Sickle cell disease

Sickle cell disease is a serious blood disease which can be found in very early ages and it leaves great effects on patients' quality of life. Nursing care provided to patients with sickle cell disease must be very caring and nurses must provide their best work to patients. Sickle cell is a disease that affects cells of blood and it is a chronic illness. Millions of people around the world have sickle cell disease, the people whose ancestors are from Africa, Central America, South America, Mediterranean countries; India and Saudi Arabia are more liable to have the disease. About 90,000 to 100,000 persons from America have the disease. (CDC, 2014) In KSA, the disease is prevailing in the Eastern and Southern regions more than other regions. (AlQurashi et al, 2008) Sickle cell was chosen because it endangers lives of new born children and adolescents and affects patients' quality of life. The female patient is a 13 years old Saudi was suffering from pain in the abdomen when being admitted at hospital in 22-11-2014, at the pain numeric scale, the number was 7. Her history shows that she was diagnosed to be affected with Sickle Cell Disease as a child. A holistic perspective is used to provide the patient with care as all her needs are clear. This assignment is a case study and a reflection about nursing care provided to a patient with sickle cell disease suffering severe abdominal pain. It will provide a presentation for female patient profile and her family's profile.

The female patient is at Grade seven at school. She is a sister for three other sisters and a brother. She likes watching T.V, playing computer games and singing. She dislikes hospital, medicines and she seems to be afraid from treatment. Her family seems to be caring and loving as they are the source of information. Her height is 147 cm and weight is 50 kg. The patient suffers sickle cell disease since childhood and she was admitted to the hospital due to having severe pain in her abdomen. It was a sickle cell crisis. Her past history of the illness included sickle cell strokes, fever and acute chest syndrome. Her family health history includes her father having strokes and diabetes and her mother suffers high blood pressure and she has an aunt who suffers sickle cell anemia. She was received in ER, her pain was measured by numeric Scale and she received morphine and hydromorphone by IV, daily folic acid and she got Tradol orally. I began a discussion with the patient who seemed to be afraid but sooner she liked me and talked about her feelings of shyness as she can't swim in the club with her friends and she said she doesn't like hospital stays she has to do from time to time and that this makes her sad for long times, she was thinking that she is deprived of playing and having a good life as her mates but I told her that she is fine and that she can enjoy many things in life as music, reading and surfing the net so she smiled and liked my words. Her food was small meals including vegetables and fruits, enough fluids and 8 glasses of water daily. I focused mainly on her breathing behavior as she had severe cough and I was very keen on preventing any possible complications related to respiratory problems. I discussed her about the possible reasons that caused her the pain, she answered that the weather was very cold and her clothes were not heavy. She has enough sleeping periods as she slept for eight hours at night and three hours in the afternoon without sleeping medications. Her family supports her in moving a little and took her to walk for 20 minutes in the hospital yard every day. Hemoglobin rates were monitored and I compared them with baseline levels. A patient with sickle cell disease has some specific signs and symptoms such as having abnormal genes.  Patients with sickle cell disease may also suffer symptoms associated with anemia such as fatigue, pallor and weakness, their Hgb and Het are usually reduced in addition to having reticulocyte count. They usually suffer severe unbearable pain. Patients of sickle cell disease may suffer acute chest syndrome, cerebrovascular accident which is stroke, priapism and or splenic sequestration crisis. Their sickle cells of the blood usually form microvascular occlusions that could cause infarct or ischemia in patient's tissues or organs.  (Hazinski, 2012)  Pain crisis are also signs of sickle cell disease as pain is characterized with being very severe coming in episode attacks that could affect many places such as the legs, arms, back or abdomen. Fever, high temperature and stress are also possible signs of the disease. (Tamparo and Lewis, 2011)

Sickle cell disease can be defined as a disease which is mostly inherited and it causes problems in hemoglobin globin genes as the disease's transmitting occurs as an autosomal recessive trait. (Nagelhout and Plaus, 2013) It can also be referred to as a blood disease which is very serious and has a few types as sickle cell anemia. The oxygen flow in the patient's body is not normal as the sickle cells do not last as normal red cells of the blood.( Bjorklund, 2010) Diagnosing sickle cell disease presenting in a person can be suggested when there is normocytic, macrocytic hemolytic anemia, high lactate dehydrogenase levels and a clinical history which is compatible.(Goldman and Schafer, 2011)  Sickle cell disease diagnosing requires many tests such as the standard CBC, hemoglobin electrophoresis (used to measure blood hemoglobin types and the sickle cell test which can identify the blood's abnormal hemoglobin which could be found. Sickle cell disease can be treated by using blood transfusions which could help stop its symptoms and prevent the disease's complications. Prenatal tests are useful for prevention procedures as they can identify fetus HbB genes. Treatment can also be done by using painkillers and fluid intake. Painful crises associated with SCD can also be well managed by hydroxyurea which is an antitumor drug which showed its effectiveness in treating SCD pain crises. (Wailoo and   Pemberton, 2008) Medications for patients with sickle cell disease can be used according to the symptom the patient suffers as pain can be treated with painkillers as aspirin, ibuprofen, morphin, perfalgan, Tradol and or opioid and they are taken daily with doses not more than 100ml three or four times daily.(University of Maryland Medical Centre, 2014) Anemia can be treated by blood transfusions with caution so as to avoid having diabetes or other diseases, they could be made for the patient every three or four weeks. Vaccinations should be presented for patients with SCD especially children to keep them away from infections. (CDC, 2014)

