Sickle Cell Disease

1. Sickle Cell Disease www.nursing.oman-face.com Done by: nursing institutes fourms Evaluated by: prince of nursing

2. Introduction xxxx is a 26 years old male who was admitted in MMW on xx/xx/xxxx at 9:08 am with the chief complaints of sever back and leg pain and. He is unconscious. He was diagnosed as SCD with VOC .

3. Past Medical History xxxx is known case of SCD with VOC. G2 + 0 in first trimester. She was admitted to Bahla Hospital on xx/xx/xxxx, but discharged lama.

4. Definition of the disease Sickle cell disease is an inherited disease in which the red blood cells, normally disc-shaped, become crescent shape (sickle-shape). As a result, they function abnormally. Sickle cell is hard and sticky so they do not move easily through blood vessels so it can block the flow of the blood and sever pain occur.

6. Pathophysiology When cellular oxygen tension decreases, RBC distorts itself into sickle shape which increase viscosity of the blood, slowing circulation and causing increased cellular hypoxia and plugging of circulation to the organs, infarcts can occur in central nervous system, eyes, lungs, liver, spleen, kidney, joints and bones.

7. Etiology of the disease According to the books: Inheritance of abnormal hemoglobin. Black people. Decrease in O2 concentration. Change of certain types of hemoglobin chains in RBC( the beta hemoglobin chains). In my patient: Inheritance of abnormal hemoglobin.

9. Clinical Manifestations • According to the books: • Pain (localized or generalized). • Fever. • Vasocclusive crises. • Leg ulcers. • Renal insufficiency, renal failure. • Ocular problems. • Tachycardia.

10. Clinical Manifestations Cardiac mumurs. Cardiomegaly. Dysrrhythmias. Heart failure. Pulmonary infarct. Autosplenectomy. Hepatomegaly. Bone and joints abnormalities.

11. Clinical Manifestations • In my pt: • Generalized bodyach. • Vasocclusive crises. • Tachycardia (pulse is 110/min).

12. Lab Investigations • S.SR had two packed blood on 16/9/2006 at 4pm and 11pm. Many CBC done for her. • The results of CBC before the blood transfusion:

13. Lab Investigations • The results of CBC after the blood transfusion:

14. Lab Investigations • Urine c/s done for her on 19/9/2006. The result shows insignificant growth of bacteria. • US shows osteomyelitis on top of a vascular necrosis of jaw, left knee effusion. Subcutaneous inflammation of the left lower thigh.

15. Medical Treatment

16. Medical Treatment

17. Nursing Care Plan • Nursing diagnosis: • Altered in comfort (leg and back pain) related to intravascular sickling with localized occlusion as manifested by: • Subjective data: pt said “I have sever legs and back pain”. • Objective data: pt looks tired. • Goals: to relieve pain and provide rest and comfort.

18. Nursing Care Plan

19. Nursing Care Plan

20. Nursing Care Plan

21. Nursing Care Plan Outcome criteria: • Pain is relieved and controlled. • Pt is able to sleep appropriately. • Pt reports comfort and less pain. • Pt will not develop dehydration.

22. Nursing Care Plan • Nursing diagnosis: Impaired physical mobility related to effusion of the left knee joint as manifested by inability to walk normally. • Goals: • To maintain normal body function. • To participate in activities with absence or improvement in gait disturbances. • Increase joint ROM exercises.

23. Nursing Care Plan

24. Nursing Care Plan Outcome criteria: • Body function is normal. • Joint ROM is increased. • Gait disturbance is improved. • Pt is able to walk normally.

25. Nursing Care Plan • Nursing diagnosis: Risk for infection related to chronic disease process, inadequate secondary defenses (decreased hemoglobin). • Goals: • To prevent infection. • To identify interventions to reduce risk for infection.

26. Nursing Care Plan

27. Nursing Care Plan Outcome criteria: • Reduce risk for infection. • Pt understands the importance of hand washing. • Pt reports no signs and symptoms of infection. • Infection is prevented.

28. Discharge Plan Pt discharge on 22/9/2006 at 11:03 am. Advice given to her about • Diet. • Rest. • Exercises. • Pregnancy. • Medications. • Follow up appointments: • Visit general medicine on 4/10/2006. • Visit OBS/Gyanology on 30/10/2006.

29. Discharge Plan • Discharge medications:

30. Discharge Plan • Condition on discharge: K/C/O SCD with VOC, pregnant in four months, developed OM of RT mandible and knee effusion. Discharged in a satisfactory condition. • Discharge status: Improved.

31. The End Thank u 4 listening