Question

J.P is a 15-year-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 10th grade, honor roll student
On the track team
Lives with mother and father

Objective Data
Vital signs: T 37 P 80 R 18 BP 140/68
Weight: 140
HT: 5 feet, 6 inches

Questions

What other assessments should be included for this patient? Explain your answers.

Discuss the various types of pain that a patient can experience. Explain your answers.

What type of pain does this patient describe? Explain your answers.

What standards of assessing pain will be applied to this patient’s plan of care? Explain your answers.

Discuss three (3) patient education/teachings that should the nurse consider from the problems list. Explain your answer.

Provide four (4) interventions that should be included in the plan of care for this patient. Explain your answers.

Answer 1

Q.N.1 What other assessments should be included for this patient? Explain your answers.

Assessment is the process of sysytematic collection of data regarding a particular situation.Here, in this situation, only the patients location and pain scre is reported. Other informations such as,

• What factors triggered his pain, the characteristics of pain like, throbing, sharp piercing type can be asked, which activity incresed his pain can be colleceted. (This will provide informations about the characteristics of pain the individual is having)
• Assess the both legs for any active bleeding site, ecchymosis, rashes etc.( To indicate any active bleeding)
• Assessment ok knee joints and other joints in leg for any swelling and pain( Joint bleeding is common in sickle cell crisis)
• Assessment of O2 saturation in body.
• Assessment of blood parameters lik Hb, RBC, platelet count, bleeding time, clotting time, prothrombin time etc. (To gather information regarding blood cell concentration and delayed clotting time, prolonged bleeding time etc.)
• Assessment of capillary refill in the lower extrimities.
• Assess for anemia, amount of Hb.( Most common complicaion associated with bleeding)
• Assess for any active gum bleeding
• Assessment of the loer extrimities for any unhealed sore.
• Family history of child
• Types of activities he involved.( To identify the risk of injury)
• Types of play he is involved.(To identify the risk of bleeding)
• Family pattern ( To identify the support system available)

Q.N.2 Discuss the various types of pain that a patient can experience. Explain your answers.

Pain is an unpleasent feeling cause by tissue trauma, tissue damage, nerve damage, inflammation etc. The various types of pain includes,

Acute pain: Acute pain is something, which have a onset of short duration, usually associated with any tissue damage and resolve once, the etiology is resolved.Usually this pain last for 2-3 months.

Chronic pain:The type of pain, which may last for many years, may be up to 6-8 years, and associated with any serious underlying issues.

Radiating pain: In radiating pain, the pain usually starts within any particular body part, later it may spread to various body parts within a short period of time.

Phantom pain: Phantom pain is associated withamputation of body parts. Where pain usullay begins from the amputed body part, which actually dosent exist. But the patient will be complaining about it frequently.

Psychological pain: Its psychological in nature. Mostly associated with any unpleasent situations like extreme sadness, anger, irritability any life experiences etc.

Neuralgia: It a form of nerve pain. Where inflammation or irritation of the particular nerve can cause severe pain for the individual. Example, trigeminal neuralgia, a irritating pain caused by inflammation of trigeminal nerve.

Q.N.3 What type of pain does this patient describe?

Here, the child is complaining of deep muscle pain in his bilateral legs. The pain is like muscle pain is usually felt like a aching pain originating from the muscles.he is scoring the pain as 8 in the pain rating scale.So seriously it might be a severe hurting pain for the child. In sickle cell crissi, usually the pain is caused due to The RBC s blocking the blood vessels.

Q.N.4 What standards of assessing pain will be applied to this patient’s plan of care?

• Assess for the onset of pain
• Assess the triggering factors
• Assess for any relieving factors
• Quality of pain to be assessed
• characteristics of pain like sharp, piercing etc
• radiating to any body parts
• any other associated symptoms

Q.N.5 Discuss three (3) patient education/teachings that should the nurse consider from the problems list. Explain your answer.

1. Avoid vigourous activities and Participating in dangerous play activities: This can cause serious injuries and associated internal bleedings, especially in the larger joints.Once bleeding is started, it may difficult to treat and control the bleeding. Hence, such activities to be restricted.

2.Closely monitor for any alateration in breathing, incresed or decreased respiratory rate: This may indicate the onset of acute chest syndrome in sickle cell patients. Acute chest syndrome is caused by blockage of blood vessels of lungs leading to serious lung injuries, breathing difficulty etc.

3.Obsereve for the development of sickle cell crisis: A life threatening complication of sickle cell crisis,where sudden bleeding and body apin develops and slowly leading the individual to collapse. So closely monitor the symptoms like body pain, chest pain or gum bleed etc.

4. Importance of wearing a meical alert bracelet: To get immediate care in case any emergency arises.

Q.N.6 Provide four (4) interventions that should be included in the plan of care for this patient. Explain your answers.

1. Assess and Monitor the pain score of the patient: As the patient is having complaints of severe bilateral pain over lower extrimities, monitor him. Inform to the physician and administer analgesics as per order.

2. Monitor for any ecchymosis, rashes or joint swelling etc: This may indicate active internal bleeding.hence measures like cold application to be intiated inorder to stop the bleeding.

3. Ausculatate the lung areas for any adventious breath sounds: Which may indicate the onset of acute chest syndrome, due to pooling of blood which may cause serious breathing difficulty.

4. Administartion of RBCs or clotting factors as per physicians order: This is important to treat tissue hypoxia, to stop any internal bleeding and to improve the circulatory status of the patient.