Nursing Care Plan for Sickle Cell Anemia

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Pathophysiology

A hereditary disease that destroys red blood cells by causing them to become rigid and “sickle” shaped. Occurs mainly in persons of African descent. When red blood cells release oxygen to the tissues and O2 concentration is reduced, the red cells and become rigid, assuming a sickle shape. As the cells are re-oxygenated the sickle-shaped cells become clogged in the small blood vessels causing obstruction of the circulation. This results in damage to the various tissues.

Etiology

A single genetic mutation of the hemoglobin molecule. Inheritance of the mutated gene from both parents results in sickle cell disease. A person who inherits the mutated gene from only one parent is a carrier of the trait. There is no cure for this condition.

Desired Outcome

Manage pain of SC crisis, promote optimal perfusion and prevention of complications

Sickle Cell Anemia Nursing Care Plan

Subjective Data:

  • Fatigue
  • Pain crisis
    • Severe pain
    • All over body
  • Shortness of breath
  • Chest pain
  • Irritability

Objective Data:

  • Swelling of hands / feet
  • Fever
  • Jaundice
  • Cyanosis
  • Presence of sickled cells on histologic exam

Nursing Interventions and Rationales

  • Assess respiratory status
    • Rate
    • Use of accessory muscles
    • Cyanosis

 

During a SC crisis, red blood cells cannot effectively deliver oxygen to the tissues resulting in poor perfusion. Frequent infections often result in pneumonia and cause shortness of breath and chest pain.

 

  • Monitor cardiac status
    • Perform 12-lead ECG

 

Changes in respiratory status and hypoxia may lead to arrhythmias

 

  • Assess for and manage pain
    • Administer medications
    • Apply warm compresses

 

  • Poor perfusion results in damage to the tissues and organs which causes intense  throbbing pain that may change location from one body part to another.
  • Avoid using cold compresses as cold causes further vasoconstriction and exacerbates pain and crisis. Warm compresses dilate vessels to promote circulation and reduce pain and muscle tension.

 

  • Administer medications / blood products as necessary
    • IV fluids (prevent or treat dehydration)
    • Analgesics for pain – opioids may be used
    • Antibiotics for infections
    • Hydroxyurea – prevents sickling of red blood cells to reduce the number of crisis episodes

 

Medication is given to manage the symptoms of a crisis event and treat any underlying infections that may cause a crisis.

In some cases, blood transfusions may be necessary to manage crisis events and increase perfusion to vital organs.

  • Monitor vital signs carefully
  • Monitor respiratory status and breath sounds

 

  • Assess for signs of infection
    • Fever

 

Bacterial infections may be severe and often result in pneumonia. Frequent infections weaken the organ systems and may lead to organ failure.

 

  • Assess for and manage dehydration

 

Stress on the organ systems from dehydration can exacerbate the pain of a crisis. Encourage adequate hydration and administer IV fluids to promote adequate blood viscosity.

 

  • Provide wound care as necessary

 

Decreased peripheral circulation often results in changes in the skin and delayed wound healing.

 

  • Encourage routine eye exams

 

Sickling of red blood cells can damage the vessels in the eyes over time and cause blindness.

 

  • Monitor vital signs closely

 

Decreased circulating blood volume can occur resulting in tachycardia and hypotension

 

  • Minimize stress
    • Teach guided imagery techniques
    • Encourage deep breathing exercises
    • Provide resources for stress management

 

Stress and physical activity  increase the body’s metabolic need for oxygen. Reducing stress helps preserve fluid balance and provides better individual pain control.

 

  • Assess for changes in consciousness and mentation

 

The brain is sensitive to fluctuations in oxygen balance. Decreased perfusion of brain tissue may result in confusion, loss of consciousness or stroke.

 


References

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