Nursing Diagnosis

Relating to the previous blog in the analyzing of support groups and their benefits related to lupus. Since lupus is an autoimmune disease the idea that this cannot be cured can really weigh heavily on some people. Having other people to talk to and relate to this feeling can be encouraging and eradicate the feeling of being all alone in the pain associated with this disease. A huge part of lupus is the overwhelming feeling of being tired and not having enough energy related to the pain and hopelessness that one may be constantly experiencing. Finding other people to speak with about the feelings of always being fatigued and exhausted might help you to find encouraging ways to boost your energy. Support groups are helpful in many aspects, but they are not for everyone. Finding hope with this disease can come from different places as well the key is finding what helps to make you feel better as you battle this disease.

Nursing Diagnosis:

1.       Ineffective coping related to illness as evidence by physical complaints such as fatigue and GI disturbance.

2.       Disturbed body image related to illness related to presence of butterfly rash, lesions, alopecia, and loss of strength

3.       Acute pain related to autoimmune disorder as evidence by a reported pain and discomfort

4.       Impaired physical mobility related to chronic inflammatory illness as evidence by pain in affected area upon movement.

5.       Fatigue related to autoimmune disorder as evidence by increased complaints of dyspnea and tachycardia.

    Website: http://advisor-edu.lww.com/lna/document.do?bid=23&did=363780&hits=lupus

Nursing Diagnosis	Goals	Interventions	Evaluation
Fatigue related to autoimmune disorder as evidence by increased complaints of dyspnea and tachycardia	The patient will have an improved ability to conduct routine daily or work activities	Encourage verbalization of lifestyle or environmental demands            Increase the patients participation in care as tolerated           Provide comfort measures to promote rest         Teach energy conserving techniques as appropriate         Assess the patient’s ability to perform activities	The patient experiences an improved ability to conduct routine daily and work activities.

Support Groups

Seeking a support group while going through a trying time in your life or learning how to deal with a disease that consumes your life will help you to learn to cope, accept, and remain positive.  Being supported by other people experiencing the same situation as you can be a powerful feeling especially with the emotional rollercoaster that this unpredictable chronic illness presents.  When you go through ups, down, flares, and remission lupus can feel overwhelming and you may experience a loss of control over your life. Having people there to talk through these times will you and people who relate to what you are experiencing can help you to keep a positive outlook on your life.

Support groups are where people with a similar disease get together at a regular time each week or month to talk. Support groups can take place in homes, clinics, offices, coffee shops, hospitals, religious gatherings.  These support groups may give you a sense of connection. Meeting and talking with others that understand your feelings and concerns will help you fight back loneliness and isolation. Many people gain coping skills. They get ideas for dealing with lupus preparing for flares, handling finances, and not just surviving, but even thriving with lupus. Another positive outcome is the gaining of motivation and hope. Being inspired to take a meaningful role in your own care and your future by sharing and listening to others. These groups can also help you to stay informed on the latest research, trials, and possibilities for new medications. One of the most beneficial outcomes is that of friendship. When it happens it can provide great relief for helping normalize feelings and concerns.

These links below will help you to discover some important support groups in your area that are specific to your location and needs. Not everyone with lupus is the same and not everyone deals with the disease the same, but connecting with people who can relate to you might just be the empowerment that you are desperately striving for.

 http://www.lupusny.org/about-lupus/newsletters/reasons-join-lupus-support-group

http://www.mollysfund.org/programs-services/lupus-support-groups/

http://www.dailystrength.org/c/Lupus/support-group

Medical Care for Lupus

The most important aspect to remember with caring for patients with lupus is that this particular disease has a variety of manifestations in different people and often never effects two people the same way. It’s very important to listen to the patient and make sure that you understand what symptoms they are having and how severe they are.  Another important aspect to keep in mind is to keep reassessing the patient’s status over time and adjusting treatment to accommodate the variability of lupus manifestations.

Specific manifestations include dermatologic issues including: butterfly rash, ulcers, purities, and bruising.  In the musculoskeletal system patients have fatigue, arthritis, and other joint complications. They may also have anemia and thrombocytopenia. In the cardiopulmonary system that can have pericarditis, myocarditis, myocardial infarction, and valvular hear disease. In the renal system the patient may have urinary tract infections fluid and electrolyte imbalances. In the central nervous system patient may experience depression, mental changes, and cranial neuropathies. Some have symptoms in the gastrointestinal system like ascites, pancreatitis, and anorexia.

