• Ms. Jennifer is a 25year old African American who presents to the ED with complaints of chest pain and some shortness of breath. Ms. Jennifer indicates that she has had a nonproductive cough and low-grade fever for the past two days. She recognizes these symptoms as typical of her sickle cell crisis episodes and knew it was important that she come in to get treatment.
• Case study:
• Ms. Jennifer was diagnosed with sickle cell anemia as a child and has had multiple crises requiring hospitalization. Ms. Jennifer states that the pain in her chest is an 8 on a 0-10 scale. She describes the pain as a constant burning pain. Her vital signs are a temperature of 100.8F, blood pressure of 120/76, pulse of 96, and respiration rate of 22. Her oxygen saturation on room air is 94%. She is having some difficulty breathing and is placed on 2 liters of oxygen by nasal cannula. Ms. Jennifer 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 a patient-controlled analgesia (PCA) pump. Her blood work reveals the following values: white blood cell count (WBC) 18,000, Red Blood Cell count (RBC) 3/106, Mean Corpuscular Volume (MCV) 70 um3, Red Cell Distribution width (RDW) 20.4%, hemoglobin (Hgb or hg) 7.5 g/dL, hematocrit 21.8%, and reticulocyte count 23%. Ms. Jennifer is admitted for pain management antibiotic treatment and respiratory support.
• Questions
• 1. Discuss how Ms. Jennifer’s laboratory results are consistent with clients who have sickle cell anemia. The total white blood cell is usually high in patients with sickle cell anemia for instant, Ms. Jennifer’s laboratory white blood cell count (WBC) is 18,000 and the normal range is 5000-10,000mm. MCV is low the normal is 80-95 FL and hers is 70, Red Cell Distribution width (RDW) is 20.4%, high and the normal is
• 2. Describe the structure and effects of RBCs that contain sickle cell hemoglobin molecules.
• 3. Is sickle cell anemia an inherited anemia or an acquired anemia? Explain.
• 4. Discuss the characteristic signs and symptoms of sickle cell anemia.
• 5. Describe the pharmacologic management for a client with sickle cell anemia. Include a discussion of the potential adverse effects of the medication.
• 6. Briefly describe the use of transfusion therapies for management for sickle cell anemia.
• 7. Briefly discuss the factors that can trigger a sickle cell crisis.
• 8. Prioritize three potential nursing diagnosis for Ms. Jennifer
• 9. Describe the nursing management goals during the acute phase of a sickle cell crisis.
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