Case Study On A Patient Suffering From Systemic Lupus Erythematosus

Introduction (Patient and problem)

T.I. is a 40-year-old African-American female who works full time is a full-time stay at home. In the past year, she starts experiencing extreme fatigue, headaches, fever, severe discomfort in the belly, joint pain, rashes on her face and body. But all these symptoms seem to resolve on their own. The rashes on her body was seen by a dermatologist and she’s been taking antibiotics for it. Other than the present symptoms, she was in good health and no underlying medical conditions present.

One night her symptoms took for the worst and she starts having chest pain (angina) and shortness of breath. Her oldest daughter calls 911 and they take her to the hospital. She was quickly admitted at the emergency department upon arrival. The nurse should ultimately focus on her signs and symptoms present as well as taking a look at her medical history.

Pathophysiology

Lupus or also known as Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that attack healthy cells and tissues. This is an autoimmune disease of the immune system and is considered to be type III hypersensitivity reaction which is non-specific immune complex reaction. Instead of only targeting bacteria, viruses, and other foreign invaders, it mistakenly attacks your healthy tissues to which damages your body’s own tissues. This could either be a gene a gene one is born with or environmental triggers that an individual is exposed to. While doctors do not exactly know what causes lupus, they do now that it involves genetic, hormones, and environment (Mayo Clinic, 2017).

Risk factors, such as heredity, gender, race, and previous illness can increase the chance of an individual to likely get lupus (Mayo Clinic, 2017). Most common symptoms are intense fatigue, fever, severe joint pain and muscle aches, skin rash (butterfly rash) on face and body, sun sensitivity, weight loss, chest pain when taking deep breaths, hair loss, poor circulation of fingers and toes, enlarged lymph nodes, and nose, mouth, or throat sores (Web MD, 2017). Less common symptoms involve confusion, seizures, anemia, dizziness, and headaches.

History

T.I. experienced swelling of ankles and fatigue but this was due to a flight late last year. She was instructed to sleep with her feet elevated. Couple months after the flight, T.I started to report joint pain, cold, and fever. Flu -test came back negative. Referred to do an X-ray to for the joint pain. X-ray results showed no erosion. Patient states that symptoms were resolved but advised to make an appointment if symptoms emerged again. Five months after the X-ray, patient comes back with rashes on her face and body. Patient was referred to a dermatologist and was diagnosed with rosacea.

Nursing Physical Assessment

Nurse should asses admission history and physical assessment as soon as the patient arrives. Patient’s blood pressure was 100/75 mmHg with 32 breaths per minute and a heart rate of 125 beats per minute. Temperature was 35.6 degrees Celsius. Patient’s abdomen was soft and non- tender, with normal bowel sounds. Nurse checked for pain assessment and ask the severity of the pain on a scale of 1-10. Patient states a 7. Pain was radiating that traveled to the left shoulder and to the neck. Patient was alert and awake. Nurse further assessed airway, breathing, circulation (whether it’s too slow or too fast), assess skin color, moisture, and temperature for signs of decreased tissue perfusion, such as pale, cool, or moist skin, and checking the level of the patient (LOC) were all normal. Pain was radiating that traveled to the left shoulder and to the neck. Diagnostic labs were ordered.

Related Treatments

Patient is on oral antibiotics for her rosacea and was taking doxycycline 40 mg per day. There is no cure for lupus but there are treatment options to relieve and improve symptoms. Treatment can vary depending upon patient’s signs and symptoms. Patient is now on triple therapy of ibuprofen, colchicine, and low dose prednisone.

Nursing Diagnosis & Patient Goal

Diagnosing lupus is a combination of blood, urine tests, and the overall signs and symptoms of the patient. Now signs and symptoms can vary per person and there can be an overlap with other patients who are facing other disorders, so doing laboratory tests, imaging tests, and biopsy can lead to the diagnosis. The diagnosis is chest pain due to the shortness of breath and fatigue. Patient could be experiencing pericarditis. The desired outcome is to relief pain and discomfort, for cardiac tamponade, asses pain level and behavior, symptom severity, reduce trigger of flare ups, compliance with the prescribed medications, and reduce inflammation and organ dysfunction. Importantly, to be able to treat the problem and while doing so preserving cardiac output and preventing major or minor complications.

Nursing Interventions

The nurse should assess heart and lung sounds. Patient may report chest pain associated with deep breathing. Encourage patient to do breathing exercises to open airways to reduce pain and relieve anxiety. Fatigue is one of the most common symptoms of lupus, so conserving energy and avoiding overexertion of activity is encouraged. Incentive spirometers and splinting with pillows may be beneficial (Nursing Central). First assessment is to assess the patient for signs and symptoms of potential cardiac arrest problems and assess for cardiac tamponade. Secondly, teach the patient about cardiac problems such as being aware of the warning signs of a heart attack, and to highly encourage telling the physician. Lastly, educate the patient on prescribed medications and activity/exercise.

As well as increased knowledge of the disease on lupus and cardiac problems. Nursing interventions include assessing client’s knowledge of the disease, teach patient stress coping mechanisms and techniques, monitor vital signs, teach joint protection measures and apply heat or cold preferred by the patient (Trethewey, 2004). The use of nonpharmacologic pain intervention such as relaxation or imagery to relief from pain (Trethewey, 2004). It is also important to monitor lab tests including ANA (antinuclear body), ESR (erythrocyte sedimentation rate), RF (rheumatoid factor), and liver function tests (Martin, 2017). Monitoring lab tests can indicate if there’s any damage of organ failure or dysfunction, or how extent and progressive the disease is to further determine treatment options.

Evaluation

As a result, the patient goal and desired outcome has been met. Patient’s overall health has been stable. Nurse has been monitoring her vital signs and signs and symptoms. After being discharged, patient came back couple weeks later for regular check-up. Patient’s flare up has been reduced, exercising regularly, and started eating healthy. Patient also started going to social groups and joined a Facebook group online with people living with lupus as well.

Recommendations

Preventing triggers and flares up are highly important to better cope with the signs and symptoms of lupus. Seeing your doctor regularly for regular checkups if new symptoms appear or worsen, and can be helpful in addressing health concerns, such as, diet, stress, and exercise. One of the symptoms of lupus is the sensitivity to the sun which can trigger a flare up, so be smart about wearing protective clothing including long-sleeve shirts, hats, and even with the use of sunscreen with at least a 55 SPF when planning to go outside (Mayo Clinic, 2017). Eating healthy and exercising regularly to keep the bones strong and reduce the risk of getting a heart attack. Focusing more on vegetables, fruits, and whole grains for eating healthy. Similarly, be advised to not smoke as it can increase risks for cardiovascular diseases and possibly worsen the effects of lupus on the heart and blood vessels (Mayo Clinic, 2017).

Moreover, being diagnosed with lupus can be challenging and painful. Being able to learn everything about lupus and the treatment options and resources available for you can put one’s mind at ease that there is help. As well as connecting with others who have lupus, thus talking and going to support groups who face the same struggles and frustrations as you do can help with connecting and supporting other people (Mayo Clinic, 2017). Lastly, having lupus can be stressful and finding new activities that you enjoy and calm you can aid your coping with stress.