Study guidee
Week 6 case study
Scenario 1
D.W. is a 23-year-old married woman with 3 children under 5 years old. She came to her physician 2 years ago with vague complaints of (C/O) intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her physician noted small patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Laboratory studies revealed that D.W. had a positive antinuclear antibody (ANA) titer, positive dsDNA (positive lupus erythematosus), positive anti-Sm (antismooth muscle antibody), elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint x-ray fi lms demonstrated joint swelling without joint erosion. D.W. was subsequently diagnosed with systemic lupus erythematosus (SLE). She was initially treated with sulindac 200 mg PO bid, prednisone 20 mg/day PO, bed rest, and ice packs. She was counseled regarding her condition and advised to balance rest and activity, eat a well-balanced diet, use strategies to reduce stress, and avoid direct sunlight. D.W. responded well to treatment, the steroid was tapered and discontinued, and she was told she could report for follow-up (F/U) every 6 months unless her symptoms became acute. D.W. resumed her job in environmental services at a large geriatric facility.
1. What is the significance of each of D.W.’s laboratory findings?
2. Given that most tests are nonspecific, how is SLE diagnosed?
3. What priority problems need to be addressed with D.W.?
CASE STUDY PROGRESS
Eighteen months after diagnosis, D.W. seeks out her physician because of puffy hands and feet and increased fatigue. D.W. reports that she has been working longer hours because of the absence of 2 of her fellow workers. Her chem 8 reveals that her BUN and creatinine are slightly elevated, and her urinalysis (UA) shows 2+ protein and 1+ RBCs.
4. Of what significance are these findings, and what is the
Scenario 1
D.W. is a 23-year-old married woman with 3 children under 5 years old. She came to her physician 2 years ago with vague complaints of (C/O) intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her physician noted small patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Laboratory studies revealed that D.W. had a positive antinuclear antibody (ANA) titer, positive dsDNA (positive lupus erythematosus), positive anti-Sm (antismooth muscle antibody), elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint x-ray fi lms demonstrated joint swelling without joint erosion. D.W. was subsequently diagnosed with systemic lupus erythematosus (SLE). She was initially treated with sulindac 200 mg PO bid, prednisone 20 mg/day PO, bed rest, and ice packs. She was counseled regarding her condition and advised to balance rest and activity, eat a well-balanced diet, use strategies to reduce stress, and avoid direct sunlight. D.W. responded well to treatment, the steroid was tapered and discontinued, and she was told she could report for follow-up (F/U) every 6 months unless her symptoms became acute. D.W. resumed her job in environmental services at a large geriatric facility.
1. What is the significance of each of D.W.’s laboratory findings?
2. Given that most tests are nonspecific, how is SLE diagnosed?
3. What priority problems need to be addressed with D.W.?
CASE STUDY PROGRESS
Eighteen months after diagnosis, D.W. seeks out her physician because of puffy hands and feet and increased fatigue. D.W. reports that she has been working longer hours because of the absence of 2 of her fellow workers. Her chem 8 reveals that her BUN and creatinine are slightly elevated, and her urinalysis (UA) shows 2+ protein and 1+ RBCs.
4. Of what significance are these findings, and what is the