Goal: Be relaxed and comfortable with controlled pain (<2/10) throughout stay until discharge.
Assess knowledge of disease and prescribed management| Patients need to understand that sickle cell anemia is a chronic lifelong disease in which they play a vital role in effective management| Assess for pain characteristics: severity, location, type, duration| Pain can be severe requiring large doses of medication. Pain may be reported as tenderness or inability to move.| Monitor laboratory values and electrophoresis for amount of sickling| A severe decrease in functioning RBC’s may indicate the need for replacement transfusion of packed RBC’s| Administer prescribed IV and oral fluids (6-8 L/day)| Fluids promote hemodilution, which reverses agglutination of sickle cells.| Use distraction devices such as television, movies, cell phone | This can facilitate pain control.|
Nursing Diagnosis: Potential for repeated sickle cell crises related to ineffective disease management as evidenced by repeated admissions (4 in 12 months)
Goal: Verbalize understanding of sickle cell disease and how to prevent crises within 7a-3p shift.
Teach patient to avoid situations that increase cellular metabolism ie. Strenuous physical activity, contact sports, emotional stress and high altitudes| The patient may not understand her ability to follow the prevention and treatment plan.| Assess pattern of physical activity| Regular, non strenuous exercise is recommended.| Assess current eating habits| Knowledge of patient’s food preferences, eating habits, attitudes about food developing an individualized nutritional plan| Set aside time to talk to the patient when the patient’s pain is controlled| During crisis, the patient is distracted by the pain therefore less receptive to teaching.| Teach about the importance of fluid intake | Adequate fluid intake will help prevent blood stasis and sickling|
Nursing Diagnosis: Risk for infection related to decreased number of normal red blood cells Goal: Will remain free from infection until next appointment Interventions| Rationale|
Ensure thorough handwashing by patient and any caregiver and visitor| Reduce spread of infection by effective handwashing| Teach importance of meticulous hygiene, oral and perianal/perineal care| Reduce risk for infection reducing risk for skin breakdown| Encourage frequent position changes, coughing and deep breathing exercises| Promotes ventilation of all lung segments to help prevent pneumonia| Administer prescribed IV and oral fluids (6-8 L/day)| Fluids promote hemodilution, which reverses agglutination of sickle cells.| Monitor vital signs | Reflective of inflammatory process which is first sign of infection|