Immune sys---Lupus Zerweck
A 32-year-old woman with systemic lupus erythematosus (SLE) is being treated with azathioprine (Imuran). Which of the following comments by the client would cause the nurse the most concern? 1. "I am going to stop my birth control pills; I am concerned about the side effects." 2. "I will take my medication with food and call the doctor if I have increased stomach problems." 3. "I will call the doctor if I begin to have problems with increased bruising." 4. "I am not going to get the recommended vaccination for rubella."
Rationale: The medication is teratogenic, and the woman should avoid pregnancy while she is taking the medication. Sexually active women of childbearing age should use a reliable method of birth control. The medication must be taken with food because it may cause gastrointestinal irritation and bleeding; blood dyscrasias are another serious side effect. The rubella vaccination is recommended for all women who have a low rubella titer; however, she should not receive any vaccinations as long as she is taking azathioprine.
A client is receiving methylprednisolone (Medrol) for treatment of an exacerbation of her systemic lupus erythematosus (SLE). While the client is receiving the medication, what would be an important for the nurse to teach the client? 1. Take the medication with food and monitor your weight. 2. Return to the office for blood work to monitor peak and trough levels. 3. If you miss a dose, double the next dose at the scheduled time. 4. Decrease your intake of dried fruit, bananas, and tomatoes.
1 Rationale: Medrol is a corticosteroid; therefore, the client should monitor her weight and call the doctor if she gains 5 pounds or more. She should also protect herself against infections because of her immunosuppression. Peak and trough levels are not monitored for steroids; the client should not double up on any dose, but take the medication as soon as she remembers and continue with the scheduled doses. The client should increase her intake of potassium-rich foods because of the potassium loss with steroids.
The nurse would anticipate which laboratory finding in a client with joint pain, butterfly rash, photosensitivity, weight loss, and fever? 1. Presence of antinuclear antibodies 2. Negative serum complement level 3. Increased red blood cell and white blood cell counts 4. Glycosuria
1 Rationale: The majority of clients with systemic lupus erythematous (SLE) have antinuclear antibodies in their blood. Clinical findings include leukopenia, thrombocytopenia, lymphopenia, and a positive lupus erythematosus cell prep. The anti-double-strand DNA is not common in other conditions and is suggestive for SLE. No specific diagnostic test exists for SLE.
A 32-year-old woman with systemic lupus erythematosus (SLE) is being treated with azathioprine (Imuran). Which of the following comments by the client would cause the nurse the most concern? 1. "I am going to stop my birth control pills; I am concerned about the side effects." 2. "I will take my medication with food and call the doctor if I have increased stomach problems." 3. "I will call the doctor if I begin to have problems with increased bruising." 4. "I am not going to get the recommended vaccination for rubella."
1 Rationale: The medication is teratogenic, and the woman should avoid pregnancy while she is taking the medication. Sexually active women of childbearing age should use a reliable method of birth control. The medication must be taken with food because it may cause gastrointestinal irritation and bleeding; blood dyscrasias are another serious side effect. The rubella vaccination is recommended for all women who have a low rubella titer; however, she should not receive any vaccinations as long as she is taking azathioprine.
The nurse is preparing discharge teaching for a woman newly diagnosed with SLE. What will be important for the nurse to include in the teaching plan? Select all that apply. 1. Wear sunscreen and protective clothing in direct sunlight. 2. Avoid nonsteroidal anti-inflammatory drugs to prevent bleeding episodes. 3. Plan activities that encourage range of motion in extremities. 4. Advise the client that pregnancy is contraindicated. 5. Observe fingertips for changes in circulation. 6. Help the client prioritize self-care activity.
1,2,3,5,6 Rationale: The client with systemic lupus erythematosus is photosensitive and needs protection from sunlight. The client needs to keep joints mobilized because of the invasion of the lupus erythematosus cells into the joints. This condition also affects the circulation in the fingertips, and Raynaud's phenomenon is characteristic of the disease. Fatigue is a problem, and the client needs to prioritize activities of daily living. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to reduce the musculoskeletal discomforts. Although individual disease progression and course of therapy need to be considered in consultation with health care providers, there is no specific contraindication to pregnancy. The woman should be advised regarding individual risk, but she can carry and deliver a healthy infant.
To evaluate the progress of the client's systemic lupus erythematosus (SLE), the nurse evaluates which data? 1. Increased serum complement fixation, which correlates with reduction of "butterfly" rash 2. Increasing levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) 3. Overall bone marrow proliferation, which correlates with symptoms of inflammation 4. Presence of antinuclear antibodies (ANA), which correlates with a diminishing immune process
2 Rationale: The ESR and the CRP are indicators of inflammation in the body. Neither is diagnostic of SLE; however, the level of inflammation is an index to the progress of the condition. Presence of ANA is a characteristic of SLE, but it does not indicate progression. Complement fixation does not indicate progression, nor does absence or presence of the butterfly rash.
Which nursing assessment finding is commonly associated with a diagnosis of systemic lupus erythematosus (SLE)? 1. Excitability, diarrhea, vomiting 2. High fever, measles-like rash on limbs, weight gain 3. Joint pain, rash over the bridge of the nose rash, photosensitivity 4. Weight loss, diarrhea, and epigastric pain
3 Rationale: The symptoms most commonly experienced are joint pain; fatigue; Raynaud's phenomenon; chronic, low-grade, or recurrent fever; sun sensitivity; hair loss; weakness; butterfly facial rash over the bridge of the nose; and weight loss. Typically, the pulmonary, cardiac, renal, and central nervous systems are involved.
A client has systemic lupus erythematosus (SLE). What statement best describes this client's immune response? 1. A delayed hypersensitivity that is cell-mediated 2. An immediate reaction to prior exposure 3. An immune complex that forms with antibody production 4. An immune response that no longer recognizes normal body tissue
4 Rationale: Systemic lupus erythematosus is characterized as an autoimmune disorder in which the body begins to invade and destroy normal tissue. A delayed hypersensitivity is a type IV response that is characteristic of a transplant rejection or reaction to tuberculin skin testing. An immediate reaction describes a type I reaction characterized by a prior exposure to antigen. This occurs with atopic reactions and anaphylaxis. An immune complex that forms with antibody production is a type III response, which occurs with acute glomerulonephritis.