Question

Kyla is a 12-year-old with sickle cell anemia. She lives with her mother and grandmother in rural neighborhood. Kyla has experienced several “sickle cell crises, “however, they seem to have become more frequent since she became an adolescent. Kyla is enjoying her summer break from school. She is active in softball and enjoys shopping with her girlfriends. Kyla’s mother brings her to the hematology clinic at the hospital with complaints of severe generalized pain following a lacrosse game in which she played mid-fielders.

She is admitted to the pediatric clinic. Her vital signs are temperature 37.6˚ C (99.7 ˚ F); pulse 118 beats/minute; respiration 33 breaths/minute; and blood pressure, 96/70. She weighs 88 lbs. Her complete blood count reveals: hemoglobin 9 g/L; hematocrit 24%, white blood cell count 12,000 cells/mm3 and platelet count 14,000 cells/mm3. Her oxygen saturation is 89%.

1. Discuss your impressions of Kyla clinical manifestations?
2. What is sickle cell crisis?
3. What are the priorities nursing diagnosis of care for Kyla?
4. Discuss the teaching priorities for Kayla before discharge from the hospital?

Answer 1

ANSWER.

* Impressions of Kayla clinical manifestations.

        * Low hemoglobin (9 g/L) and low hematocrit (24%) indicate

           Anemia.

        * Low platelet (14000 cells/mm3) indicate Thrombocytopenia.

        * Elevated heart rate (118 beat/min) indicate Tachycardia.

        * Low oxygen saturation(89%) indicate Hypoxia.

* Sickle cell crisis.

        In patient with sickle cell anemia blood vessels which carry blood

        to the bone become obstructed due to accumulation of sickle shaped

        RBC's (Red blood cells) and it result in generalized sharp or stabbing

        pain over the body parts known as sickle cell crisis.

* Priority nursing diagnoses for care of Kayla.

      * Acute pain related to accumulation of sickle cells in the blood vessels.

      * Fatigue related to disease induced helplessness.

      * Risk of infection related to disease condition.

      * Imbalanced nutrition less than body requirement related to inadequate

        intake of nutrients.

* Teaching priorities for kayla before discharge.

       * Teach about methods to prevent sickle cell crisis which include

          maintaining adequate hydration,keep warm and avoid stressful

          situations etc.

       * Teach about relaxation techniques like breathing exercises and

          diversion methods to effectively manage pain.

       * Teach about importance of taking antibiotics as per physicians order

          to manage infections.

        * Educate about use of aseptic techniques and personal hygiene to prevent

          infections.

        * Instruct the patient to seek immediate medical care if crisis arises at home.

        * Educate the patient to avoid doing strenuous exercises and sports activities

           which may cause trauma or injuries.