Ms.

Fox
Sickle Cell Anemia
GENDER : Female
AGE : 20
SETTING : Hospital
ETHNICITY : Black American
CULTURAL CONSIDERATIONS : Increased risk for sickle cell disease
PREEXISTING CONDITION : Sickle cell disease
COEXISTING CONDITION :
COMMUNICATION :
DISABILITY :
SOCIOECONOMIC : Risk for substance abuse
SPIRITUAL/RELIGIOUS :
PHARMACOLOGIC :
● Acetaminophen (Tylenol);
● Hydroxyurea (Droxia);
● Morphine sulfate (MS contin);
● Ibuprofen (Advil, Motrin);
● Acetaminophen 300 mg/codeine 30 mg (Tylenol with codeine
No. 3);
● Meperidine hydrochloride (Demerol);
● Hydromorphone hydrochloride (Dilaudid)
LEGAL :
ETHICAL :
ALTERNATIVE THERAPY :
● Breathing techniques;
● relaxation;
● distraction;
● transcutaneous nerve stimulation (TENS)
PRIORITIZATION :
DELEGATION :

THE CARDIOVASCULAR SYSTEM & THE BLOOD

Overview:

This case requires the nurse to define different types of anemia, recognize the symptoms of a sickle
cell crisis, and discuss short- and long-term management of sickle cell disease. Nursing diagnoses
appropriate for the client are prioritized.

Client Profile:

Ms. Fox is a 20-year-old black American who presents to the emergency department with complaints
of chest pain and some shortness of breath. Ms. Fox indicates that she has had a nonproductive
cough and low-grade fever for the past two days. She recognizes these symptoms as typical of her
sickle cell crisis episodes and knew it was important she come in to get treatment.
Case Study:

Ms. Fox was diagnosed with sickle cell anemia as a child and has had multiple crises requiring
hospitalization. Ms. Fox states that the pain in her chest is an “8” on a 0 to 10 pain scale. She
describes the pain as a “constant burning pain.” Her vital signs are temperature of 100.8ºF (38.2ºC),
blood pressure 120/76, pulse 96, and respiratory rate of 22. Her oxygen saturation on room air is
94%. She is having some difficulty breathing and is placed on 2 liters of oxygen by nasal cannula. Ms.
Fox explains that she took Extra Strength Tylenol for the past two days in an effort to manage the
pain, but when this did not work and the pain got worse, she came in for a stronger pain medication.
She explains that in the past she has been given morphine for the pain and prefers to use the
patient-controlled analgesia (PCA) pump. Blood work reveals the following values: white blood cell
count (WBC) 18,000 cells/mm3, red blood cell count (RBC) 3 3 106, mean corpuscular volume (MCV)
70 μm3, red cell distribution width (RDW) 20.4%, haemoglobin (Hgb) 7.5 g/dL, hematocrit (Hct)
21.8%, and reticulocyte count 23%. Ms. Fox is admitted for pain management, antibiotic treatment,
and respiratory support.

Questions

1. Three types of anemia are hypoproliferative, bleeding, and hemolytic. Provide a basic
definition of the etiology of each type and one example of each type.

2. Discuss how Ms. Fox’s laboratory results are consistent with clients who have sickle cell
anemia.

3. Describe the structure and function of normal red blood cells in the body.

4. Describe the structure and effects of red blood cells (RBCs) that contain sickle cell
haemoglobin molecules.

5. Is sickle cell anemia an inherited anemia or an acquired anemia? Explain.

6. Discuss the relationship between sickle cell anemia and Ms. Fox’s ethnicity.

7. Discuss the characteristic signs and symptoms of sickle cell anemia.

8. Discuss the potential complications associated with sickle cell anemia.

9. Describe the pharmacologic management for a client with sickle cell anemia. Include a
discussion of the potential adverse effects of the medication.

10. Describe the use of transfusion therapy for management of sickle cell anemia. Include a
discussion of the potential complications of chronic red blood cell transfusions.

11. Bone marrow transplantation (BMT) offers a potential cure for sickle cell disease. Why is
BMT a treatment option available to only a small number of clients with sickle cell disease?

12. In the adult, three types of sickle cell crisis are possible: sickle crisis, aplastic crisis, and
sequestration crisis. Briefly describe the pathophysiological changes that lead to each type.
13. There are four common patterns of an acute vaso-occlusive sickle cell crisis: bone crisis,
acute chest syndrome, abdominal crisis, and joint crisis. Briefly describe the characteristic
symptoms of each pattern.

14. Which pattern discussed in question number 13 is most congruent with Ms. Fox’s presenting
signs and symptoms?

15. Discuss the symptoms the nurse should look for while completing an assessment of a client
in potential sickle cell (vaso-occlusive) crisis.

16. Briefly discuss the factors that can trigger a sickle cell crisis.

17. Prioritize three potential nursing diagnoses appropriate for Ms. Fox.

18. Describe the nursing management goals during the acute phase of a sickle cell crisis.

19. Explain why individuals with sickle cell disease may be at risk for substance abuse.

20. Discuss the long-term prognosis for Ms. Fox.