Case Study 76 Systemic Lupus Erythematosus, Exams of Nursing

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Case Study 76 Systemic Lupus Erythematosus Name….. HACC

1. What is the relevance of this information to her disease? Her age currently is 47, she had been diagnosed 18 years ago with SLE. This would put her at 19 years of age at diagnosis which is typical falling in between 15-45 years. Females are at a greater risk for SLE, 85%-90% of SLE patients are women. The occasional Naproxen and antacid use are normal. Naproxen can be used and effective for minor joint pain. Joint pain is a common manifestation of SLE.
2. What is the significance of the patient’s family history? The family history of rheumatoid arthritis, pernicious anemia, and graves disease is relevant because each of these are autoimmune diseases. Autoimmune diseases are found to run in families and have a genetic component that increases risks to develop these diseases.
3. Is this patient underweight, overweight, obese, or is this patient’s weight considered healthy and normal? The patient is currently underweight at 102lbs with a BMI of 17. A BMI of less than 18. is considered underweight. This is a change since her last exam 1 year prior where her weight was 125lbs with a normal BMI of 20.8. Decreased appetite and weight loss are clinical manifestations of SLE.
4. Explain the pathophysiology that underlies hair loss in this patient and the relevance of the abnormal ESR. The helper T cells or suppressor T cell function causes B lymphocytes to create antibodies against its own tissues. These autoantibodies bind with antigens creating immune complexes. Inflammation occurs when the immune complexes are trapped in body tissues, triggering the inflammation process the body uses to try to remove the

Jaundice can be caused by the break down of RBC’s. Bilirubin can accumulate in the body when the breakdown of RBC’s is accelerated.

9. It is appropriate for her PCP to inform her that the arthritis of lupus, which is a likely possibility, is relatively benign, unlike rheumatoid arthritis, which destroys cartilage in the joints and causes deformities.
10. Why might the PCP be concerned about the possibility for pneumonia? SLE can cause lupus-induced leukopenia putting the patient at a greater risk of developing infections.
11. What is the pathophysiology that underlies lymph node enlargement in this patient? Lymph nodes can swell with SLE during flares of the disease due to systemic inflammation. As well as, Bronchitis could cause the lymph nodes to swell due to the infection.
12. Which of the three blood test results directly above would be of most concern? Give a likely cause for the abnormality. The WBC is low at 1,2200/mm3. Type II complement-mediated cytotoxic hypersensitivity immune reaction can cause cell lysis of WBC’s causing them to be low.
13. The patient’s WBC differential was: 75% neutrophils, 15% lymphocytes, 5% monocytes/macrophages, 4% eosinophils, and 1% basophils. Which one of these 5 white blood cell types has been specifically targeted by the patient’s immune system? All the values are still within normal range however, the lymphocytes are in the low end of that range. This would suggest that the lymphocytes are being targeted by the immune system.

14. What is the association between the abnormal blood test results, abnormal lung sounds, and productive cough? All of these suggest there is possibly an infection developing/developed in the lungs.
15. Give a reasonable explanation for the cause of tachycardia and elevated blood pressure in this patient. Tachycardia and elevated BP could be compensation from decreased oxygenation due to the mild pulmonary edema from bronchitis. Stress from coughing could also contribute to these findings.
16. What is the likely cause of the abnormal blood test results now? The likely cause is from an SLE exacerbation and the immune system attacking the red and white blood cells.
17. Explain the pathophysiology of swelling throughout the body. Swelling throughout the body can be cause when the kidneys are inflamed making it difficult for them to remove waste or control a proper fluid balance.
18. Suggest one reasonable explanation for an association between systemic swelling and anorexia/weight loss in this patient. Systemic swelling can be caused by nephrotic syndrome as a manifestation of the SLE. The anorexia and weight loss are also caused by the SLE exacerbation effecting the gastrointestinal. GI system is affected by anorexia, nausea, abdominal pain, diarrhea, and hepatomegaly.
19. Patients with SLE should receive an influenza vaccination every year and a pneumococcal vaccination every 5 years. Why?

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