Systemic Lupus Erythematosus

Michelle is a 40-year-old teacher who was recently diagnosed with Lupus Erythematosus. The disease has attached her GI tract. One week ago she endured a bowel resection and ostomy placement after high doses of steroids failed to control her autoimmune response. She is presently crying because she hates the ostomy, hates the steroid effects, is afraid of losing her job, and she just doesn’t feel well. She is nauseated and has cold symptoms. This morning her glucose level was 324, her white count was 15,000, her temperature is 100.8, and her incision is “red and sore.” Her medications include: • Solu-Medrol IV 40mg BID • Hydroxychloroquine PO 150 mg twice a day • Vicodin ES PO 1 tablet every six hours for moderate pain PRN • Acetaminophen PO 650mg every 4 hours PRN for mild pain or temp > 100.5 Assignment: 1. Name three nursing priorities, and why? 2. List a short-term (during shift) and a long-term (within one week) SMART goal for the patient? 3. What are the classification, action, and therapeutic effects (reason) for solu-medrol, hydroxychloroquine, and acetaminophen? 4. List drug interactions or contraindications to be concerned about for solu-medrol, hydroxychloroquine, and acetaminophen? 5. What adverse effects/side effects does the nurse need to monitor for solu-medrol, hydroxychloroquine, and acetaminophen? 6. Because of the temperature of 100.8, you administer 650mg of acetaminophen. Two hours later Michelle asks for a Vicodin, how would you respond? 7. Michelle asks if you can stop giving her the solu-medrol, why is this not an ideal course of action?