Five yearsago,NN, a 22 year old nurse, was seen by her dentist five… Five years ago, NN,

Five yearsago,NN, a 22 year old nurse, was seen by her dentist five… Five years ago, NN, a 22 year old nurse, was seen by her dentist five times with complaints of swollen, tender gums which bled easily. On the fifth visit, the dentist noticed a swelling of her tongue and a light macular-papular rash under her eyes. He referred her to her PCP.At the time, her health history included a recurrent low grade fever over a year, general aching and weakness, loss of appetite and joint pain…all of which she attributed to overwork. Lab tests showed: LE cell positive, ANA positive: low serum complement, WBC – 17,000 with 2x normal lymphocyte percentage; BUN 37, Creatinine 1.0; albumin 3.4; total cholesterol 487; hemocrit 38. She was diagnosed with SLE. At the time NN was newly married, working evenings at the local hospital. Her family lived in Wisconsin, running the family dairy farm business.Over the next five years, NN experienced increased weakness and malaise, had to give up her job as a nurse, and, because of her inability to become pregnant, was separated from her husband.She presents at the ED with severe malaise and confusion. Admission: Complaints: intolerance to cold; dyspnea on exertion; weakness, malaise; periods of severe joint and muscle pain; anorexia, nausea and vomiting with a 32 lb weight loss over the last six months; headaches; periods of depression, forgetfulness, extreme nervousness; irregular menstrual periods over four years and amenorrhea for past seven months (her husband is in the process of divorcing her because he wants a family).General: T – 102.6 FSkin:? painful, scaly rashes over much of her body; spotty scarring noted; patches ?of erythematous scales; patches of increased pigmentation throughout?multiple ecchymotic areas noted over both legs, back and right arm?ulcers noted in mouth, throat and outer vaginal area?hair – thin, dry, patchy loss in spots?Musculoskeletal: large, red, swollen and tender joints noted throughout; muscular atrophy in both legsCV:   BP: 180/110; P – 122, thready?2-3 + edema of the feet, ankles, lower legs?S1, S2, S4, grade I/IV holosystolic murmur?Sinus tachycardia, rate 122Resp: R: 24?lungs clear, friction rub notedGI: liver – 16 cm and tender, bowel sounds presentLab tests: LE cell positive, ANA positive, low serum complement, WBC – 24,000 with 2x normal lymphocyte percentage; BUN 54, Creatinine 2.0; albumin 2.4; total cholesterol 519; hemocrit 40; electrolytes elevated throughout; AST – 72, ALT – 67 Urinalysis: gross hematuria, 4+ protein Plan: admit to medical service; cardiac monitor; O2 at 4 L via nasal prongs; IV at low flow to ensure access; I & O; cultures of urine, sputum, mucosal ulcers, blood cultures; ACE inhibitor to control BP; furosemide to relieve edema; broad spectrum antibiotic until cultures return; nephrology consult; social work consultProposed plans: steroids for friction rub; antibiotic switch to cover culture, push fluids, diet as tolerated, skin care as needed; encourage activity The narrative must address the following questions:Discuss and explain the following physiologic mechanisms involved in the patient presentation STRESS response.Link the physiologic mechanisms with the clinical presentation of the patient and also explain which clinical signs/symptoms are not demonstrated that you would expect to see. Health Science Science Nursing NUR 370 Share QuestionEmailCopy link Comments (0)

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