Nursing Care Plan (NCP) for Sickle Cell Anemia

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Outline

Pathophysiology

A hereditary disease that destroys red blood cells by causing them to become rigid and “sickle” shaped. Occurs mainly in persons of African descent. When red blood cells release oxygen to the tissues and O2 concentration is reduced, the red cells and become rigid, assuming a sickle shape. The sickle-shaped cells become clogged in the small blood vessels causing obstruction of the circulation. This results in damage to the various tissues.

Etiology

A single genetic mutation of the hemoglobin molecule. Inheritance of the mutated gene from both parents results in sickle cell disease. A person who inherits the mutated gene from only one parent is a carrier of the trait. There is no cure for this condition.

Desired Outcome

Manage the pain of SC crisis, promote optimal perfusion and prevention of complications

Sickle Cell Anemia Nursing Care Plan

Subjective Data:

  • Fatigue
  • Pain crisis
    • Severe pain
    • All over body
  • Shortness of breath
  • Chest pain
  • Irritability

Objective Data:

  • Swelling of hands/feet
  • Fever
  • Jaundice
  • Cyanosis
  • Presence of sickled cells on histologic exam

Nursing Interventions and Rationales

  • Assess respiratory status
    • Rate
    • Use of accessory muscles
    • Cyanosis
  During an SC crisis, red blood cells cannot effectively deliver oxygen to the tissues resulting in poor perfusion. Frequent infections often result in pneumonia and cause shortness of breath and chest pain.
  • Monitor cardiac status
    • Perform 12-lead ECG
  Changes in respiratory status and hypoxia may lead to arrhythmias
  • Assess for and manage pain
    • Administer medications
    • Apply warm compresses
  • Clogged vessels result in damage to the tissues and organs which causes intense throbbing pain that may change location from one body part to another.
  • Avoid using cold compresses as cold causes further vasoconstriction and exacerbates pain and crisis. Warm compresses dilate vessels to promote circulation and reduce pain and muscle tension.
  • Administer medications/blood products as necessary
    • IV fluids (prevent or treat dehydration)
    • Analgesics for pain – opioids may be used
    • Antibiotics for infections
    • Hydroxyurea – prevents sickling of red blood cells to reduce the number of crisis episodes

  Medication is given to manage the symptoms of a crisis event and treat any underlying infections that may cause a crisis. In some cases, blood transfusions may be necessary to manage crisis events and increase perfusion to vital organs.

  • Monitor vital signs carefully
  • Monitor respiratory status and breath sounds
  • Assess for signs of infection
    • Fever
  Bacterial infections may be severe and often result in pneumonia. Frequent infections weaken the organ systems and may lead to organ failure.
  • Assess for and manage dehydration
  Stress on the organ systems from dehydration can exacerbate the pain of a crisis. Encourage adequate hydration and administer IV fluids to promote adequate blood viscosity.
  • Provide wound care as necessary
  Decreased peripheral circulation often results in changes in the skin and delayed wound healing.
  • Encourage routine eye exams
  Sickling of red blood cells can damage the vessels in the eyes over time and cause blindness.
  • Monitor vital signs closely
  Decreased circulating blood volume can occur resulting in tachycardia and hypotension
  • Minimize stress
    • Teach guided imagery techniques
    • Encourage deep breathing exercises
    • Provide resources for stress management
  Stress and physical activity increase the body’s metabolic need for oxygen. Reducing stress helps preserve fluid balance and provides better individual pain control.
  • Assess for changes in consciousness and mentation
  The brain is sensitive to fluctuations in oxygen balance. Decreased perfusion of brain tissue may result in confusion, loss of consciousness, or stroke.

Writing a Nursing Care Plan (NCP) for Sickle Cell Anemia

A Nursing Care Plan (NCP) for Sickle Cell Anemia starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Let’s take a look at the care plan for sickle cell anemia. In this lesson, we’ll briefly take a look at the pathophysiology and etiology of sickle cell anemia. We’re also going to take a look at additional things that will be included in this care plan, like subjective and objective data, as well as nursing interventions and rationales. 

