Brittany Long Pre-Sim.WELL ELABORATED GRADED A.

In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen. Both mother and father must pass the defective form of the gene for a child to be affected. If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. Sickle cell disease is caused by a mutation in the beta-globin chain of the haemoglobin molecule. Sickle haemoglobin, the result of this mutation, has the singular property of polymerizing when deoxygenated. Exactly how normal tissue perfusion is interrupted by abnormal sickle cells is complex and poorly understood. In a sickle cell crisis, sickled cells clump together and block the blood vessels that carry the blood to the bones. This causes intense pain in arms, knees, chest, back, legs, or stomach that can last for hours DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS) Basic Metabolic Panel to measure levels of electrolytes in the blood CBC w/differential to determine blood cells affected by vaso- occlusive crisis - RBC – 3.2 (low) - Hgb: 9.8 (low) - Hct: 29.6 (low) - RDW 14.8% (high) - Reticulocyte 5.5% (high) PATIENT INFORMATION Brittany Long, 5 Year Old African American Female Sickle Cell Disease—Vaso- occlusive crisis Height: 45.7 in Weight: 35 lb MD: Annie Phillips Full Code Standard Precautions NKA ANTICIPATED PHYSICAL FINDINGS Moderate-to-severe pain in extremeties, back, and chest Dactylitis Tachypnea Tachyardia Hypertension SOB Fatigue Headache/Dizziness Jaundice Anxiety ANTICIPATED NURSING INTERVENTIONS Vital Signs Q4H Continuous Pulse Ox O2 2 L/min to keep sats >94% Strict I/O Nonpharmacologic: Apply K-pad to RLE PRN Incentive spirometry education/encouragement of use Physical assessment once a shift Pain assessment Q4H and PRN Pain Management/Medication Monitor lab findings Educate patient and family