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Medical-Surgical Nursing II · Chapter 9

Flare or Infection? Reading Lupus and the Connective Tissue Emergencies

A lupus flare and sepsis look almost identical — fever, malaise, tachycardia, a high sedimentation rate — and treating the wrong one is fatal. Two laboratory pairs separate them. Set the complement, the anti-dsDNA titre and the C-reactive protein below and watch the verdict move, then learn what each autoantibody is actually telling you and work the emergencies that will not wait.
Your patientA 31-year-old woman with systemic lupus erythematosus, on hydroxychloroquine, mycophenolate and prednisone 10 mg daily, admitted feeling unwell. Her sedimentation rate is elevated — which it will be either way. Set the discriminating labs.
1 · Complement C3 and C4
2 · Anti-double-stranded DNA
3 · C-reactive protein
4 · What she looks like

Which one is she having?

Baseline therapy for essentially every lupus patient is hydroxychloroquine. It reduces flares, protects the kidney, lowers thrombosis risk and improves survival. Dose it at or below 5 mg/kg of actual body weight, get a baseline retinal examination, and screen annually after five years of use, because retinal toxicity is dose- and duration-dependent and irreversible. Teach broad-spectrum sunscreen of SPF 30 or higher, hats and long sleeves, paced activity for fatigue, and prompt reporting of fever.