 

Sickle cell disease is a hereditary disease that destroys red blood cells by causing them to be rigid and sickled, which occurs mainly in people of African descent. When red blood cells release oxygen to the tissues and O2 is reduced, the red cells become rigid. Assuming this sickle shape, the sickle-shaped cells become clogged in the small vessels causing obstruction of the circulation resulting in damage to various tissues. Sickle cell is caused by a single genetic mutation of the hemoglobin molecule. Inheritance of the mutated gene from both parents results in sickle cell disease. A person who inherits the mutated gene from only one parent is a carrier of the traits. There is no cure for sickle cell anemia. The desired outcome is going to be to manage the sickle cell crisis, promote optimal perfusion and the prevention of complications. 

 

Let’s take a look at some of the subjective and objective data that your patient with sickle cell may present with. Now, remember, subjective data are going to be things that are based on your patient’s opinions or feelings. So, for sickle cell, your patient might express fatigue, a pain crisis, meaning severe pain all over the body, shortness of breath, chest pain, and irritability. 

 

Objective or measurable data includes swelling of the hands and feet, fever, jaundice, cyanosis, or the presence of sickled cells on histologic exam. 

 

So, let’s take a look at the nursing interventions. When caring for a patient with sickle cell, it is important to assess your patient’s respiratory status, including the rate, the use of accessory muscles, and cyanosis. During a sickle cell crisis, red blood cells cannot effectively deliver oxygen to the tissues resulting in poor perfusion. Frequent infections often result in pneumonia and cause shortness of breath and chest pain. Also guys, monitor your patients cardiac status, including a 12 lead EKG as changes in respiratory status and hypoxia may lead to arrhythmias.

 

So with sickle cell blockage in the vessels, this causes intense throbbing pain that may actually change a location from one body part to another, so avoid cold compresses as the cold will cause further vasoconstriction and exacerbate the pain, while warm compresses will dilate vessels to promote circulation and reduce the pain, as well as muscle tension. 

 

Medications are given to manage the symptoms of a crisis event and treat any underlying infections that may cause a crisis including IV fluids to prevent and treat dehydration, analgesics for pain, including opioids, antibiotics for infection, and hydroxyurea, which prevents sickling of red blood cells to reduce the number of crisis episodes. In some cases, blood transfusions may be necessary to manage crisis events and increase the perfusion to those vital organs. So, with blood transfusions, be sure to monitor vital signs carefully, as well as the respiratory status and breast sounds of your patient. Assess for signs of infection in your patient. Bacterial infections may be severe and often result in pneumonia. Frequent infections weaken the organ systems and may lead to organ failure. Assessing and managing dehydration is so important in sickle cell patients because stress on the organ systems from dehydration can exacerbate the pain of a crisis. Encourage adequate hydration and administer IV fluids to promote adequate blood viscosity. 

 

Decreased peripheral circulation often results in changes in the skin and delayed wound healing, so provide wound care in sickle cell patients as needed. Also, routine eye exams should be encouraged because sickling of red blood cells can damage the vessels in the eyes over time and cause blindness. Be sure to monitor vital signs closely because the decreased circulating blood volume can result in tachycardia as well as hypotension. Minimizing stress is super important for these patients as well. Teach guided imagery techniques, encourage deep breathing, and provide resources for stress management as stress and physical activity increases the body’s metabolic need for oxygen. Reducing stress helps preserve fluid balance and provides better individual pain control. Also assess for changes in consciousness and mentation. The brain is super sensitive to fluctuations in oxygen balance. Decreased perfusion to the brain may result in confusion, loss of consciousness and even stroke. 

 

All right, guys, here is a look at the completed care plan for sickle cell anemia. That’s it guys. We love you. Now, go out and be your best self today and as always, happy nursing!

 

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