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Case Study: Nisha
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Case Study
Nisha
Sickle cell anemia
Carla Pryor, SRN
Subjective: Severe generalized pain
Objective: v/s Temp. 99.7, Pulse- 110, RR- 30, BP- 96/70 110lb(50kg).
Hgb: 9, Hct: 24, WBc: 12,000, platelet count: 140,000, O2 sat: 89%
Low Hgb, Hct, platelet, O2 sat. Elevated Wbc
Clinical manifestations
Patho
2. Sickle cell anemia is the most common and severe variant of sickle cell disease, it is caused by an autosomal recessive genetic mutation that results in an abnormal type of hemoglobin called hemoglobin S. SCA is characterized by defective hemoglobin synthesis, which produces deformed (sickle-shaped) red blood cells (RBCs).
The sickle-shaped cells have a shortened life span, they are unable to carry adequate oxygen to tissues, and become trapped and clump in the vessels due to their shape.
Mainly affected is African, Asian and Middle East descent
Causes
3. If both parents carry the trait, the child has a 25% chance of getting the disease. It is estimated that 1 in 12 African Americans will have the trait and 1 in 500 will have sickle cell anemia disease
4. By 6 years of age, many children with SCA have severely impaired spleen function, which increases the risk to systemic infections, pneumonia, and development of painful crises. Sickle cell crisis is caused by blocked circulation and low oxygen perfusion to the tissues.
Crises usually cause severe bone, joint, back, and abdominal pain, and can cause the vessels to become occluded, causing distal ischemia, spleen entrapment of a massive amount of destroyed RBCs, or hyperhemolytic (i.e., causing profound aplastic anemia, jaundice, and reticulocytosis) or immature red blood cells
Sickle cell crisis
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5. Do a pain assessment PQRST, Skin assessment, Body system assessment.
Assess for fatigue
Assessment
6. Oxygen 2L/min
IV started with fluids for hydration,
Pain medication
All to help stabilize the vital signs
Possible blood transfusion
Nursing
Priorities
Healthcare team
Team Health
Hematologist
Nurse
Pediatrician
Experience
7. The prescriptions ordered was adequate. CBC will show chronic hemolytic anemia characterized by hemoglobin level 7–10 g/dL (however this value may drop to life-threatening levels at times of splenic sequestration or aplastic crises) and markedly elevated reticulocyte count (i.e., increased numbers of immature RBCs
Chest-X Ray will show any complications to SCA.
Nursing Interventions
Nursing Interventions
8. Managing pain, managing fatigue, preventing and managing infection, promoting coping skills, educating on crisis prevention, monitoring and managing potential complications, promoting home, community-based, and transitional care
Adolescent
Indentity vs. Role confusion
Erikson
9. Based on her level of development she is in the identity vs role confusion. She may be trying to figure out where she fit. Will she be able to be productive when dealing with a lifelong illness.
Trying to figure it all out.
What do I do?
Conclusion
Nurse Teaching
10. Educate about self-care . Always stay hydrated 2-3L of water. Maintain low stress levels as possible.
Its ok to participate in sports, however allow self to have periods of rest and hydration. Get enough sleep through the night. Maintain an adequate diet with increase folic acid.
Enjoy self with friends and live