As a nurse the care for the patient will include: assess the patient’s general fatigue level, presence of depression, anxiety, and other stressors. Determine the patient’s daily activity levels and help the patient come up with an energy conserving plan. Encouraging the patient to get 8 to 10 hours of sleep a night and activity as tolerated.  Assess the patient’s prescription regimen. Develop a dietary plan with the patient and record the patient’s weight every visit. Instruct the patient to weight themselves weekly.  Assessing certain signs of depression and social support systems that the patient may have.  Have patient take medication that alleviate discomfort and itching as ordered.  Teach patient self-management techniques to control pain, apply heat or cold, and use prescription and nonprescription pain medications.  For muscle joint pain suggest warm baths, physical therapy regime, assistive devices, and an exercise plan. Asses the patient for signs and symptoms of bleeding, petechiae, and bruising.  Encourage the patient to wear a medical alert bracelet and to prevent bleeding such as using a soft tooth brush.  Assess how well the patient is getting oxygen by auscultating breath sounds, skin color, nailbeds, and skin temperature.

Since there is no specific medication regime or outline of procedures that will cure lupus form a medical standpoint the care involved is the treat the symptoms that are being presented. These are interventions from a nursing standpoint to see the variety of management that goes into caring for a patient with lupus. 

This article provided by the lupus organization goes into detail about how lupus is managed and treated. This website gives important information about how health care providers have recently found the best methods to treat the symptoms of lupus.  http://www.lupus.org/answers/entry/how-is-lupus-treated

References: http://www.webmd.com/lupus/care-lupus-patient?page=10 

What do I eat if I have Lupus?

There is not a magic formula that if you eat these certain foods then lupus will go away.  Since lupus is an autoimmune disease then the best method for your diet is to eat healthy. There are some foods to avoid if you have lupus that have been known to cause flare ups and foods to avoid or eat when taking medications associated with lupus. Bad eating habits can make it more difficult on your body to fight lupus.  Simply making changes to your diet can make a big difference about how you feel day to day and protect your body, especially your heart from lupus damage.

Certain foods that are important to avoid when eating a healthy diet are fried foods, fast foods made with oil and butter which are usually high in fat. Eating too much of these foods can increase your risk of a heart attack, stroke, and diabetes which will cause your lupus symptoms to worsen if your body is forced to compensate for two different conditions.  Caffeine is also important to limit or cut out of your diet because it can upset your stomach and not having it will give your stomach a chance to rest because most likely the medication your taking for lupus will be difficult for your stomach to handle anyway. Salt is important to stay away from as well because it will increase or worsen high blood pressure. Also, mixing alcohol with lupus medications even Tylenol can be dangerous to your health.

Good foods to focus on are having foods high in calcium and vitamin D such as yogurt, cheese, and milk to make your bones stronger because if you are taking a corticosteroid to treat lupus then this puts you at a higher risk for osteoporosis a disease that weakens your bones. Eating foods with alfalfa have been associated with reports of lupus flares which include muscle pain, fatigue, abnormal blood tests, changes in immune system, and kidney problems.  It’s important to eat low fat proteins like fish to keep your heart healthy. Also for heart health it’s important to have whole grains, whole wheat, and high fiber foods.

Overall, maintaining your health and focusing on eating foods that decrease your risk of cardiovascular problems, high blood pressure, and kidney disease will help to manage your lupus symptoms.

This article will provide important information regarding what to eat and important dietary tips for lupus. http://www.lupusny.org/about-lupus/newsletters/september-october-2005/healthy-eating-tips-people-lupus 

 

References: http://www.lupus.org/answers/entry/lupus-diet-and-nutrition

Ways to treat Lupus

The treatment for lupus varies with each person depending on their symptoms and how far along this disease is. Since lupus does not have a cure all that can be done is to try and maintain a balance between preventing flare ups and potentially life threatening organ damage that lupus can cause. Also the side effects of the medications being taken are factors to consider and ways to reduce the side effects.  This fine balance can only happen with constant monitoring of the disease as well as side effects caused by the medication regime. It is extremely important to always communicate with your doctor and the responses to the medication. This will lead to optimizing the medication regime and will promote the best course of action taken by you and your physician.

            There are several drug classes that I will go over that help control the symptoms of lupus and give several examples of each. The first is nonsteroidal anti-inflammatory medications or NSAIDS. These reduced inflammation, stiffness, and pain in the joints. Since NSAIDS are a milder from they are to treat milder signs of lupus or combined with other medications. People with lupus may have a higher risk of liver or kidney damage while taking an NSAID. Some examples are aspirin and naproxen or aleve.  Another medication category is antimalarial medications. These are generally used to treat malaria but can help control lupus. Some side effects are stomach upset, and damage to the eye. Some examples are plaquenil which can suppress the immune response in lupus. Next is corticosteroids like prednisone that can counter the inflammation of lupus. They produce side effects like weight gain, easy bruising, thinning of the bones, and high blood pressure. They work my mimicking cortisol which your body makes naturally to reduce inflammation.  The last category is immunosuppressant these help with more serious cases of lupus. Side effects may include increased risk of infection, liver damage, and increased risk of cancer. Some examples are Belimumab which is the newest medication out to reduce the symptoms of lupus, cellcept is another immune suppressor that is used for lupus in the kidneys, cytoxane is a cancer treatment medication that suppresses the immune system.

