NUR 2214 Study Guide Spring 2020 Exam 3

NUR 2214 Study Guide Spring 2020 Exam 3 1. Sickle cell anemia a. Definition/Pathophysiology • Sickle cell disease (SCD), which used to be called sickle cell anemia, is a genetic disorder that results in chronic anemia, pain, disability, organ damage, increased risk for infection, and early death • This disorder results in the formation of abnormal hemoglobin chains. • the clumped masses of sickled RBCs block blood flow, known as a vaso-occlusive event (VOE). VOE leads to further tissue hypoxia (reduced oxygen supply) and more sickle-shaped cells, which then leads to more blood vessel obstruction and ischemia in the affected tissues. Repeated episodes of ischemia cause progressive organ damage from anoxia and infarction. Conditions that cause sickling include hypoxia, dehydration, infection, venous stasis, pregnancy, alcohol consumption, high altitudes, low or high environmental or body temperatures, acidosis, strenuous exercise, emotional stress, and anesthesia. • Pain is the most common manifestation of SCD crisis. Others vary with the site of tissue damage. Cardiovascular changes, including the risk for high-output heart failure, occur because of the anemia. Assess the patient for shortness of breath and general fatigue or weakness. Other problems may include murmurs, the presence of an S3 heart sound, and increased jugular-venous pulsation or distention. Assess the cardiovascular status by comparing peripheral pulses, temperature, and capillary refill in all extremities. Extremities distal to blood vessel occlusion are cool to the touch with slow capillary refill and may have reduced or absent pulses. Heart rate may be rapid and blood pressure may be low to average with anemia. b. Pathologic changes c. Vaso occlusive crisis • Caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction Manifestations: Fever; painful swelling of hands, feet, and joints; and abdominal pain Precipitating factors for a crisis • Conditions that cause sickling include hypoxia, dehydration, infection, venous stasis, pregnancy, alcohol consumption, high altitudes, low or high environmental or body temperatures, acidosis, strenuous exercise, emotional stress, and anesthesia. • Situations that precipitate sickling include fever, dehydration, and emotional or physical stress; any condition that increases the need for oxygen or alters the transport of oxygen can result in sickle cell crisis (acute exacerbation). Nursing care during a crisis • Care of the Patient in Sickle Cell Crisis • Administer oxygen. • Administer prescribed pain medication. • Hydrate the patient with normal saline IV and with beverages of choice (without caffeine) orally. • Remove any constrictive clothing. • Encourage the patient to keep extremities extended to promote venous return. • Do not raise the knee position of the bed. • Elevate the head of the bed no more than 30 degrees. • Keep room temperature at or above 72° F (22.2° C). • Avoid taking blood pressure with external cuff. • Check circulation in extremities every hour: Pulse oximetry of fingers and toes Capillary refill Peripheral pulses Toe temperature • 1. Maintain adequate hydration and blood flow through oral and intravenously (IV) administered fluids. Electrolyte replacement is also provided as needed; without adequate hydration, pain will not be controlled. 2. Administer oxygen and blood transfusions as prescribed to increase tissue perfusion; exchange transfusions, which reduce the number of circulating sickle cells and the risk of complications, may also be prescribed. 3. Administer