AS is a 59-year-old black female who was diagnosed with Systemic Lupus Erythematous (SLE) 5 years ago.

1. Explain the pathophysiology of SLE.

2. What medications would you anticipate are included in AS’ medication list? What do these medications do?

3. How does SLE affect the other body systems?

Today, AS presents with complaints of a squeezing type pain across her chest and into her left jaw area.

Current Vital signs:

· Blood Pressure-200/110;

· Pulse-128 beats per minute;

· Respirations- 26 per minute;

· Temperature-99.8;

· Saturation of Oxygen-86% on room air;

· pain level 9/10.

4. What abnormals are present in the patient’s vital signs?

5. What health history information would the nurse assess after the patient’s pain is gone.

6. What additional assessments should be performed and why? Include labs and diagnostic tests.

7. What would the results be if the patient is having cardiac damage? Are abnormal labs expected related to the patient’s diagnosis of SLE?

8. How might SLE contribute to the patient’s development of cardiac problems?

The nurse notes that AS is rubbing her mid-chest, grimacing and is diaphoretic. The pain has been occurring intermittently throughout the evening and night. Her color is pale except around her lips which are bluish. Cardiac auscultation reveals a rapid regular rhythm and a murmur, no pulse deficit. She has never had this pain before. Lungs sounds are crackles in both bases with clear upper lobes. She is afraid she is going to die.

9. Is the type of pain this patient is having typical or atypical of cardiac type of chest pain.

10. What other types of pain would indicate a cardiac type problem but would not be specifically in the chest area?

11. Describe how women often present with cardiac problems and how they are different from men.

12. What provider orders will the nurse expect for AS? Why?

Per standing orders, a nurse administers & administers Nitroglycerine 0.4mg sublingually; applies cardiac electrodes for continuous cardiac monitoring; obtains an electrocardiogram; places a peripheral intravenous catheter with saline lock; positions patient in low Fowlers.

13. How might these orders change AS’ assessment findings? Why?

14. What statements by the patient depict extreme anxiety and feelings of doom?

15. A provider orders Aspirin 81 mg x 3 tabs by mouth chewed. What is the rationale for this order?

16. What is the reason for the diaphoresis?

17. The patient’s skin color is abnormal, describe this in medical terms?

On re-assessment vital signs are Blood Pressure-180/95; Pulse-108 beats per minute; Respirations- 22 per minute; Temperature-99.0; Saturation of Oxygen-90% on 2 liters per minute; Pain level 8/10. She says her chest pain hasn’t changed. Heart and lung sounds are unchanged. Color is pale without previous blue changes.

18. Does this patient need oxygen? If so what type of oxygen administration device would be applied and what rate of flow?

19. Describe how you assess JVD in this patient?

20. What results would indicate that the patient has JVD?