SHORT ANSWER QUESTIONS

Q. Outline 5 nursing interventions for a client under thalassemia treatment.

1. **Blood Transfusions:** Administer regular blood transfusions to replenish the patient’s hemoglobin
levels and improve overall oxygen-carrying capacity.

2. **Chelation Therapy:** Implement chelation therapy to remove excess iron accumulated from
frequent blood transfusions, helping prevent iron overload complications.

3. **Nutritional Support:** Provide nutritional counseling and support to ensure the patient receives
adequate iron intake while managing other essential nutrients, promoting overall health.

4. **Monitoring and Assessments:** Conduct regular monitoring of the patient’s blood counts, iron
levels, and organ function to detect and manage potential complications early.

5. **Psychosocial Support:** Offer emotional support and education to the patient and their family,
addressing concerns related to the chronic nature of thalassemia and promoting adherence to treatment
plans.

Q. Elucidate 5 major causes of thrombocytopenia

1. **Bone Marrow Disorders:** Conditions such as aplastic anemia, leukemia, and myelodysplastic
syndromes can disrupt normal platelet production in the bone marrow, leading to thrombocytopenia.

2. **Immune System Disorders:** Immune-mediated destruction of platelets, known as immune

thrombocytopenic purpura (ITP), can result from autoimmune conditions where the body mistakenly
attacks and destroys its own platelets.

3. **Medications:** Certain drugs, such as heparin, some antibiotics, and chemotherapy agents, may
induce thrombocytopenia as a side effect by affecting platelet production or causing immune reactions
against platelets.

4. **Viral Infections:** Viral infections like HIV, hepatitis C, and Epstein-Barr virus can lead to decreased
platelet production or increased destruction, contributing to thrombocytopenia.
5. **Hypersplenism:** An enlarged spleen (splenomegaly) can sequester and destroy platelets
prematurely, reducing their circulating levels and causing thrombocytopenia. This can be associated with
various medical conditions, including liver cirrhosis.

Q. State any 5 causes of foliate deficiency anemia

1. **Inadequate Dietary Intake:** Insufficient consumption of foods rich in folate, such as leafy green
vegetables, legumes, and fortified cereals, can lead to folate deficiency anemia.

2. **Malabsorption Syndromes:** Conditions like celiac disease, inflammatory bowel disease (IBD), and
certain medications can impair the absorption of folate in the small intestine, contributing to a
deficiency.

3. **Alcoholism:** Chronic alcohol consumption can interfere with the absorption and utilization of
folate, leading to decreased levels in the body and potentially causing folate deficiency anemia.

4. **Pregnancy and Breastfeeding:** During pregnancy and lactation, the demand for folate increases.
Inadequate dietary intake or increased metabolic demands during these periods can result in folate
deficiency anemia.

5. **Certain Medications:** Some medications, such as anticonvulsants and methotrexate (used in

cancer treatment and certain autoimmune conditions), can interfere with folate metabolism and
contribute to folate deficiency.

Q. State any 5 clinical manifestations for a patient diagnosed with polycythemia vera

1. **Headaches and Dizziness:** Increased blood volume and viscosity associated with
polycythemia vera can lead to frequent headaches, dizziness, and difficulty concentrating.

2. **Pruritus (Itching):** A common symptom in polycythemia vera is itching, particularly after

exposure to warm water or when the skin warms up. This is believed to be related to altered
blood flow and histamine release.
 3. **Erythromelalgia:** Some individuals with polycythemia vera may experience erythromelalgia,
a condition characterized by a burning pain and redness, usually affecting the hands and feet. It
is triggered by warmth and is relieved by cooling.

4. **Hypertension:** Elevated red blood cell counts can contribute to increased blood pressure,
leading to hypertension in patients with polycythemia vera.

5. **Enlarged Spleen (Splenomegaly):** Due to increased production of blood cells, the spleen
may become enlarged, causing discomfort or pain in the left upper abdomen.

It’s important to note that the clinical manifestations can vary among individuals, and not all patients
may experience all of these symptoms. Regular medical follow-ups are crucial for monitoring and
managing polycythemia vera.

LONG ANSWER QUESTIONS

Q. A 30 years old patient is admitted to the ward with diagnosis of sickle cell crisis.

(A) outline 3 types of sickle cell crisis in adults population

1. **Vaso-Occlusive Crisis:** This is the most common type of sickle cell crisis. It occurs when the
sickle-shaped red blood cells block small blood vessels, leading to tissue ischemia and pain.
Vaso-occlusive crisis can affect various organs and cause severe pain episodes. In adults, it
commonly presents with pain in the bones, joints, and abdomen.

2. **Hemolytic Crisis:** This crisis is characterized by an accelerated breakdown of red blood cells,
leading to anemia. It can be triggered by various factors such as infections, certain medications,
or stress. Hemolytic crisis contributes to fatigue, paleness, and jaundice in affected individuals.

