripheral neuropathy, meningitis, coma, psychosis

Gastrointestinal (GI): anorexia, ascites, pancreatitis, mesenteric or intestinal vasculitis

Ophthalmologic: cytoid bodies, dry eyes

Other Key Issues

Pregnancy: lupus flare, miscarriage or stillbirth, pregnancy-induced hypertension, neonatal lupus

Infection: increased risk of respiratory tract, urinary tract, and skin infections; opportunistic infections

Nutrition: weight changes, poor diet, appetite loss

Systems Potentially Affected by Lupus