A patient with a history of systemic lupus erythematosus (SLE) presents with increased joint pain, fatigue, rash extending to the neck and chest, and mild proteinuria. Which nursing intervention is most appropriate to prioritize at this time?

C) Monitor renal function and assess for signs of worsening nephritis

A) Encourage increased physical activity to combat fatigue

B) Educate the patient on the importance of sun protection measures

C) Monitor renal function and assess for signs of worsening nephritis

D) Advise the patient to reduce fluid intake to decrease proteinuria

A patient with systemic lupus erythematosus (SLE) presents with worsening fatigue, joint pain, and a rash extending to the neck and chest. Laboratory tests show elevated ESR, CRP, and mild proteinuria. What nursing intervention is most appropriate to prioritize in the management of this patient?

B) Discuss the importance of medication adherence and regular follow-up visits

A) Encourage increased physical activity to combat fatigue

B) Discuss the importance of medication adherence and regular follow-up visits

C) Recommend dietary modifications to reduce protein intake

D) Advise the patient to use topical corticosteroids for rash management

A patient with systemic lupus erythematosus (SLE) on immunosuppressive and corticosteroid therapy presents with new onset hypertension, dyspnea, and evidence of pleural effusion. Which nursing intervention is the most appropriate to address the patient's respiratory symptoms while awaiting further evaluation?

B) Position the patient in a high Fowler's position to facilitate lung expansion

A) Encourage the patient to increase fluid intake to thin secretions

B) Position the patient in a high Fowler's position to facilitate lung expansion

C) Administer a loop diuretic as per standing order to reduce pleural effusion

D) Initiate supplemental oxygen therapy at 6 L/min via nasal cannula

A patient with systemic lupus erythematosus (SLE) has recently started immunosuppressive therapy and increased doses of corticosteroids. She is now experiencing persistent hypertension, dyspnea, and dry cough. Which nursing intervention is the most appropriate to address these new complications?

A) Monitor blood pressure closely and educate the patient on low-sodium diet.

B) Encourage increased fluid intake to manage pleural effusions.

C) Advise the patient to increase physical activity to improve lung function.

D) Discontinue corticosteroids to resolve hypertension and respiratory symptoms.

A patient with systemic lupus erythematosus (SLE) has been diagnosed with Class III lupus nephritis and early-stage interstitial lung disease. Which nursing intervention is most critical to implement first in this patient’s care plan?

C) Assess the patient's respiratory status and oxygen saturation levels regularly.

A) Educate the patient about the importance of adhering to the immunosuppressive therapy regimen.

B) Monitor the patient's blood pressure and adjust antihypertensive medication as needed.

C) Assess the patient's respiratory status and oxygen saturation levels regularly.

D) Initiate a dietary consultation to manage proteinuria through nutritional adjustments.

A patient with systemic lupus erythematosus (SLE) has been diagnosed with Class III lupus nephritis and early stages of interstitial lung disease. The healthcare team has initiated treatment with mycophenolate mofetil, a tapering schedule for corticosteroids, and a low-dose diuretic. Which of the following nursing interventions is the highest priority to prevent complications related to the new treatment regimen?

C) Assess the patient's respiratory status for signs of worsening pleural effusions.

A) Monitor blood glucose levels closely to detect corticosteroid-induced hyperglycemia.

B) Educate the patient on the importance of adhering to the prescribed immunosuppressive therapy.

C) Assess the patient's respiratory status for signs of worsening pleural effusions.

D) Schedule regular follow-ups to monitor renal function and adjust treatment as necessary.

A patient with a history of systemic lupus erythematosus (SLE) presents with increased fatigue, joint pain, elevated blood pressure, and a facial rash. Considering these symptoms and her recent laboratory findings of elevated creatinine levels and pulmonary crackles, what is the most appropriate initial nursing action?

D) Collaborate with the healthcare team to review and adjust the immunosuppressive regimen.

A) Increase the patient's fluid intake to assist with renal function.

B) Elevate the head of the bed to improve pulmonary aeration.

C) Educate the patient on avoiding sun exposure to prevent rash exacerbation.

D) Collaborate with the healthcare team to review and adjust the immunosuppressive regimen.

A patient with a history of systemic lupus erythematosus (SLE) presents with increased fatigue, joint pain, a new onset of facial rash, elevated blood pressure, and elevated creatinine levels. Given these symptoms, what would be the most appropriate immediate nursing intervention?

B) Notify the healthcare provider to consider adjusting the patient's corticosteroid dosage.

A) Educate the patient about avoiding sun exposure to prevent further photosensitive reactions.

B) Notify the healthcare provider to consider adjusting the patient's corticosteroid dosage.

C) Administer antihypertensive medication to address elevated blood pressure.