3. **Aplastic Crisis:** This crisis is characterized by a sudden decline in red blood cell production,
often triggered by infection, particularly with parvovirus B19. Aplastic crisis can exacerbate
anemia and lead to symptoms such as fatigue, weakness, and pallor. It is important to monitor
and manage the underlying cause of the crisis to support the recovery of red blood cell
production.

(B) state 5 potential complications of clients with sickle cell anemia

 1. **Organ Damage:** Sickle cell anemia can lead to chronic organ damage over time.
Organs commonly affected include the spleen, kidneys, liver, and lungs, which may result
in long-term complications and impaired organ function.

2. **Stroke:** Individuals with sickle cell anemia have an increased risk of stroke due to
the blockage of blood vessels by sickle-shaped cells. This can result in neurological
deficits and long-term complications.

4. **Infections:** Sickle cell anemia can weaken the immune system, making individuals more
susceptible to infections, particularly those caused by encapsulated bacteria such as
Streptococcus pneumoniae. Infections can lead to serious complications and require prompt
medical intervention.

5. **Acute Chest Syndrome:** This is a severe and potentially life-threatening complication

characterized by chest pain, fever, and respiratory distress. It often arises from a combination of
vaso-occlusion, infection, and inflammation in the lungs.

6. **Pulmonary Hypertension:** Chronic blockage of pulmonary blood vessels by sickle cells can
lead to pulmonary hypertension, a condition where elevated pressure in the lungs’ arteries can
strain the heart and lead to heart failure over time. Monitoring and managing pulmonary
complications are crucial in individuals with sickle cell anemia.

(C) describe the management of the patient till discharge

The management of a patient with sickle cell anemia until discharge involves a comprehensive approach
to address acute crises, prevent complications, and provide ongoing care. Here’s an overview:

1. **Pain Management:** Address acute vaso-occlusive pain crises promptly with analgesics,
hydration, and, if necessary, stronger pain medications. Pain management is crucial for
improving the patient’s quality of life.

2. **Hydration:** Maintain adequate hydration to prevent dehydration, which can exacerbate

sickle cell crises. Intravenous fluids may be necessary during acute episodes, and patients should
be encouraged to maintain regular fluid intake.
 3. **Blood Transfusions:** In cases of severe anemia or complications, blood transfusions may be
necessary to replenish hemoglobin levels and improve oxygen-carrying capacity. This is often
done selectively based on the severity of symptoms and clinical indications.

4. **Disease-Modifying Medications:** Hydroxyurea is a medication commonly used to reduce the

frequency and severity of sickle cell crises. It helps by increasing the production of fetal
hemoglobin. Regular monitoring of blood counts and potential side effects is essential.

5. **Antibiotic Prophylaxis:** Due to the increased risk of infections, particularly with

encapsulated bacteria, prophylactic antibiotics like penicillin may be prescribed, especially in
children.

6. **Education and Counseling:** Provide extensive education to the patient and their family
about the nature of sickle cell anemia, triggers for crises, and the importance of adherence to
medications. Counseling can address psychosocial aspects and coping strategies.

7. **Regular Follow-up:** Schedule regular follow-up appointments to monitor the patient’s

health, adjust medications, and address any emerging issues. This ensures ongoing management
and preventive care.

8. **Vaccinations:** Ensure that the patient is up-to-date with vaccinations, particularly against
infections such as influenza and pneumococcal disease, to reduce the risk of complications.

9. **Pulmonary Care:** Monitor and manage respiratory symptoms promptly, as respiratory

complications can be serious. Encourage measures to prevent respiratory infections.

10. **Genetic Counseling:** For those planning to have children, genetic counseling can provide
information about the risk of passing on the sickle cell gene and discuss reproductive options.

The ultimate goal is to provide comprehensive care that addresses both acute crises and long-term
management, enhancing the patient’s quality of life and minimizing complications. Discharge planning
should include clear instructions for ongoing care, medication management, and follow-up
appointments with the healthcare team.

(D) Formulate 3 nursing diagnosis for a patient with sickle cell crisis

1. **Acute Pain related to vaso-occlusive crisis as evidenced by patient’s verbalization of severe pain in
the joints and bones, facial grimacing, and guarding behaviors.**

2. **Impaired Gas Exchange related to compromised pulmonary function secondary to acute chest
syndrome, as evidenced by increased respiratory rate, dyspnea, and decreased oxygen saturation
levels.**

3. **Deficient Fluid Volume related to dehydration and increased fluid loss during the sickle cell crisis, as
evidenced by decreased urine output, dry mucous membranes, and elevated blood urea nitrogen (BUN)
and creatinine levels.**