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Subject:NursingPrice: Bought3
D.W. is a 28-year-old married woman with three children under 6 years old. She came to her physician 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 D.W. had a positive antinuclear antibody (ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint x-ray films demonstrated joint swelling without joint erosion. D.W. was diagnosed with systemic lupus erythematosus (SLE). Her initial treatment consisted of hydroxychloroquine (Plaquenil) 400 mg and prednisone (Deltasone) 20 mg orally per day, bed rest, and ice packs. D.W. responded well and the steroid was tapered and discontinued. She was told she could report for follow-up every 6 months unless her symptoms became acute. D.W. resumed her job in environmental services at a large geriatric facility.
1. What is the significance of each of D.W.'s laboratory findings?
2. What priority problems would be addressed in D.W.'s care plan at that time of diagnosis?
CASE STUDY PROGRESS
Twenty-eight months after diagnosis, D.W. seeks out her physician with complaints of puffy hands and feet and increased fatigue. D.W. reports that she has been working longer hours because of the absence of two of her fellow workers.
Laboratory Test Results
Sodium 129 mmol/L
Potassium 4.2 mmol/L
Chloride 1 mmol/L
Total CO2 21 mmol/L
Blood urea nitrogen (BUN) 34 mg/dL
Creatinine 2.6 mg/dL
Glucose 123 mg/dL
Urinalysis 2+ protein
3. Which laboratory findings concern you, and why?
CASE STUDY PROGRESS
D.W. is seen in the immunology clinic twice monthly during the next 3 months. Although her condition does not worsen, her BUN and creatinine remain elevated. While at work one afternoon, D.W. begins to feel dizzy and develops a severe headache. She reports to her supervisor, who has her lie down. When D.W. starts to become disoriented, her supervisor calls 911, and D.W. is taken to the hospital. D.W. is admit- ted for probable lupus cerebritis related to acute exacerbation of her disease.
4.What other findings indicative of central nervous system involvement should you assess for in D.W.?
