Overview

Fatigue is a nearly universal complaint of patients with SLE even when no other manifestations of the disease are present. The cause of this debilitating fatigue is not known. The patient should be evaluated for factors that may exacerbate fatigue, such as hypothyroidism, adrenal dysfunction, overexertion, insomnia, depression, stress, anemia, and other inflammatory diseases. Fatigue in SLE patients may be lessened by adequate rest, healthful diet, exercise, and attention to psychosocial factors. One common cause of fatigue in SLE patients is fibromyalgia.

Many patients with SLE experience changes in weight. At least one-half of patients report weight loss before being diagnosed with SLE. Weight loss in SLE patients may be attributed to a decreased appetite, side effects of medications, GI problems, or fever. Weight gain can occur in some patients and may be due in part to prescribed medications, especially corticosteroids, or fluid retention from kidney disease.

Episodic fever is experienced by more than 80 percent of SLE patients, and there is no particular fever pattern. Although high fevers can occur during a lupus flare, low-grade fevers are more frequently seen.

A complicating infection is often the cause of an elevated temperature in a patient with SLE. The patient's WBC count may be normal to elevated with an infection, but low with SLE alone. However, certain medications, such as immunosuppressives, will suppress the WBC count even in the presence of fever. Therefore, it is important to rule out other causes of a fever, including an infection or a drug reaction. Urinary and respiratory infections are common in SLE patients.

Some patients with SLE experience racing of the heart, or tachycardia. This rapid pulse is frequently the result of inflamed heart tissue. However, tachycardia may have other causes as well, such as an infection.

Psychological Manifestations

People with lupus often experience psychological and emotional effects, such as grief, depression, and anger. These effects can be related to outward changes, such as skin alterations caused by the disease. They can also be related to concerns about the future, and about other aspects of the disease and its treatment. It is important for health professionals to be alert to potential psychological repercussions and to assist in alleviating them.

Potential Physiological Manifestations fatigue weight gain or loss fever (increased temperature over normal baseline) tachycardia depression: lowered selfesteem; negative feelings about body; feelings of decreased confidence and self-worth; feelings of sadness, hopelessness and helplessness; crying difficulty in completing self-care activities, caring for children, maintaining a household, and other activities of daily living inability to maintain full- or part-time employment decreased social activities lack of energy or ambition irritability impaired concentration insomnia suicidal thoughts

Potential Problems

1. inability to complete activities of daily living because of fatigue, weakness, and psychological difficulties

2. changes in weight

3. fever

Nursing Interventions

Objective: Minimize fatigue.

1. Assess the patient's general fatigue level.

2. Assess for the presence of depression, anxiety, and other stressors.

3. Conduct an assessment to determine the patient's daily activities that contribute to fatigue.

4. Help the patient to develop an energy-conserving plan for completing daily and other activities and work. Many people with lupus need to take a daily nap.
5. Encourage the patient to get 8 to 10 hours of sleep at night.

6. Encourage exercise as tolerated.

Objective: Maintain weight at optimal range.

1. Assess the patient's prescription and nonprescription drug regimen and dosages.

2. Assess the patient's usual daily dietary intake by asking her or him to keep a food diary.

3. Develop a dietary plan with the patient that encourages healthful eating. If the patient has nutrition-related lupus complications, refer her or him to a registered dietitian for specialized counseling.

4. Encourage exercise as tolerated.

5. Record the patient's weight at each visit.

6. Instruct the patient to weigh herself or himself at home once a week and record it.

Objective: Teach the patient to recognize fever and signs and symptoms of infection.

1. Assess the patient's prescription and nonprescription drug regimen and dosages.

2. Monitor the patient's WBC count.

3. Teach the patient to monitor temperature during a lupus flare.

4. Teach the patient to look for signs and symptoms of infection, particularly urinary and respiratory infections. (Note: The cardinal signs of infection may be masked because of corticosteroids and antipyretic medications.)

5. Instruct the patient to call a physician if signs and symptoms of an infection appear or if a fever is elevated above 101°F.

Objective: Assist the patient in adjusting to physical and lifestyle changes.

1. Allow the patient to express feelings and needs.

2. Assess the patient's usual coping mechanisms.

3. Acknowledge that feelings of denial and anger are normal.

4. Explore with the patient sources of potential support and community resources.

5. Explore possible ways of concealing skin lesions and hair loss.

6. Encourage the patient to discuss interpersonal and social conflicts

that arise. 7. Encourage the patient to accept help from others, such as counseling or a support group.

Objective: Recognize the signs and symptoms of depression and initiate a plan of care.

1. Assess the patient for the major signs and symptoms of depression.

2. Assess the patient's interpersonal and social support systems.

3. Encourage the patient to express feelings.

4. Initiate a referral to a mental health counselor or psychiatrist.

For further information and nursing interventions, see the section on infection. Also see the Patient Information Sheets in the chapters on Living With Lupus, Preventing Fatigue Due to Lupus, Skin Care and Lupus, and Fever and Lupus.



Source: National Institutes of Health, U.S.Dept of Health and Human Services