Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

pre assessment medication dosage calculations, Exams of Nursing

A case study of a patient diagnosed with Systemic Lupus Erythematosus (SLE), a chronic inflammatory disorder characterized by autoantibody production responsible for antibody-mediated and immune complex deposition tissue damage. the criteria for diagnosing SLE and the patient's symptoms, medical history, medications, and completed and follow-up lab tests. It also provides nursing orders and recommendations for treatment, including antimalarials and corticosteroids.

Typology: Exams

2023/2024

Available from 10/09/2023

kinuthia-mbiukia
kinuthia-mbiukia 🇬🇧

3

(2)

454 documents

1 / 4

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
Primary Diagnosis: Systemic Lupus Erythematosus (SLE) - Chronic inflammatory disorder
characterized by autoantibody production responsible for antibody-mediated and immune
complex deposition tissue damage (Ferri, 2019). A patient can be diagnosed with SLE if that
patient fulfills 4 of 11 criteria in the 1997 ACR, have 4 of 17 criteria of the 2012 SLICC or has a
biopsy proven nephritis compatible with SLE in the presence of ANA or anti-dsDNA antibodies [
CITATION Per20 \l 1033 ]. This patient has 6 of 11 criteria of the 1997ACR.
Brief HPI: Patricia Doyle is a 21 y/o female who presents to the clinic today with complaints of
fever and rash. She also has associated symptoms of fatigue, pain and stiffness to her hands and
knees, shortness of breath and chest pain. She feels her symptoms began approximately 2 weeks
ago after taking a vacation to Florida. She states her fever has been elevated to a little over 100
degrees that comes and goes. Her rash started on her cheeks and nose and progressed to her
forearms and chest. She feels like it started with sun exposure. Her knee and hand pain is rated at
a 3/10 and is worsened with movement such as climbing stairs or turning a door knob. She
becomes short of breath with exertion and had an episode of increased shortness of breath with
laughing. Her chest pain began a couple of days ago, and has progressively worsened from mild
to being unable to ignore. She rates her chest pain at a 7/10 that is worsened with deep
inspiration and has some alleviation with sitting up. She has been taking Tylenol but has had
minimal relief of her symptoms.
Status/Condition:
Stable
Code Status:
Full Code
Allergies:
NKDA
Admit to Unit:
Medical Surgical
Activity Level:
Up as tolerated
Diet:
Regular diet
IVF:
0.9% NS at 75/hr
Critical Drips: n/a
Respiratory:
Monitor O2 saturations, oxygen therapy as needed per protocol. Incentive spirometer
education to prevent pneumonia [ CITATION Fer19 \l 1033 ].
pf3
pf4

Partial preview of the text

Download pre assessment medication dosage calculations and more Exams Nursing in PDF only on Docsity!

Primary Diagnosis: Systemic Lupus Erythematosus (SLE) - Chronic inflammatory disorder characterized by autoantibody production responsible for antibody-mediated and immune complex deposition tissue damage (Ferri, 2019). A patient can be diagnosed with SLE if that patient fulfills 4 of 11 criteria in the 1997 ACR, have 4 of 17 criteria of the 2012 SLICC or has a biopsy proven nephritis compatible with SLE in the presence of ANA or anti-dsDNA antibodies [ CITATION Per20 \l 1033 ]. This patient has 6 of 11 criteria of the 1997ACR. Brief HPI: Patricia Doyle is a 21 y/o female who presents to the clinic today with complaints of fever and rash. She also has associated symptoms of fatigue, pain and stiffness to her hands and knees, shortness of breath and chest pain. She feels her symptoms began approximately 2 weeks ago after taking a vacation to Florida. She states her fever has been elevated to a little over 100 degrees that comes and goes. Her rash started on her cheeks and nose and progressed to her forearms and chest. She feels like it started with sun exposure. Her knee and hand pain is rated at a 3/10 and is worsened with movement such as climbing stairs or turning a door knob. She becomes short of breath with exertion and had an episode of increased shortness of breath with laughing. Her chest pain began a couple of days ago, and has progressively worsened from mild to being unable to ignore. She rates her chest pain at a 7/10 that is worsened with deep inspiration and has some alleviation with sitting up. She has been taking Tylenol but has had minimal relief of her symptoms. Status/Condition:

  • Stable Code Status:
  • Full Code Allergies:
  • NKDA Admit to Unit:
  • Medical Surgical Activity Level:
  • Up as tolerated Diet:
  • Regular diet IVF :
  • 0.9% NS at 75/hr Critical Drips : n/a Respiratory:
  • Monitor O2 saturations, oxygen therapy as needed per protocol. Incentive spirometer education to prevent pneumonia [ CITATION Fer19 \l 1033 ].

Medications:

  • Tylenol 650 mg PO Q6H as needed for pain or fever.
  • Hydroxychloroquine 200 mg PO daily. Antimalarials (hydroxychloroquine) may be helpful in treating lupus rashes or joint symptoms and appear to reduce the incidence of severe disease flares [ CITATION Bar15 \l 1033 ].
  • Methylprednisone 50mg IV daily. Prednisone 1mg/kg/day for serious manifestations and during flare ups then taper to low doses during disease inactivity [ CITATION Per20 \l 1033 ]. Nursing Orders:
  • Vital signs Q 4 Hour
  • Monitor intake and output
  • Notify if BP <100, HR >100 or temp >101.
  • Obtain and maintain IV access
  • Continuous telemetry monitoring
  • DVT prophylaxis Completed studies:
  • Antinuclear antibody (ANA) 1:512; Positive
  • Anti-DNA antibody positive at 300
  • Rheumatoid Factor: Negative
  • ESR 90; elevated
  • HIV Antibody: Negative
  • Creatinine Kinase; Normal
  • CBC o Hgb 10.4, Hct 31, MCV 92; Normocytic Anemia o Leukopenia 3000 o Thrombocytopenia 125
  • UA revealed: o Proteinuria o 10 RBCs o Positive occult blood; Microscopic hematuria. Initially, the kidneys may "leak" protein from the blood into the urine. When severe, this can cause water retention, swelling in the feet and lower legs, and other changes referred to as the nephrotic syndrome [ CITATION Bar15 \l 1033 ]
  • CXR: Bilateral pleural effusions Follow Up Lab tests:
  • BMP daily
  • CBC daily to watch for anemia
  • 24 - hour urine collection – given patient’s proteinuria

Discharge planning and required follow-up care:

  • Follow up with nephrology, rheumatology and dermatology per their recommendations
  • Follow up with primary care provider within 1 week of discharge Resources Barkley, T., & Myers, C. (2015). Practice considerations for the adult-gerontology acute care nurse practitioner. West Hollywood, CA: Barkley & Associates. Davis, J., & Silverman, M. (2019). Roberts and Hedges' clinical procedures in emergency medicine and acute care. Elsevier. Ferri, F. (2019). Ferri's best test: A practical guide to clinical labratory medicine and diagnostic imaging. Elsevier. UptoDate. (2020). Clinical Manifestations and diagnosis of systemic lupus erythematosus in adults. Retrieved from UptoDate: http://www.uptodate.com/?search=SLE