Read the situation provided. Then, provide a brief description of the pathophysiology of sickle cell anemia and complete the nursing care plan by filling in the goals, outcomes, and nursing orders for the diagnoses provided in the table.
SITUATION: Lavon is a 30 year old, single African American who was diagnosed with sickle cell anemia when he was 4 years old. He works for a computer company and has been working 12 hour days to meet the deadline for a special project. Lavon is complaining of fatigue and decided to relax by playing golf on a warm Saturday morning. After the seventh hole he experienced dyspnea, tingling, and numbness in his legs. After the next hole, he experienced severe pain in his right ankle and knee. He was taken to the local medical center, where he was admitted. Lavon rates his pain at 8 on a scale of 1-10. The physician ordered oxygen, IV fluids, and a PCA pump with morphine sulfate.
Describe the pathophysiology that occurs in sickle cell anemia (4 points).
Sickle cell anemia is the most common form of sickle cell disease which is an inherited, autosomal recessive disorder that causes an abnormal hemoglobin cell. The person with this specific disorder inherited hemoglobin S from both parents, also known as homozygous (Lewis, Dirksen, Heitkemper, & Bucher, 2014, pp. 644-647). This hemoglobin S results from the substitution of valine for glutamic acid on the B-globin chain of hemoglobin, and this ultimately causes the erythrocyte to stiffen and elongate taking a sickle shape in response to low oxygen levels (Lewis et al., 2014, pp. 644-647). Due to the sickle cells elongated shape, and its stiff and sticky consistency it tends to get stuck in capillaries and vessels, and blocks blood flow to limbs and organs (Lewis et al., 2014, pp. 644-647). The major problems with sickle cell anemia is due to their sickled shape, reduced life expectancy and their ability to carry enough hemoglobin or transport it properly to the body to provide adequate oxygenation. Therefore a person who has sickle cell anemia has a lower number of red blood cells related to the shortened cell life that dies after only 10-20 days, compared to a normal red blood cell which lives about 120 days (Lewis et al., 2014, pp. 644-647). Bone marrow is unable to keep up with the demand for new red blood cells to replace the dying ones, making a person with sickle cell anemia left in a state of constant inadequate oxygenation (Lewis et al., 2014, pp. 644-647). Occlusion of capillaries and small vessels lead to acute or chronic tissue injury. This leads to further problems related to hemostasis which continues to perpetuate a cycle of local hypoxia, deoxygenation of more erythrocytes, and more sickling which continue to cause irreversible cell membrane damage (Lewis et al., 2014, pp. 644-647).
Unless you’re directly quoting you only need to address the authors once
According to Lewis et al., SSA is xxx or write your summary and add to the end of the paragraph ….(Lewis et al., 2014 pp. 644-647) since all your information is from 1 source.
If your quoting directly from the source you need to enclose in “ ……” Nursing Diagnoses
Pain related to occlusion of small vessel by sickle cells as evidenced by severe pain in rt. knee and ankle.
Altered tissue perfusion related to a decreased number of RBC's and decreased oxygenation as manifested by dyspnea, tingling/numbness in ankle and knees.
Activity Intolerance related to imbalance between oxygen supply and demand, as manifested by fatigue, dyspnea, pain.
Goal: (Remember goals are broad)
Well done!
(3 points per NANDA)
Long Term- Patient will experience diminished pain as evidenced by statement of a pain level of
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