Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient. Three (3) resources after 2008 are required along with APA format.
A 38 year female old med student goes to her physician with complaints of arthralgia and a new rash on her face bilaterally. The rash get worse when in the sun. When she is fatigued, she complains of a sharp pain in her chest when taking a deep breath. She has experienced this before, but this present episode has been the worst she has ever felt. An exam was completed and tests ordered. The following results are:
Physical:
Temperarture, respiratory rate, and BP normal, Heart rate regular and normal
Facial rash macular over the bridge of her nose and cheeks. Discoid scaling also noted on her extensor surfaces of her arms.
Joint pain and stiffness and pain in hands on active and passive motion
Pleural friction rub auscultated with deep respiration
Other systems examined normal.
Labs:
Serum electrolytes – normal
Hemoglibin and Hematocrit – low
Platelet count – slightly low
White blood cells – normal
BUN and Creatinine – elevated
Urine – Positive for Protein
CXR – Small pleural effusion noted
Antinuclear antibody (ANA) – positive
Anti-DNA antibodies – positive
Diagnosis: Systemic Lupus Erythematosus (SLE)
Questions:
1. What is the common descriptive term for this patient’s facial rash and why?
2. What does sunlight do to people with this disease that they are taught t avoid it?
3. Which lab results indicate renal dysfunction. Is this dysfunction related to SLE? Why or why not?
4. State the other signs and symptoms of SLE that are manifested in this patients physical exam and labs? Give the rationale for each.
5. What is the pathophysiology behind SLE causing widespread tissue damage?
6. What is discoid lupus and is it different from SLE?
7. What type of teaching and management plan will be need to be devised by the APN for this patient?
Guide On Rating System
Vote
1. The common descriptive term for this patient's facial rash is "butterfly rash" or malar rash. This term is used because the rash is characterized by a reddish or purplish butterfly-shaped rash that spans across the bridge of the nose and cheeks.
2. People with systemic lupus erythematosus (SLE) are taught to avoid sunlight because exposure to ultraviolet (UV) light can trigger or worsen symptoms of SLE. UV light can induce an immune response and cause inflammation, leading to skin rashes and other symptoms associated with SLE.
3. The elevated BUN (blood urea nitrogen) and creatinine levels indicate renal dysfunction. This dysfunction can be related to SLE as the disease can cause inflammation of the kidneys, known as lupus nephritis, which can lead to impaired kidney function.
4. Other signs and symptoms of SLE manifested in this patient's physical exam and labs include:
- Joint pain and stiffness: This is a common symptom of SLE and is caused by inflammation of the joints.
- Pleural friction rub: The presence of a pleural friction rub suggests inflammation of the pleura, which is the lining around the lungs, commonly seen in SLE.
- Hemoglobin and hematocrit levels are low: This can be indicative of anemia, which is common in SLE due to chronic inflammation and destruction of red blood cells.
- Platelet count slightly low: Thrombocytopenia, or low platelet count, can occur in SLE as a result of autoantibodies and abnormal clotting factors.
5. The pathophysiology behind SLE causing widespread tissue damage involves an autoimmune response. In SLE, the body's immune system mistakenly attacks healthy tissues and organs, leading to chronic inflammation. This inflammation can damage various tissues and organs, including the skin, joints, kidneys, heart, and lungs.
6. Discoid lupus is a form of lupus erythematosus that primarily affects the skin. It presents with disc-shaped lesions that can cause scarring and hair loss. Discoid lupus can occur in individuals with SLE, but it can also occur on its own without systemic involvement. Therefore, discoid lupus is different from SLE as it primarily affects the skin.
7. The APN will need to devise a teaching and management plan for this patient, which may include the following:
- Educating the patient about the importance of avoiding sunlight and using sun protection measures, such as wearing sun-protective clothing, using sunscreen, and seeking shade.
- Providing information on managing joint pain and stiffness, which may include lifestyle modifications, physical therapy, and medications.
- Monitoring renal function and managing lupus nephritis through medications and lifestyle changes, such as managing blood pressure and maintaining a healthy diet.
- Monitoring and managing any other symptoms or complications that may arise from SLE, such as anemia or thrombocytopenia.
- Collaborating with other healthcare professionals, such as rheumatologists and nephrologists, for specialized management of SLE and its comorbidities.
- Providing emotional support and counseling to the patient, as SLE can have a significant impact on their quality of life.
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