D) Encourage the patient to increase fluid intake to improve renal function.

A patient with systemic lupus erythematosus is experiencing a flare, as evidenced by increased pulmonary involvement and renal dysfunction. The healthcare team has decided to adjust her corticosteroid regimen and consider adding mycophenolate mofetil. Which nursing intervention is most critical to ensure the safety and efficacy of the adjusted treatment plan?

A) Monitor the patient's blood glucose levels closely to detect hyperglycemia due to increased corticosteroid dosage.

B) Educate the patient on the importance of adhering to a low-protein diet to manage renal dysfunction.

C) Assess the patient's respiratory status regularly to evaluate for potential pulmonary embolism.

D) Encourage increased fluid intake to promote renal function and flush out toxins.

A patient with systemic lupus erythematosus (SLE) is experiencing a disease flare characterized by increased interstitial lung disease and renal dysfunction. The healthcare team has decided to increase the corticosteroid dosage and consider adding mycophenolate mofetil. As a nurse, which intervention is most important to prioritize during this phase of treatment?

A) Monitor the patient’s blood pressure closely for signs of hypertension.

B) Educate the patient about the importance of avoiding sunlight exposure.

C) Encourage the patient to maintain a high-protein diet to support renal function.

D) Administer a bronchodilator to manage pulmonary symptoms.

autoimmunity - Nursing Case Study

Pathophysiology

• Primary mechanism: Loss of self-tolerance - The immune system fails to recognize the body's own cells as "self," leading to an attack on healthy tissues. This is often due to genetic predispositions or environmental triggers, resulting in the activation of autoreactive T and B cells.

• Secondary mechanism: Molecular mimicry - Pathogens with antigens similar to host molecules can trigger an immune response that cross-reacts with the body's own tissues, perpetuating inflammation and tissue damage.

• Key complication: Chronic inflammation - Persistent immune activity against self-antigens causes ongoing tissue damage, leading to organ dysfunction and symptoms like fatigue, joint pain, and skin rashes, significantly impacting patient quality of life.

Patient Profile

Demographics:

42-year-old female, high school teacher

History:

• Key past medical history: Diagnosed with systemic lupus erythematosus (SLE) 5 years ago, history of mild hypertension

• Current medications: Hydroxychloroquine, Lisinopril, Prednisone (as needed for flare-ups)

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing joint pain and fatigue

• Key symptoms: Swollen and painful joints, fatigue, mild skin rash on the face, occasional low-grade fever

• Vital signs: Blood pressure 148/92 mmHg, heart rate 92 bpm, respiratory rate 18 breaths per minute, temperature 37.9°C (100.2°F)

Section 1

New Complications:

During a follow-up visit, the patient reports worsening fatigue and more persistent joint pain, with increasing stiffness in the mornings that lasts for several hours. A physical examination reveals more pronounced joint swelling in the hands and knees, with limited range of motion. Additionally, the mild rash on her face, which has been persistent, now shows signs of extending to her neck and upper chest. The patient also mentions experiencing episodes of shortness of breath, particularly when engaging in activities that were previously manageable.

Laboratory tests are ordered to further assess her condition. The results reveal elevated inflammatory markers, with an ESR of 45 mm/hr and a CRP level of 25 mg/L, indicating heightened systemic inflammation. Additionally, her renal function tests show a slight increase in serum creatinine at 1.2 mg/dL, raising concerns about potential renal involvement. Urinalysis reveals mild proteinuria, suggesting the possibility of lupus nephritis, a known complication of systemic lupus erythematosus.

These findings prompt a reassessment of her treatment plan. The healthcare team considers adjusting her medication regimen to better control the inflammatory process and prevent further organ damage. The potential need for a renal biopsy is discussed to confirm the diagnosis of lupus nephritis and to guide treatment decisions. The patient's response to these interventions will be crucial in managing her condition and preventing further complications.

Section 2

Following the adjustment of the patient's treatment regimen, which included the initiation of immunosuppressive therapy and increased doses of corticosteroids, there was a noted initial improvement in her joint symptoms and energy levels. However, within weeks, the patient began experiencing new complications. She presented with persistent hypertension, with blood pressure readings consistently around 150/95 mmHg, despite being previously normotensive. This raised the suspicion of renal involvement progressing beyond initial mild proteinuria.

During a routine follow-up, the patient also reported increasing episodes of dyspnea and a persistent dry cough. A chest x-ray was ordered, revealing bilateral pleural effusions and interstitial markings suggestive of early pulmonary involvement, possibly lupus-related pleuritis or interstitial lung disease. Her oxygen saturation was slightly decreased at 92% on room air, prompting further evaluation.

