Client D. B. is a 30-year-old Black woman who lives

Client D. B. is a 30-year-old Black woman who lives in a small town and works as a secretary for a farm machinery company. She is a single parent of two small children. She is overweight due to poor eating habits and lack of physical activity. Over the past six months, she has noticed that she is more fatigued, has anxiety, and heart palpitations. She believes she is just tired from looking after her children and working full time. However, she presents now to her health provider as she is now experiencing abdominal pain. Since she is eating mostly take-out fast-food meals, D. B.’s health provider believes she may be having some biliary colic and recommends that she start a low-fat diet and try to reduce the stress in her life to address the anxiety and heart palpitations. D. B. is also found to be hypertensive and placed on a beta-blocker for treatment. A year later, D. B. is now noticing that her knees and ankles are swelling bilaterally and continued fatigue. She is also complaining of pain in all her joints, and it is difficult to get up off the floor when playing with her children. She is noticing that her clothes are becoming looser. As it is becoming colder, D. B. is finding that her extremities are becoming stiff and discolored when exposed to the cold, and it is becoming more difficult to perform her secretarial work. D. B. accompanied her oldest child to a field trip to a farm on a sunny day and started to experience itching. When returning home, she saw that she had a raised red rash with a butterfly appearance on her face. She also had small, raised sores on her legs and arms. Concerned with these new symptoms and because it is becoming more difficult to do her secretarial work, D. B. makes an appointment to see her health provider. On assessment, she has lost 15 lbs. without trying over the past year. D. B. has not been adherent with her antihypertensive treatment due to financial constraints. Her provider performs a small skin biopsy and refers D. B. to a rheumatologist for further evaluation. Lab work is ordered. At the rheumatologist’s office, D. B. vital signs are BP 145/83, HR 88 bpm, Temperature 98.5 deg F, Respiratory rate 24 breaths/min not labored, Oxygen saturation 92%. Review of systems: General system: Client appears fatigued, short of breath, and mildly anxious Integumentary: mucosal pallor, no signs of cyanosis, pitting edema 2+, no rash, or joint deformities Respiratory system: Decreased breath sounds and dullness to percussion at the left base. Cardiovascular and Neurological: Normal limits MSK: Painful ROM in bilateral elbows, wrists, and knees. All other joints within normal limits GI: Distended abdomen non-tender to palpation. Lymph: Rubbery axillary and inguinal lymphadenopathy Laboratory Findings Lab Result RBC 3.8 million/mm3 Hbg 10.5 g/dL Hct 0.35 WBC 6,000/mm3 Plt 138,000/mm3 CRP 11 mg/dL ANA 0.4861111111111111 Anti-DNA Elevated Rh Negative Complement Assay Lab Result D3 3.8 million/mm3 D4 10.5 g/dL ESR 0.35 Urinalysis Lab Result RBC 3.8 million/mm3 WBC 10.5 g/dL Ketones 0.35 Protein Positive Skin biopsy results come back as small vessel vasculitis Based on this case study, answer the following questions in your initial post: Identify the physical signs and symptoms of systemic lupus erythematosus demonstrated by D. B. What abnormal laboratory and pathology results are consistent with systemic lupus erythematosus? How is rheumatoid arthritis ruled out as a diagnosis? Using the EULAR/ACR criteria (see attached document) score D. R. to see if criteria for SLE diagnosis is met. What are two priority teaching points for D. B. (consider her psychosocial needs and social history).

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