Lupus Health Center

Care of the Lupus Patient

Central Nervous System Manifestations continued...

Nursing Interventions

Objective: Develop Plan for Patient to Perform ADL Appropriately and Independently

Assess and document patient's mental status to determine her or his capabilities:

• general appearance
• unusual body movements
• speech patterns and word use
• alertness and orientation to time, place, and person
• memory of remote and recent past
• perception of self and environment
• affect and emotional stability
• ability to solve problems
• presence of depression

Support patient's need to maintain some control over daily activities and decisions:

• encourage patient to plan and participate in daily routines
• set aside time to develop trust and rapport with patient, and be consistently truthful (patients are keenly aware of inconsistencies in information provided)

Potential CNS Manifestations

General CNS Lupus

• Headaches
• Fever
• Confusion
• Seizures
• Psychosis

Cranial Neuropathies

• Visual defects
• Blindness
• Nystagmus (involuntary movement of the eyeball)
• Ptosis (paralytic drooping of the eyelid)
• Papilledema (edema in the optic disk)
• Tinnitus
• Vertigo
• Facial palsy

Cognitive Impairment

• Confusion
• Impaired long- and short-term memory
• Difficulty in conceptualizing, abstracting, generalizing, organizing, and planning information for problem solving
• Difficulties in personal and extrapersonal orientation
• Altered visual-spatial abilities
• Selective attention
• Difficulties in pattern recognition, sound discrimination and analysis, and visual-motor integration

Mental Changes

• Depression
• Anxiety
• Affective disorder
• Mood swings
• Hypomania or mania (especially with corticosteroid use)

Rare CNS Manifestations

• Movement disorder
• Aphasia
• Coma

Encourage patient to discuss effects of SLE on her or his personal life and coping methods. Allow expressions of fear and anger.

Objective: Assist Patient in Identifying Family and Community Support Services

1. Assess patient's support network. Discuss alternatives for strengthening supports.
2. Anticipate family concerns. Seek out the family to answer their questions and to provide support. Include significant others in patient care as appropriate.
3. Help family identify potential coping skills, environmental supports, and community services for dealing with chronically ill people.
4. Encourage patient and family members to consider professional counseling.

Objective: Minimize Potential for Injury

1. Assist patient and family in identifying and removing potentially dangerous items in the environment.
2. Involve family members in planning of patient's care and safety measures.
3. Assess patient's ability to safely administer own medications.