D.W. is a 28-year-old married woman with three children under 6 years old. She came to her physici. Question
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Asked by mluctama
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.
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
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?
10.You need to call the physician regarding D.W.’s status. What do you anticipate your
care of D.W. will include over the next 2 to 3 hours?
11.You note that D.W.’s husband is visiting her. You enter the room to ask whether they
have any questions. D.W.’s husband states, “I have tried to tell her that she cannot go
back to work. Sure, we need the money, but the kids and I need her more. I’m afraid that
this lupus has weakened her whole body and it will kill her if she goes back to work. Is
that right?” How should you respond to his concerns?
SCIENCE
HEALTH SCIENCE
NURSING
NUR 2261
D.W. is a 28-year-old married woman with three children under 6 years old. She came to her physici
