Scenario DW is a 25 year old

Scenario DW is a 25 year old married woman with three children under 5 years old. She came to her primary care physician (PCP) 7 months ago with vague complaints of intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her physician noted small, patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Laboratory studies revealed that DW had a positive antinuclear antibody (ANA) titer, positive dsDNA (double-strand deoxyribonucleic acid), positive anti-Sm (antismooth muscle antibody), and elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Joint x-ray films demonstrated joint swelling without joint erosion. DW was subsequently diagnosed with systemic lupus erythematosus (SLE). She was initially treated with hydroxychloroquine (Plaquenil) 400mg and prednisone (Deltasone) 20mg orally per day, bed rest, and ice packs. DW responded well to treatment, the steroid was tapered and discontinued, and she was told she could report for follow-up every 6 months unless her symptoms became acute. DW resumed her job in environmental services at a large geriatric facility. 1. What is the significance of each of DW’s lab findings? 2. Given that most tests are nonspecific, how is SLE diagnosed? 3. Explain why DW was prescribed belimumab, hydroxychloroquine, and prednisone as part of her therapeutic regimen? (ie. What are the meds, why are they used in SLE, etc.) 4. What side effects and nursing responsibilities should the nurse address with DW for each medication? 5. What priority problems were addressed in DW’s care plan at the time of diagnosis? Case Study Progress Eighteen months after diagnosis, DW seeks out her PCP because of puffy hands and feet and increased fatigue. DW reports that she has been working longer hours because of the absence of 2 of her fellow coworkers. DW gets blood drawn and gives a urine sample. The results are listed below: Laboratory Test Results Sodium 129 mmol/L Potassium 4.2 mmol/L Chloride 119 mmol/L Total CO 2 21 mmol/L BUN 34 mg/dL Creatinine 2.6 mg/dL Glucose 123 mg/dL Urinalysis 2+ protein 1+ RBCs 6. Which lab findings concern you, and why? 7. How will DW’s treatment and care plan likely change? 8. DW’s PCP orders cyclophosphamide (Cytoxan) 3mg/kg/day orally in 2 divided dosses. DW weighs 140 pounds and is 5 feet, 4 inches tall. How much will she receive with each dose? Why is DW being prescribed this medication and what side effects and nursing responsibilities are should the nurse address? Case Study Progress DW is seen in the immunology clinical twice monthly during the next 3 months. Although her condition does not worsen, her BUN and creatinine remain elevated. While at work one afternoon, DW begins to feel dizzy and develops a severe headache. She reports to her supervisor, who has her lie down. When DW starts to become disoriented, her supervisor calls 911, and DW is taken to the hospital. DW is admitted for probable lupus cerebritis related to acute exacerbation of her disease. 9. What other findings indicative of central nervous system (CNS) involvement from SLE should DW be assessed for? 10. What preventive measures need to be instituted to protect DW at this time? 11. While caring for DW, which of these care activities can be safely delegated to the NAP? (Select all that apply). a. Measuring DW’s blood pressure every 2 hours b. Assisting DW with personal hygiene measures c. Counseling DW on seizure safety precautions d. Assessing DW’s neurologic status every 2 hours e. Emptying the urine collection device and measuring the output f. Monitoring DW’s BUN and creatinine levels

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