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

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Sickle Cell Disease

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Sickle cell 5crdisease

Sickle Cell

Disease

www.nursing.oman-face.com

Done by:nursing institutes fourms

Evaluated by:prince of nursing


Sickle cell 5crdisease

Patient’s Demographic data:Name of patient: xxxxAge: 23 yearsAddress: xxxxReligion: MuslimMarital status: SingleLevel of education: class 11Occupation: Doesn’t workNationality: xxxxxData of hospitalization: xx-xx-xxxxDuration of hospitalization: 2 days


Health history

Health History

  • The patient came to the hospital because she complaints of severe joint pain’ pain in the arms, back and complete fatigue.

  • Vital signs:

  • BP:120/70mmHg

  • Temperature:37C

  • RR:20 per min

  • P:80 bate/ min


Medical data

Medical Data:

  • Diagnosis

  • SCD with VOC with pain upper limb and lower limb.


Past medical history

Past medical History

  • The patient doesn’t have any significant illness but she has known case of SCD since she was child.


Definition of the disease

Definition of the disease:

  • Sickle cell anaemia is the most severe from of sickle cell disease. It is severe haemolytic anaemia that results from inheritance of the sickle haemoglobin gene. When the oxygen level in venous blood is low it to causes change in RBC containing haemoglobin HBS. Loses its round, biconcave disk shape, deformed and sickle shaped. The abnormal HGB turns RBCs in to sickle shaped. This decrease the oxygen carrying capacity of the RBC. If deformed RBC obstructs blood flow to tissue, ischemia or infarction results. Sickling crises are intermittent because RBC can revert to normal shape if it takes adequate oxygen.


Etiology of sickle cell disease

According to books:

Genetic factor.

Increase destruction of RBC.

Nutritional deficiency.

Infection.

Cardiac dysfunction.

Impaired production of RBC.

Undergoing anesthesia with out proper oxygenation.

Climbing to high altitude.

Excessive exercising

Pulmonary dysfunction.

In the patient:

Genetic factors

Nutrional deficiency

Etiology Of Sickle-cell Disease


Clinical manifestations

According to books:

Jaundice , pale.

Dysrhythmias and heart failure.

Sudden change in temperature.

There is sever pain in various part of the body.

Loss of appetite.

Weakness.

Fever.

Clinical Manifestations


Clinical manifestation

According to books:

.Ischemic necrosis or hypoxic damage.

Bone pain: painful and swollen large joints.

Cardiomegaly

Splenomegaly.

Decreased splenic function

Clinical Manifestation


Clinical manifestation1

In the patient

Pale

Decrease in hgb 9 QIDC

Loss of appetite

Weakness

Sudden change in temperature .Increase when she has pain 37.5C.

Severe pain in various part of body. L and R lower and upper limbs. Pain score 8.

Clinical manifestation:


Pathophysiology

PATHOPHYSIOLOGY

Abnormal hemoglobin turns in to sickle shaped

Decrease oxygen carrying capacity of the RBCs

The deformed RBCs obstruct blood flow to tissue

Vaso occlusive crisis

Hypoxia

Joint pain and organ infraction


Blood investigation

Blood investigation:


Pharmacology

Pharmacology:


Non pharmacologic

Non pharmacologic:

  • Massage

  • Heat application


Tramadol

Tramadol:

  • Action:

  • Bind to mu- opioid receptors and inhibits the reuptake of norepinphrine and serotonin causes many effects similar to the opioids, dizziness, somuolence, nausea, constipation but does not have the respiratory depressant effects.


Tramadol1

Tramadol:

  • Possible side effects:

  • CNS: Headache, fatigue.

  • CV: Tachycardia, angina pectoris.

  • CHF: hypotintion in salt or volume depleted pt.

  • Dermatologic: rash

  • GI: glupset, dirrhea.

  • GU: renal insufficiency, renal failure, polyuria, oliguria.

  • Others: cough, dizziness, malaise and dry mouth.


Tramadol2

Tramadol

  • Nurse’s Responsibilities:

  • Administer once a day at same time each day.


Mefenamic acid ponstan

Mefenamic Acid [ponstan ]:

  • Action:

  • Anti inflammatory, analgesic and antipyretic activities related to inhibition of prostaglandin synthesis exact mechanisms of action are not know.


Possible side effects

Possible side effects:

  • CNS: headache, dizziness, insomnia, fatigue, tiredness and ophthalmic effect.

