Question

O.P is a 15 years old African American adolescent

JP is a 16 years old African American adolescent who was diagnosed with sickle cell disease 3 years ago. J.P presents to the emergency department with pain related to sickle cell crisis

Subjective data:

Pain level is an 8/10 location=bilateral legs, described as deep muscle pain.

Student in 10^th grade, honor roll student

On the track team

Lives with mother and father.

Objective Data:

Vital signs; T37, P 80,R 18, BP 140/68

Weight: 140

HT, 5feet, 6 inches

Question:

1. What other assessments should be included for this patient.

2. Identify the various types of pain

3. What type of pain does this patient describe?

4. What standards of assessing pain will be applied to this patients plan of care?

5. What teaching should the nurse consider from the problems list?

6. What interventions should be included in the plan of care for this patient?

Answer 1

`1.A patient in sickle cell crisis should be assessed for factors that could have precipitated the crisis,such as symptoms of infection or dehydration ,or situations that promote fatigue or emotioal stress.The patient is asked to recall factors that precipitated previous crisis and measures he or she uses to prevent and manage crisis.Because the sickling process can interrupt circulation in any tissue or organ ,with resultant hypoxia and ischaemia,a careful assessment of all body systems is necessary.All joint areas are carefully for pain and swelling .The abdomen is assessed for pain and tenderness because of the possibility of splenic infarction.The respiratory system must be assessed carefully ,including auscultation of breath sounds,measurement of oxygen saturation and signs of cardiac failure ,such as the presence and extent of dependent edema,an increased point of maximal impulse and cardiomegaly.The patient is assessed for signs of dehydration by a history of fluid intake and careful examination of mucous membranes,skin turgor,urine output and serum creatinine and BUN values.Because patients with sickle cell anaemia are susceptible to infections,they are assessed for the presence of any infectious process.

2 Pain is categorized according to its duration,location and etiologyThree basic categories of pain are generally recognized.They are acute pain,chronicpain and cancer-related pain.Acute pain is of recent onset and commonly associated with a specific injury.,acute pain indicates that damage or injury has occured.Chronic pain is constant or intermittent pain that persists beyond the expected healing time and that can seldom be attributed to a specific cause of injury.Cancer-related pain are pain associated with cancer,can be acute or chronic.

3 Acute pain during a sickle cell crisis can be severe and unpredictable.The patients subjective description and rating of pain on a pain scale must guide the use of analgesics,which are valuable in controlling the acute pain of a sickle crisis..After the acute painful episode has diminished ,aggressive measures should be implemented to preserve function..

4 Pain levels should always be monitored using a pain intensity scale,such as 0 to 10 scale. The quality of pain,frequency of the pain and factors that aggravate or alleviate the pain are included in this assessment.If a sickle cell crisis is suspected ,the nurse needs to determine whether the pain currently experienced is the same as or different from the pain typically encountered in crisis.

5 Acute pain during a sickle cell crisis can be severe and unpredictable .The patients subjective description and rating of pain on a pain scale must guide the use of analgesics,which are valuable in controlling the acute pain of a sickle crisis.Any joint that is acutely swollen should be supported and elevated until the swelling diminishes.Relaxation techniques,breathing excercises and distraction are helpful for so,e patients.After the acute painful episode has diminished,aggressive measures should be implemented to preserve function.Physical therapy,whirlpool baths and transcutaneous nerve stimulation are examples of such modalities