(Solved): \( \underline{\text { Laboratory Test Results }} \) Sodium \( 129 \mathrm{mEq} / \mathrm{L} \) ( \( ...

\( \underline{\text { Laboratory Test Results }} \) Sodium \( 129 \mathrm{mEq} / \mathrm{L} \) ( \( 129 \mathrm{mmol} / \mathrm{L}) \) Potassium \( 4.2 \mathrm{mEq} / \mathrm{L} \) ( \( 4.2 \mathrm{mmol} / \mathrm{L} \) ) Chloride \( 119 \mathrm{mEq} / \mathrm{L} \) (119 \( \mathrm{mmol} / \mathrm{L} \) ) Total \( \mathrm{CO} 221 \mathrm{mEq} / \mathrm{L}(21 \mathrm{mmol} / \mathrm{L}) \) Blood urea nitrogen (BUN) \( 34 \mathrm{mg} / \mathrm{dL}(12.1 \mathrm{mmol} / \mathrm{L}) \) Creatinine \( 2.6 \mathrm{mg} / \mathrm{dL} \) ( \( 230 \mathrm{mcmol} / \mathrm{L} \) ) Glucose \( 123 \mathrm{mg} / \mathrm{dL}(6.8 \mathrm{mmol} / \mathrm{L}) \) Urinalysis \( 2+ \) protein, \( 2+ \) hematuria 4. Which lab findings concern you, and why? BoN, creetinine 5. The goal of therapy in lupus nephritis is to normalize or prevent the loss of renal function. To reach this goal, what additions to D.W.'s care can you anticipate? 6. The provider orders cyclophosphamide \( 100 \mathrm{mg} / \mathrm{m} 2 / \) day orally in two divided doses. D.W. weighs \( 140 \mathrm{lbs}(63.5 \mathrm{~kg}) \) and is 5 feet, 4 inches \( (163 \mathrm{~cm}) \) tall. How much will she receive with each dose? 7. What key points should you include in a teaching plan about cyclophosphamide therapy? Case study progress D.W. is seen in the immunology clinic twice monthly during the next 3 months. Although her condition does not worsen, her BUN and creatinine remain elevated. While at work one afternoon, D.W. begins to feel dizzy and develops a severe headache. She reports to her supervisor, who has her lie down. When D. W. starts to become disoriented, her supervisor calls 911 , and D.W. is taken to the hospital. D.W. is admitted for probable lupus cerebritis related to acute exacerbation of her disease. 8. What other findings indicative of central nervous system involvement should you assess for in D. W.? 9. What protective measures need to be instituted at this time? 10. In caring for D.W., which care activities can be delegated to the UAP? Select all that apply. a. Monitoring D. W.'s BUN and creatinine levels b. Counseling D.W. on seizure safety precautions c. Assisting D.W, with personal hygiene measures d. Assessing D. W.'s neurologic status every 2 hours e. Measuring D.W.'s blood pressure (BP) every 2 hours f. Emptying the urine collection device and measuring the output Case study progress The provider orders pulse therapy with methylprednisolone \( 125 \mathrm{mg} \) IV every 6 hours and plasmapheresis once daily. 11. What major complications associated with immunosuppression therapy will D.W. have to be monitored for? Vitalsign chages, increaged risk for infection, GI d sodn as N/, Alopecia, Bone marow suppres, an, Lethong 12. D. W. asks about what plasmapheresis does and why it might help her feel better. How you would respond? chart View Vital Signs BP \( 80 / 43 \) Pulse rate 118 Respiratory rate 18 Temperature \( 97.2^{\circ} \mathrm{F}\left(36.2^{\circ} \mathrm{C}\right) \) 13. D. W. returns to the floor after the plasmapheresis. The UAP reports D.W.'s vital signs to you. Based solely on her vital signs, what could be happening with D. W, and why? 14. You go to assess D.W. What do you need to include in your assessment? ilverfes/s op Hpocalcema, assess other commen reaclions apton piasmapene 15. D.W. is complaining of dizziness and is slightly diaphoretic but denies any headache, nausea, or paresthesia. What do you immediately suspect is occurring and why? 16. You need to call the provider regarding D. W.'s status. Using SBAR, what would you report to the provider? Sure, we need the money, but the kids and I need her more: I'm afraid that this lupus has weakened her whole body and it will kill her if she goes back to work. Is that right?" How should you respond to his concerns?