Care of the Lupus Patient
Potential Ophthalmologic Manifestations continued...
- Visual impairment
- Potential for injury
- Difficulty carrying out ADL
- Allow time for patient to express concerns
and ask questions.
- Teach the patient how to apply artificial
tears for dry eyes to increase comfort and prevent corneal
- Teach patient the correct way to take
prescribed medications, such as eye drops for glaucoma.
- Suggest warm, moist compresses, which may
help ease discomfort and itching from conjunctivitis.
Objective: Minimize Potential for
Serious Visual Impairment or Blindness
- Assess patient's vision changes and
- Reinforce the need to follow up with an
Objective: Develop a Plan for Patient to
Perform ADL Appropriately and Independently
- Provide referrals to support groups and
services for the visually impaired.
Twenty years ago, women with
lupus were counseled not to become pregnant because of the risk of a flare of
the disease and an increased risk of miscarriage. Research and careful
treatment have made it possible for more and more women with lupus to have
successful pregnancies. Although a lupus pregnancy is still considered high
risk, most women with lupus are able to carry their babies safely to term.
Experts disagree on the exact numbers, but approximately 20-25% of lupus
pregnancies end in miscarriage, compared with 10-15% of pregnancies in women
without the disease. Pregnancy counseling and planning before pregnancy is
important. Optimally, a woman should have no signs or symptoms of lupus before
she becomes pregnant.
Researchers have now
identified two closely related lupus autoantibodies, anticardiolipin antibody
and lupus anticoagulant, that are associated with risk of miscarriage.
One-third to one-half of women with lupus have these autoantibodies, which can
be detected by blood tests. Identifying women with the autoantibodies early in
the pregnancy may help physicians take steps to reduce the risk of miscarriage.
Pregnant women who test positive for these autoantibodies and who have had
previous miscarriages are generally treated with baby aspirin or heparin
throughout their pregnancy.
Some women may experience a
mild to moderate flare during or after their pregnancy; others may not.
Pregnant women with lupus, especially those taking corticosteroids, are also
likely to develop pregnancy-induced hypertension, diabetes, hyperglycemia, and
kidney complications. About 25% of babies of women with lupus are born
prematurely, but do not suffer from birth defects.
About 3% of babies born to
mothers with SLE will have neonatal lupus, or specific antibodies called
anti-Ro(SSA) and anti-La(SSB). This is not the same as SLE and is almost always
temporary. The syndrome is thought to be caused by passive transfer of anti-Ro
antibodies from the mother to the fetus. About one-third of women with SLE have
this antibody. By 3-6 months of age, the rash and blood abnormalities
associated with neonatal lupus disappear. Very rarely, babies with neonatal
lupus will have a congenital complete heart block. This problem is permanent,
but can be treated with a pacemaker.