Question

Client Profile

Nisha is a 14 year old with sickle cell anemia. She lives with her mother and grandmother in a rural neighborhood. Nisha has experienced several “sickle cell crises”, however, they seem to have become more frequent since she became an adolescent. Nisha is enjoying her summer break from school. She is active in softball and enjoys shopping with her girlfriends.

Case Study

Nisha’s mother brings her to the hematology clinic at the hospital with complaints of severe

generalized pain following a softball game in which she pitched seven innings. She is admitted to the medical pediatric unit. Her vital signs are: temperature, 37.6° C (99.7° F); pulse 110

beats/minute; respirations, 30 breaths/minute; and blood pressure, 96/70. She weighs 110 lb. Her complete blood count reveals: hemoglobin, 9 g/dL (low); hematocrit, 24%; white blood cell

count, 12,000 cells/ mm3 ; and platelet count, 140,000 cells/ mm3 . Her oxygen saturation is

89%.

Questions

1. What other assessment data would be helpful for the nurse to have to prepare Nisha’s care plan?
2. Discuss the following orders for Nisha and explain why is each is important? Vital signs q4h. Notify health care provider of temperature > 38° C (100.4° F) Regular diet Strict bedrest Complete blood count with differential in the morning Urine for urinalysis (U/A) and culture and sensitivity (C/S) Chest x-ray IV fluids of 5% dextrose in water with 0.45% normal saline to infuse at 175 mL/hour PCA morphine sulfate 1.5 mg continuous and 1 mg every 8 minutes, PCA dose Acetaminophen 650 mg q4h PO for temperature > 38° C (100.4° F) Oxygen at 2 L per nasal cannula titrating to maintain oxygen saturation > 94%
3. What nursing interventions would be appropriate in meeting Nisha’s needs?
4. After 4 days of treatment, Nisha’s intravenous fluids and medication are discontinued and her pain assessment reveals a pain level of 1/10. When the nurse enters Nisha’s room, Nisha is sitting quietly in a chair at the bedside and seems sad. Discuss your impressions of Nisha’s condition based on her level of growth and development.
5. Discuss the teaching priorities for Nisha before her discharge from the hospital after her crisis is resolved.

Answer 1

#The other assessment data which can be helpful to plan for nursing care are

• The growth and developmental assessment to know her pattern of growth and identify any abnormalities to the age
• Inflammation present in the limbs
• Any infection
• Her premenstrual assessment in regards to her age
• Pain assessment in the abdomen and lower back as this symptoms are common in sickle cell crisis
• Assess for jaundice as this can elevate the liver enzymes
• Fatigue due to low hemoglobin
• Breathing problems due to anemia

#The importance of patient orders are as following

• Vital signs recording every 4 hours because rise of temperature is possible due to infection and alterations in the body can be alarmed with this reading
• The patient can tolerate diet so a regular diet can be provided in order to prevent malnutrition
• Strict bed rest to prevent fatigue due to low heamoglibin levels
• CBC innthe morning to rule out any infection and know the basic counts in the blood and the hemoglobin levels
• Chest x rau to assess fir any lung infection
• Urine analysis and C/S to rule out any blood spills in urine and Al's to identify any disease causing pathogens in the urine
• IV fluid to maintain hemodynamic stability
• Morphine to relieve pain
• Acetaminophento reduce fever
• Oxygen is needed as there will be drip of oxygen saturation due to low hemoglobin levels

#The appropriate nursing interventions are

• Monitor vital signs
• Pain management
• Reducing fever
• Psychosocial support

#The impression based on the growth and development is she in a stage of identity vs confusion. She feels complexed for not being like other childrens of her age due to hospitalization.

#The teaching priorities are

• To avoid strenuous activity or exercise or sports
• Take medication as directed
• To maintain hygienic measures and prevent infection
• Well balanced diet
• Adequate rest and sleep