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 feve
I need help answering questions 7-9 please
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.?
5. What protective measures need to be instituted at this time?
6. In caring for D.W., which care activities can be delegated to the UAP? Select all that
apply.
a. Monitoring D.W.’s BUN and creatinine levels
b. Counseling D.W. on seizure safety precautions
c. Assisting D.W. with personal hygiene measures
d. Assessing D.W.’s neurologic status every 2 hours
e. Measuring D.W.’s blood pressure (BP) every 2 hours
f. Emptying the urine collection device and measuring the output
CASE STUDY PROGRESS
The physician orders pulse therapy with methylprednisolone (Solu-Medrol) 125 mg IV
every 6 hours and plasmapheresis once daily.
7.What major complications associated with immunosuppression therapy will D.W. have
to be monitored for?
Vital signs
BP 80/43 mm Hg
Pulse Rate 118 beats/min
Respiratory rate 18 breaths/min
Temperature 97.2 F (36.2 C)
8.D.W. returns to the floor after the plasmapheresis. The UAP reports to you D.W.’s vital
signs. Based solely on her vital signs, what could be happening with D.W. and why?
9.D.W. is complaining of dizziness and is slightly diaphoretic but denies any headache,
nausea, or paresthesia. What do you immediately suspect is occurring and why?
I need help answering questions 7-9 Please
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