Assessment and Management of Patients With Rheumatic Disorders

1. Ellie Long, a 55-year-old patient, presents to the pain clinic with the diagnosis of fibromyalgia syndrome. The nurse at the clinic obtains a history and physical assessment of the patient. (Learning Objective 2) 1 PAGE
   a. On what areas should the nurse concentrate when interviewing the patient during the history process? b. On what areas should the nurse concentrate when assessing the patient? c. What diagnostic tests are used with fibromyalgia syndrome?
2. Julie Walker, a 22-year-old patient, is newly diagnosed with systemic lupus erythematosus (SLE). She presented with extreme fatigue; muscle and joint aching and swelling; a butterfly-shaped, flat, red rash across the bridge of the nose; patchy alopecia; a low-grade fever; and loss of appetite. Further workup revealed a positive antinuclear antibodies (ANA) titer, anemia, leucopenia, and mild thrombocytopenia. She has an abnormal lipid profile, proteinuria, and hypertension. The liver and renal profiles are within normal range. The physician ordered over-the-counter ibuprofen as needed for joint discomfort, but not to exceed 1,200 mg/day; hydroxychloroquine sulfate (Plaquenil) before meals at the same time each day; and prednisone in tapering doses over the next month. The physician also started the patient on lisinopril, an ACE inhibitor for the hypertension and a statin for the elevated lipids. The clinic nurse is asked by the physician to provide patient and family education. (Leaming Objective 5) 1 PAGE
   a. What teaching-plan topics should the nurse provide for the patient?

Optional Activities: • Have a student role play with another student, teaching the patient with SLE the topics covered in the case study. • Have students explore local resources for support groups for patients diagnosed with SLE and their families. • Have students explore online resources for support for patients diagnosed with SLE. http://www.lupus.org/webmodules/webarticlesnet/templates/new_communityboards.aspx?articleid=13058zoneid=98 . • Have students prepare a brief patient-education pamphlet on SLE based on the information from the textbook and online resources. • Have students make a concept map of the patient in the case study, prioritizing the nursing diagnoses.
Case Study, Chapter 34, Management of Patients With Hematologic Neoplasms

1. John King, 60 years of age, is a male patient who is admitted with the diagnosis of multiple myeloma. He presents with a spinal fracture of the fifth lumbar vertebrae. The patient is scheduled for a vertebroplasty of the spinal fracture. The patient is to remain on bed rest and should be log rolled. Osteolytic lesions are seen in x-rays of the skull, vertebrae, and ribs. The patient has hypercalcemia. The patient's uric acid level is elevated. The patient has orders for zoledronic acid (Zometa), thalidomide (Thalomid), allopurinol (Zyloprim), calcitonin, ibuprofen, and Vicodin. (Learning Objective 5) 1 PAGE
   a. What nursing management should the nurse provide the patient?
   b. Explain the indication and action of the various medications ordered to treat the patient's symptoms.
2. Susan Clare. age 38, is admitted to the medical oncology unit with acute myeloid leukemia (AML). She has many areas of ecchymosis and petechiae on her skin, as well as generalized pallor. She states she has lost 15 pounds in the last 2 months, and often has a low-grade fever. On physical assessment, you find her liver and spleen to be enlarged on palpation. (Leaming Objective 3) 1 PAGE
   a. What laboratory results would you anticipate due to her ecchymosis and petechia? b. Why would it be important to inspect her gums and teeth? c. Why is her liver enlarged?