 

References:

http://www.mollysfund.org/2013/03/lupus-treatment-options-lupus-medications/?gclid=COjb6I3P5cgCFUiEfgodXQcIWQ

http://www.lupus.org/answers/entry/medications-to-treat-lupus?gclid=CPaTk4PP5cgCFYZefgodcowF_w

Symptoms of lupus

The progression of lupus over time varies within individuals. Some patients have more severe onset of the disease early on and then the disease will slowly become dormant.  Other patients can have a mild form of lupus early on and eventually gets worse.  Early on in the disease the problems of the autoimmune disease are that it attacks the body’s healthy tissue these attacks can lead to irreversible damage to orangs such as the kidney and heart.  About half of patients have a milder form that is confined to the skin and musculoskeletal system. The other half will have a more severe form of lupus generally the type that attacks the internal organs.

Going through the body by system there are signs and symptoms that will help determine lupus. In the brain and nervous system if you have frequent headaches, confusion or memory loss.  In your lungs, if you have pleurisy and inflammation such as pneumonitis or pulmonary emboli causing shortness of breath and pain while breathing. In the renal system the kidneys can become inflamed and cause lupus nephritis. The inflammation can most likely cause kidney failure and you will have symptoms associated with that such as blood in the urine, swelling of your feet and legs, and a high blood pressure.  Lupus also effects the eyes as well causing nerve and blood vessel damage, dry, puffy eyes. Someone with lupus might get sores in their mouth. On the skin there may be rashes such as a butterfly rash on the face. These rashes can be further irritated by the sun. Some may also experience hives or sores that worsen with sun exposure.  If your fingers and toes turn blue with exposure to cold or during stressful situations this is because your blood vessels are constricting a condition called Raynaud´s phenomenon which is associated with having lupus. In the stomach lupus can increase ulcerative colitis, liver disease, and pancreatitis. This can cause vomiting, abdominal pain, bladder infections, and blood in the urine. The legs and joints will swell and be painful like rheumatoid arthritis and disease that exits in conjunctions with lupus.

This is a great article to read about lupus in general and the signs and symptoms. http://go.galegroup.com.georgefox.idm.oclc.org/ps/retrieve.do?sort=RELEVANCE&docType=Article&tabID=T002&prodId=AONE&searchId=R1&resultListType=RESULT_LIST&searchType=AdvancedSearchForm&contentSegment=&currentPosition=1&searchResultsType=SingleTab&inPS=true&userGroupName=newb64238&docId=GALE%7CA294505172&contentSet=GALE%7CA294505172

References: 

http://www.mollysfund.org/2013/01/lupus-symptoms-and-signs/?gclid=CNSEwq3K5cgCFYlafgod4bkItg

http://www.everydayhealth.com/lupus/living/battling-lupus.aspx

How does Lupus become diagnosed?

Lupus is not an easy disease to diagnose and your doctor need to rule out other possible disease scenarios before confirming the diagnosis of lupus.  Since there is not a lot of information regarding exactly why lupus happens it is hard to pinpoint the exact clinical manifestations that might be present. The symptoms of lupus often mimic other illnesses and sometimes some symptoms will be present and not others.

If a doctor was considering the possible diagnosis of lupus they would look for signs and symptoms of inflammation which are generally pain, heat, and redness, swelling, and loss of function in a certain place in the body. Inflammation can occur in the inside and outside of the body. Inside the body the lining around the heart and kidney disorders causing excessive protein in the urine are symptoms of inflammation inside the body that a person with lupus would have. Inflammation can occur on the outside of the body as well it will manifest as a malar or butterfly rash, raised red patches, and photo-sensitivity. There also may be neurological manifestations such as seizures or psychosis. Other manifestations that can occur are hematologic or blood disorders like anemia, low white blood cell count or low platelet count.

            Since Lupus is such a hard disease to pinpoint the doctor will go through numerous laboratory tests to gain a full picture of the forming of the illness. Even if you have some of the symptoms no single laboratory test can determine lupus. A test result one time may be positive and negative another time and different laboratories may produce different results. If someone presents with multiple criteria simultaneously then a physician might diagnose a patient with lupus. Most often though these manifestations happen over time and the diagnosis may not be as obvious. Setting up an appointment with a rheumatologist may be necessary to either diagnose or rule out the option of lupus. 

References: 
http://www.lupus.org/answers/entry/diagnosing-lupus
http://www.lupusresearchinstitute.org/lupus-facts/lupus-diagnosis