ESTUDYR
NCLEX-RN CASE STUDY: SICKLE CELL
CRISIS
Client Scenario
0800 Nurses' Notes:
An 18-year-old male with a known history of Sickle Cell Anemia (HbSS) presents to the
emergency department. He reports severe, throbbing pain (10/10) in his back, chest, and long
bones that began last night. He states he recently recovered from a "bad cold."
Physical Assessment:
General: Appears in acute distress; restless and guarding his chest.
Respiratory: RR 28, shallow. SpO2 90% on room air. Lungs have diminished breath
sounds in the bases.
Integumentary: Sclera appears slightly jaundiced. Skin is cool and pale; capillary
refill is 4 seconds.
Vital Signs: BP 118/76, HR 114, RR 28, Temp 101.1°F.
Item 1: Recognizing Cues (Visual/Diagram)
Question: The nurse understands the underlying pathophysiology of the client's pain. Which
diagram correctly illustrates the mechanism of a Vaso-occlusive Crisis?
Correct Findings to Identify:
✅Abnormal Hemoglobin (HbS)
✅Deoxygenation causing "sickling" shape
✅Clumping of cells in the microvasculature
✅Tissue Ischemia and Infarction (The cause of the pain)
Rationale: When oxygen levels drop (due to infection, dehydration, or cold), the hemoglobin
S polymerizes, causing the RBCs to become rigid and sickle-shaped. These cells get stuck in
small vessels, blocking blood flow and causing severe "ischemic" pain.
Item 2: Analyzing Cues (Labs)
NCLEX-RN CASE STUDY: SICKLE CELL
CRISIS
Client Scenario
0800 Nurses' Notes:
An 18-year-old male with a known history of Sickle Cell Anemia (HbSS) presents to the
emergency department. He reports severe, throbbing pain (10/10) in his back, chest, and long
bones that began last night. He states he recently recovered from a "bad cold."
Physical Assessment:
General: Appears in acute distress; restless and guarding his chest.
Respiratory: RR 28, shallow. SpO2 90% on room air. Lungs have diminished breath
sounds in the bases.
Integumentary: Sclera appears slightly jaundiced. Skin is cool and pale; capillary
refill is 4 seconds.
Vital Signs: BP 118/76, HR 114, RR 28, Temp 101.1°F.
Item 1: Recognizing Cues (Visual/Diagram)
Question: The nurse understands the underlying pathophysiology of the client's pain. Which
diagram correctly illustrates the mechanism of a Vaso-occlusive Crisis?
Correct Findings to Identify:
✅Abnormal Hemoglobin (HbS)
✅Deoxygenation causing "sickling" shape
✅Clumping of cells in the microvasculature
✅Tissue Ischemia and Infarction (The cause of the pain)
Rationale: When oxygen levels drop (due to infection, dehydration, or cold), the hemoglobin
S polymerizes, causing the RBCs to become rigid and sickle-shaped. These cells get stuck in
small vessels, blocking blood flow and causing severe "ischemic" pain.
Item 2: Analyzing Cues (Labs)
