Sickle Cell Anemia- Concept Case Analysis

Concept Case Analysis – NUR 401
Anemia – Sickle Cell Anemia
Case Study
CLIENT PROFILE
Joan is a 55-year-old black American who presents to the emergency department with complaints of
chest pain and some shortness of breath. Joan indicates that she has had a non-productive cough and lowgrade fever for the past two days. She recognizes these symptoms as typical of her sickle cell crisis episodes
and knew it was important she come in to get treatment. She has a past medical history of high cholesterol,
and hypertension.
CASE STUDY
Joan was diagnosed with sickle cell anemia at the age of 6 years. She has had multiple crises requiring
hospitalization. She states that the pain in her chest is an “8” on a 0 to 10 pain scale. She describes the pain as
a “constant burning pain.” Her vital signs are temperature of 38.2 degrees Celsius, blood pressure 140/90,
pulse 96 bpm, and respiratory rate of 25. Her oxygen saturation on room air is 90%. She is having some
difficulty breathing and is given 3 liters of oxygen by nasal cannula. Joan explains that she took Extra Strength
Tylenol for the past two days in an effort to manage the pain, but when this did not work and the pain got
worse, she came in for a stronger pain medication. She explains that in the past she has been given morphine
for the pain and prefers to use the patient-controlled analgesia (PCA) pump. Other routine medications
include: Ramipril 5 mg po OD, Atrovastatin 10 mg po qhs.
Joan is admitted for pain management, antibiotic treatment, and respiratory support. The physician’s orders
include:
CBC (film and differential) Reticulocyte count Blood cultures
ABG’s CXR Cross type and match
Titrate O2 to keep saturation > 92% Cefuroxime 1 gm q8h IV Ramipril 5 mg po OD
PCA Morphine 30mg over 4 hours IV Lactated Ringers @ 100cc/hr Atrovastatin 10mg po qhs
Blood work reveals the following values:
white blood cell count (WBC) 18,000 cells/L
red blood cell count (RBC) 3 x 106
hemoglobin (Hgb) 75 g/L
hematocrit (Hct) 0.218
reticulocyte count 23%
Blood Cultures Results pending
ABG’S
pH 7.54
PaCO2 32
HCO3 22

Questions

1. Discuss the relationship between sickle cell anemia and a client’s ethnicity. Does Joan’s ethnicity play a role in her diagnosis? If so. How and why? (3 points)

ANS:

2. Discuss the pharmacologic management for a client with sickle cell anemia. Discuss the potential adverse effects of the medication (5 points)
3. Describe the use of transfusion therapy for the management of sickle cell anemia. Discuss the potential complications of chronic red blood cell transfusions. (5 points)
4. Bone marrow transplant (BMT) offers a potential cure for sickle cell disease. Why is BMT a treatment option available to only a small number of clients with sickle cell disease? Would Joan be a candidate for BMT? Why or why not? (3 points)
5. a) Discuss the symptoms the nurse should assess while completing a head-to-toe assessment of a client in potential sickle cell (yaso-occlusive) crisis.
6. b) What diagnostic and lab tests should be ordered for a client with sickle cell anemia and ii) state why for each (10 points)
7. Discuss how Joan’s lab results are consistent with clients who have sickle cell anemia. Discuss at least 3 of the abnormal lab values provided.
8. Identify three priority potential nursing problems appropriate for Joan and a potential cause for each (3 points)
9. Describe the nursing management goals (at least 5) during the acute phase of sickle cell crisis (10 marks – must identify goals based upon the problems that are associated with acute phase and describe it – not just list them)
10. Need
11. There are four common patterns of an acute vaso-occlusive sickle bone crisis, acute chest syndrome, abdominal crisis and joint crisis. Briefly describe the characteristics symptoms of each pattern. Which pattern is most congruent with Joan’s presenting signs and symptoms?