  • Dermatologic: rash, sweating, dry mucous membrane and stomatitis.

  • GI: nausea, dyspepsia, GI pain, dirrhea, vomiting and constipation.

  • GU: dysuria and renal impairment.

  • Hematologic: bleeding, platelets inhebition with higher doses and neutropenia.

  • Respiratory: dyspnea, hemoptysis, rhinitis.

  • Perepheral edema: anaphylactic shock..


Nurse s responsibilities

Nurse’s responsibilities:

  • Give with milk or food to decrease GI upset.

  • Arrange for periodic ophthalmologic examinations during long term therapy.


Folic acid

Folic Acid:

  • Action:

  • Required for nucleoprotein synthesis and maintenance of normal erythropoiesis.

  • Possible side effects:

  • Hypersensitivity.

  • Local pain and discomfort at injection site.


Nurse s responsibility

Nurse’s Responsibility:

  • Administer orally if it all possible with severe GI malabsorpation or very severe disease give IM, IV or subcutaneously.

  • Test using schilling test and serum vitamin B12 levels to rule out pernicious anemia apy may mask signs of pernicious anemia while the neurologic deterioration continues.


Paracetamol

Paracetamol:

  • Action:

  • Inhibits the synthesis of prostaglandins in the CNS and peripherally blocks pain impulse generation.

  • Artipyresis from inhibition of hypothalamus heat regulating centre.


Possible side effects1

Possible Side Effects:

  • Endocrine and metabolic:

  • May increase chloride, uric acid and glucose.

  • Hematologic:Anemia, blood dyscrasia.

  • Hepatic: may increase bilirubin.

  • Renal: nephrotoxiaty with over dosage.


Nursing care plan

NURSING CARE PLAN


Sickle cell 5crdisease

Evaluation:

  • Report that pain is relieved promptly and lower discomfort.

  • Identifies effective pain relief strategies.

  • Use pain medication as prescribed .

  • Experiences minimal side effects of analgesia.


Evaluation

EVALUATION

  • Exhibits improve nutritional status by increasing weight and improve laboratory data.

  • States rationale for dietary modification

  • Identifies foods high in carbohydrates.

  • Report improved appetite.

  • hydration.Give him written instructions.Regarding the minimum amount of fluid required each day.

  • Instruct him to avoid strenuous physical activity.

  • Teach him to avoid undue emotional stress.

  • Instruct him to avoid areas of low oxygen concentration.


Sickle cell 5crdisease

Nursing Diagnosis:Activity intolerance related to illness as manifested by pain, loss appetite and patient looks pale.GOAL:Encourage power.


Out come criteria

Out come Criteria:

  • Expresses improved sense of control.

  • Participates in goal setting and in planning and implementing daily activity.

  • Participates indecisions about care.


Nursing diagnosis

Nursing Diagnosis:

  • Knowledge deficient regarding sickle crisis prevention related to lack of exposure/ recall, information misinterprtation and unfamiliarity with resources as manifested by in adequate nutrition in take and regular admition in the hospital.

  • Goal:

  • Verbalizes understanding of disease process and therapeutic needs, initiates behaviours/ lifestyle changes.


Out come criteria1

Out come Criteria:

  • Increases knowledge about disease process.

  • Identifies situations and factors that can precipitate sickle cell crisis.

  • Describes the importance of warmth, adequate hydration, and prevention of infection in preventing crisis.


Discharge plan

Discharge Plan:

  • xxxx 23years old. She is from Nizwa. She came to NH because she complaints from arms and back pain. She was very tired, weakness, looks pale, fever. Her temperature 37.5C. BP 120/80mmHg. P 70bate/min. RR 20per/ min.


Health education

Health Education:

  • Exercise regularly but not so much that became really tired.

  • When do exercise, drink a lots of water.

  • Drink at least 8 glasses of water a day, specially during warm weather.

  • Avoid stress .

  • Treat any infection as soon as it occurs.

  • Wear warm clothes out side in cold weather. And don’t swim in cold water.

  • Tell the doctor if might has as sleep problem like snoring or some time during sleep- apnea.

  • If has any another medical condition like diabetes get treatment and control the condition.

  • Take food that including liver, green leafy vegetables, citrus fruits and wheat germ and regarding supplementary vitamins such as folic acid.


Sickle cell 5crdisease

THE END


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