 Goals of care were set according to the patient's case. There were two actual goals which are: reducing the patient's pain to a level that she accepts and helping the patient to breath easily by preserving her ventilation to be adequate and not causing complications. There were two potential goals which are: keeping the patient protected from infections and keeping the patient protected from falls due to the painkillers she took.  According to  (Boyle and  Andrews, 2008) a nurse should have strategies for pain management such as pain assessment, identifying reasons for pain by building a good nurse patient relationship and confirming the transcultural concepts when applying such strategies and this what I really tried to do with the female patient as everything about her was recorded in notes but I think I would have done better job by filing everything about her on my computer. The pain scale was used to measure pain level, the right medications were used with her and her vital signs were monitored as I checked her temperature from time to time as I learnt to do this which is clear according to (Nettina et al,2013) that reported the importance of nursing interventions to check temperature of the patient which prevents fever. I was very keen on keeping the patient's breathing as adequate as possible as she suffered difficulties with cough and shortness of breath and the pain caused her to have breathing difficulties. (Nettina et al,2013)

According to  (Hughson et al, 2012), the patient position is very important to prevent breathing difficulties as the upright position or the semi upright can help the patient breath easily and I did this as I raised the bed to higher position with regard to the patient's rest and comfort, this was useful for her but I think I should have used pillows to add more comfort for the patient.  (Hughson et al, 2012) suggested that oxygen therapy is also useful to prevent breathing difficulties. I tried to keep watching the patient to administer oxygen for her when it is needed. This was very helpful for her and she appreciated this, I tried to educate the patient and her family regarding methods for breathing management at home such as relaxing techniques and be away from stress and exhaustion. (Moyeet, 2009) The patient was in risk of infection due to her being hospitalized so many precautions were taken to help her. Hands hygiene was a first care point that I used to make sure that my hands are very clean before and after dealing with X as according to (Elsevier Health Sciences, 2008), hygiene is the nurse's responsibility and glove and masks use are very essential to prevent the patients from infections. I did not use the mask too much but in future I will do, I suggest that all nurses should not work without masks at all and I think everyone in the care unit or in the hospital should be keen on wearing masks and gloves to prevent infections.

 The patient was at risk of falling as she was a teenager and the medications she used to take as painkillers made her liable to fall so I ensured her safety through many procedures to prevent falls. According to (Iyer, 2006) mobility and fall preventing are the nurse's responsibility as nurses should make sure that beds do not make the patient liable to falls, family members should be educated regarding watching the patient and bell ringing when falls occur and the nurse could help the patient wear good type foot wear that prevent falls. I was doing my best to ensure the bed's safety by providing the patient with a bed with surrounding rails to prevent her from falling, provide the family with a bell and a stick to help the patient walk. I also tried to put the patient in a room near the nursing room but this was not possible so I suggest that hospitals and all healthcare organizations should take this into consideration as patients who are in risk of falls should be put as near as possible to the nurse's room. Pain was well managed and reached zero in the female patient discharge day, breathing was good, the patient did not get any infections and she did not fall. I learned too much experience in nursing care and practice which will help me in the future as a registered nurse. As an educator, I can provide families of patients with sickle cell disease with information about home management for pain crises and other symptoms of SCD. (Iyer, 2006)

   Conclusion

Sickle cell disease is a case that affects the blood and it has great impact on patients as it affects quality of life greatly. People with African origin are the most to be carrying the disease. Testing is very important in diagnosing SCD as there are a number of tests to diagnose it. There are many signs that tell a person has sickle cell disease such as having abnormality in the genes. Symptoms related to sickle cell disease can include pain, fever, fatigue and weakness. Nursing care for a patient with sickle cell disease must be well planned so as to help achieving goals of care and help protect the patient from complications and injuries that may happen due to lack of care during time of hospitalization. The information got from literature added to real life situation experience will be very useful for future work, more researches should be done regarding treatment and management of sickle cell disease and its symptoms. The current assignment is a case study and a reflection about nursing care provided to a patient with sickle cell disease suffering severe abdominal pain. Skills got and learnt through this experience were too many and useful for nurses' practice in pain management and patients' assessment to set the right goal of care and apply them to reach the best quality of care level provided to hospitalized patients of sickle cell disease.