The healthcare team decided to proceed with a renal biopsy to clarify the extent of renal involvement and to tailor the immunosuppressive therapy more precisely. Additionally, a referral to a pulmonologist was made to address the respiratory issues, and a possible adjustment in her medication regimen was considered to manage the hypertension and further prevent potential cardiovascular complications. The patient’s response to these interventions and the upcoming biopsy results will be critical in determining the next steps in her management plan, aiming to stabilize her condition and mitigate further organ damage.

Section 3

New Diagnostic Results:

The renal biopsy results confirmed the presence of Class III lupus nephritis, indicating moderate to severe renal involvement with focal proliferative glomerulonephritis. This finding explained the patient's persistent hypertension and proteinuria, necessitating a more aggressive approach to her immunosuppressive treatment. Laboratory results showed an increase in creatinine levels to 1.8 mg/dL from a baseline of 0.9 mg/dL, indicating a decline in renal function. The healthcare team decided to intensify the immunosuppressive therapy by adding mycophenolate mofetil to her regimen, alongside a tapering schedule for the corticosteroids to minimize long-term side effects.

Simultaneously, the pulmonologist's evaluation, supported by pulmonary function tests, confirmed the early stages of interstitial lung disease, likely secondary to systemic lupus erythematosus. The presence of bilateral pleural effusions and the decrease in oxygen saturation to 92% on room air suggested significant pulmonary involvement, requiring prompt intervention. The patient was started on a low-dose diuretic to manage the pleural effusions while closely monitoring her respiratory status.

These new diagnostic results prompted the healthcare team to implement a comprehensive management plan, balancing the need for aggressive immunosuppression to control the lupus activity while mitigating the risk of further organ damage and managing the side effects of treatment. Close monitoring of her renal function, blood pressure, and respiratory status was prioritized, with follow-up appointments scheduled to assess her response to the adjusted treatment regimen. The integration of these findings into her care plan would be crucial in stabilizing her condition and preventing further complications.

Section 4

Several weeks into the adjusted treatment regimen, the patient began experiencing new symptoms, prompting her to return to the clinic for evaluation. She reported increased fatigue, joint pain, and a new onset of facial rash. On examination, her blood pressure was elevated at 150/90 mmHg, and her heart rate was 98 beats per minute. Her oxygen saturation remained stable at 93% on room air, but auscultation revealed bilateral crackles at the lung bases, indicating persistent pulmonary involvement. Laboratory tests revealed a further rise in creatinine levels to 2.1 mg/dL, suggesting continued renal impairment despite the intensified immunosuppression.

The healthcare team faced a complex clinical situation, needing to discern whether these symptoms indicated a flare of her systemic lupus erythematosus or side effects from the medications. Given the patient's increased fatigue and joint pain, there was concern for a lupus flare, necessitating a re-evaluation of her immunosuppressive regimen. Meanwhile, the facial rash raised the possibility of a photosensitive reaction or a cutaneous manifestation of lupus, requiring dermatology consultation for further assessment.

In response to these developments, the team decided to conduct a more comprehensive evaluation, including repeat renal ultrasound to assess for any structural changes and a high-resolution CT scan of the chest to better understand the progression of her interstitial lung disease. The potential need for an adjustment in her corticosteroid dosing was also considered, balancing the risk of exacerbating side effects against the need to control her lupus activity. These steps were crucial in refining the treatment strategy and preventing further complications, setting the stage for the next phase of her management journey.

Section 5

New Diagnostic Results

Following the comprehensive evaluation, the results of the high-resolution CT scan of the chest revealed progression of interstitial lung disease with increased ground-glass opacities and mild honeycombing, suggesting worsening pulmonary involvement. The repeat renal ultrasound showed no significant structural changes, but the increased creatinine levels pointed towards ongoing renal dysfunction, likely related to lupus nephritis. The dermatology consultation identified the facial rash as a malar rash, a classic cutaneous manifestation of systemic lupus erythematosus, further supporting the suspicion of an active lupus flare.

Laboratory tests showed an elevated anti-dsDNA antibody titer, which is often associated with active disease, and decreased complement levels (C3 and C4), reinforcing the likelihood of a lupus exacerbation. Additionally, her erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated, indicating systemic inflammation. These diagnostic findings suggested that the intensified immunosuppressive therapy had not sufficiently controlled her disease activity, necessitating a re-evaluation of her treatment plan.

The healthcare team, considering these results, decided to adjust her corticosteroid regimen, increasing the dosage to better manage the flare while meticulously monitoring for potential side effects. They also discussed the possibility of introducing a second-line immunosuppressant, such as mycophenolate mofetil, to provide more targeted control of her lupus nephritis and pulmonary manifestations. This multidisciplinary approach aimed to stabilize her condition, reduce inflammation, and prevent further organ damage, while remaining vigilant for any new complications that might arise.