1.	What is the significance of each of D. W.’s laboratory findings?
A positive ANA means that the body has an autoimmune disease.  A positive dsDNA indicates SLE in most people.  A positive anti-Sm indicates an autoimmune disease and is found in most people with SLE.  An elevated C-reactive protein indicates inflammation.  An elevated ESR indicates inflammation.  A decreased C3 and C4 indicate an autoimmune disorder and the results rules out rheumatoid arthritis.  When they are all put together, it is very likely that the person has SLE.
2.	Given that most tests are nonspecific, how is SLE diagnosed?
There are 11 criteria in diagnosing SLE and in some cases 4 findings may be used out of the 11.  The criteria include a butterfly rash, photosensitivity, discoid skin rash, mucous membrane ulcers, arthritis, pleuritis or pericarditis, abnormal amounts of proteinuria, seizures and/or psychosis, low RBCs, low WBCs, low platelets, abnormal anti-DNA or anti-Sm antibodies, anticardiolipin antibodies, lupus anticoagulant, or a positive LE prep test, and a positive ANA antibody test.  Additional tests include sedimentation rate and C-reactive protein.
3.	What priority problems need to be addressed with D.W.?
Her inflammation must be addressed to prevent irreversible damage.  Her autoimmunity should also be addressed to prevent further damage.  She also needs to reduce her stress level.
4.	Of what significance are these findings, and what is the relationship of such findings to D.W.’s diagnosis of SLE?
These findings are indicative of kidney inflammation, which can lead to kidney failure.  All of these findings go along with kidney inflammation related to SLE.
5.	How will D.W.’s treatment and care plan likely change?
She would have diuretics to get rid of her excess fluid.  She should be put on fluid restriction and weigh daily.  Also, her medications may need to changed or dosage changed for desired effects.
6.	What preventive measures should be instituted to protect D.W. at this time?
She should be put on seizure precaution, as well as, fall precaution.  Monitor for signs of a stroke.