Exemplar 8.4: Systemic Lupus Erythematosus

You have a young female nursing student just diagnosed with lupus. She's heard of this disorder, but knows very little about it and decides to ask you, the university nurse, about it. Which of the following statements made by the student nurse shows that teaching has been effective?

A 20-year-old female patient presents to you because she's had a 100.1 degree Fahrenheit fever, appetite loss, and pain in both elbows, wrists, shoulders, ankles. and knees for the past 2 weeks. She tells you she's lost about 6 pounds and she has had a hard time concentrating on schoolwork because hasn't "felt very good", though she can't identify why. She explains that this has been happening on and off for the past two years, but she hasn't gone to the doctor about it because her symptoms haven't been this troublesome before. What follow up question would you want to ask this patient?

You are a nurse in a doctor's office about to see a male patient that has been taking procainamide for a little over a year. What questions might you ask this patient when he comes in?

Select the medications that have potential to cause drug-induced lupus.

Your female lupus patient is presenting with severe weakness, fatigue, dyspnea, and heart palpitations. She reports that her grades have been dropping because she's too exhausted to do anything and she can't concentrate. She is pale, her skin is cold, and the tips of her fingers are slightly cyanotic. Her heart rhythm is sinus rhythm; upon auscultation, S1 and S2 could clearly be heard, no extra sounds or murmurs identified. Her hematocrit is 22% and her hemoglobin is 7.5 g/dL. Which of the following orders should you place FIRST?

A patient with lupus is in the doctor's office during a flare up. She complaining about getting random nose bleeds, gum bleeds, and bruising. She is embarrassed to wear skirts and short sleeved shirts because of the extensive bruising and "bumpy, non-itchy rashes" (petechiae) on her skin. It is even interfering with her relationship with her fiance; due to the extensive bruising and the patient trying to cover it up, people will assume that her fiance is abusing her and act judgmentally. Which of the following orders will you suggest to the doctor for this patient?

A lupus patient presents with chest pain radiating to his back., dry cough, fever, and anxiety. He reports that he is very tired, but he can't lay down and rest because that makes the pain worse. He is pale and cold. Upon auscultation you hear a high-pitched grating sound, no crackles or rales in the lungs. Telemetry and ECG shows ST elevation and PR depression. Which of the following interventions should you order FIRST?

You are concerned that the patient you are caring for might have systemic lupus erythematosus. Which tests might you order?

You have a patient presenting to the hospital with anasarca, with increased edema in the hands, feet, and face; fatigue; anorexia; and foamy urine. This patient has been diagnosed with lupus in the past. What tests might you order?

Which of the following instructions is important to give to a female patient taking hydroxychloroquine?

What are your responsibilities when taking care of a patient on IV azathioprine?

You have just taught a patient about precautions to take to prevent infection while taking cyclophosphamide. Which of the following statements made by the patient shows that teaching has been effective?

You have a female patient admitted to the hospital with pericarditis due to an acute flare up of lupus. She also has kidney damage due to extensive renal involvement. She has been prescribed prednisone and cyclophosphamide to control her disease. Select appropriate interventions for this patient.

You have a 20-year-old patient recently diagnosed with lupus. She is wondering how to avoid acute exasperation and painful dermatological manifestations of the disease. Which of the following interventions is not correct advice to give to the patient?