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:
- What is the common descriptive term for this patient’s facial rash and why?
- What does sunlight do to people with this disease that they are taught t avoid it?
- Which lab results indicate renal dysfunction. Is this dysfunction related to SLE? Why or why not?
- State the other signs and symptoms of SLE that are manifested in this patients physical exam and labs? Give the rationale for each.
- What is the pathophysiology behind SLE causing widespread tissue damage?
- What is discoid lupus and is it different from SLE?
- What type of teaching and management plan will be need to be devised by the APN for this patient?
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