Care of Clients on Steroid Therapy

1. monitor vital signs
2. monitor serum electrolytes and blood glucose level
3. monitor for hypokalemia and hyperglycemia
4. monitor intake and output and weight and for edema
5. monitor for hypertension
6. assess for changes in muscle strength
7. instruct the client to take at mealtime or with food
8. advise client to eat foods high in potassium
9. instruct client to avoid individuals with respiratory infections
10. inform all health care providers of the medication regimen
11. report signs and symptoms of medication overdose or Cushing's syndrome, incuding moon face, puffy eyelids, edema in the feet, increased bruising, dizziness, bleeding, and menstrual irregularities.
12. client may need additional doses during periods of stress, such as surgery.
13. DO NOT abruptly stop the medication because it may cause sever adrenal insufficiency.
14. consult with physician before receiving vaccinations.
15. report signs of infection, muscle aches, sudden weight gain, or headache.


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Systemic Lupus Erythematosus

Systemic Lupus Erythematosus (SLE) is an autoimmune disease. It is a chronic progressive systemic inflammatory disease that can cause major organs and systems to fail.
Connective tissue and fibrin deposits collect in blood vessels on collagen fibers and on organs.
The deposits lead to necrosis and inflammation in blood vessels, lymph nodes, gastrointestinal tract, and pleura.
No cure for the disease is known.

Cause is unknown. SLE is thought to be due to a defect in the immunological mechanisms or from genetic origin.
Precipitating factors include medications, stress, genetic factors, sunlight or ultraviolet light, and pregnancy.

Signs and Symptoms
Precipitating factors such as sunlight, stress, medications, and pregnancy
Dry scaly raised rash on the face or upper body
Fever
Weakness, malaise, and fatigue
Anorexia
Weight loss
Photosensitivity
Joint pain
Erythema of the palms
Butterfly erythema of the face
Anemia
Positive antinuclear antibodies test and lupus erythematosus preparation
Elevated sedimentation rate

Care for Patients with SLE
1. Monitor skin integrity and provide frequent oral care
2. Instruct the client to clean skin with a mild soap, avoiding harsh and perfume substances.
3. Assist with the use of ointments and creams for rash as prescribed.
4. Identify factors contributing to fatigue.
5. Administer iron, folic acid, or vitamin supplements as prescribed if anemia occurs.
6. Provide a high-vitamin and high-iron diet.
7. Provide a high-protein diet if there is no evidence of kidney disease.
8. Instruct in measures to conserve energy, such as pacing activities and balancing rest with exercise.
9. Administer topical or systemic corticosteroids, salicylates, and nonsteroidal antiinflammatory drugs as prescribed for pain and inflammation.
10. Administer hydroxychloroquine sulfate (Plaquenil) as prescribed to decrease the inflammatory response.
11. Instruct the client to avoid exposure to sunlight and ultraviolet light.
12. Monitor for proteinuria and red cell casts in the urine.
13. Monitor for bruising, bleeding, and injury.
14. Assist with plasmapheresis as prescribed to remove autoantibodies and immune complexes from the blood beforeorgan damage occurs.
15. Monitor for signs of organ involvement such as pleuritis, nephritis, pericarditis, coronary artery disease, hypertension, neuritis, anemia, and peritonitis.
16. Note that lupus nephritis occurs early in the disease process.
17. Provide supportive therapy as major organs become affected.
18. Provide emotional support and encourage the client to verbalize feelings.
19. Provide information regarding support groups and encourage use of community resources.


Medical treatment
There is no permanent cure for SLE. The goal of treatment is to relieve symptoms and protect organs by decreasing inflammation and/or the level of autoimmune activity in the body. Many patients with mild symptoms may need no treatment or only intermittent courses of antiinflammatory medications. Those with more serious illness involving damage to internal organ(s) may require high doses of corticosteroids in combination with other medications that suppress the body's immune system.

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Glossary