Sickle Cell Anemia
UNFOLDING Reasoning
Anthony Perkins, 15 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
Pain
Clotting
Fluid and Electrolyte Balance
Clinical Judgment
Patient Education
Communication
Sickle Cell Crisis
, History of Present Problem:
Anthony Perkins is a 15-year-old African American male who was at a medically monitored summer camp and
participated in several sports activities when the outside temperature was greater than 90 degrees. He began having pain in
his knees and was evaluated by the camp nurse. After evaluation, he was transported to his primary care provider and
evaluated. Anthony was transferred as a direct admit to the pediatric floor of the community hospital where you are the
primary nurse responsible for his care. He weighs 154 lbs or 70 kg.
Personal/Social History:
Anthony was diagnosed with sickle cell anemia at birth during a routine newborn screening. He was a term newborn with
normal childhood illnesses. He has been hospitalized with pneumonia four times – at age 8, 9, 11, and 14. He is up to date
on childhood immunizations, and recently received his pneumococcal and influenza vaccines.
Anthony has had multiple hospitalizations for sickle cell crises and transfusions. He lives with his parents and two
siblings, a younger brother (9 years old), and sister (4 years old). His family lives in a three-bedroom, two-bath home.
Anthony’s father is an accountant and the sole financial provider of the family. Anthony’s mom stays home, raising the
children. The family is covered by a private medical insurance PPO through Anthony’s father’s employer.
1. What data from the histories are important and RELEVANT and have clinical significance for the nurse? (5 points)
RELEVANT Data from Present Problem: Clinical Significance:
-Participated in several sports activities -Generally sport activities involve being physically active, running
-Outside temperature was greater than 90 around, and getting the blood pumping. Activities like this will
degrees increase the oxygen demands of the body which can trigger the
sickling of red blood cells.
-The high outdoor temperature indicates the patient probably was
sweating a lot will he was engaging in the activities. This could lead to
a decrease in fluid volume which increases the viscosity of the blood
and the chance for clotting,
RELEVANT Data from Social History: Clinical Significance:
-Hospitalized with pneumonia four times -This is likely due to the patients increased risk for infections. Proper
-Up to date on childhood immunizations infection control steps should be taken to prevent any hospital
and recent pneumococcal and influenza acquired infections.
vaccines. -Being up to date on immunizations and vaccinations is very important
-Multiple hospitalizations for sickle cell for people with sickle cell due to the increased risk for infections. The
crisis and transfusions pneumonia vaccine is particularly important because he has been
hospitalized four times in the past 7 years.
-Multiple hospitalizations could indicate the patient does not have a
good handle on his disease and may need more education. The
patient has required transfusions during his previous crisis which may
indicate the need for a transfusion to correct his current crisis.
2. What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect.) (5 points)
PMH: Home Meds: Pharm. Expected Outcome:
Classification:
*Sickle cell anemia 1. Folic Acid 1 mg po 1. Water soluble 1. Increase the number of red blood cells
daily vitamin produced.
2. Antimetabolite 2. Decrease the formation of sickle-shaped
2. Hydroxycarbamide red blood cells.
200 mg po daily
UNFOLDING Reasoning
Anthony Perkins, 15 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
Pain
Clotting
Fluid and Electrolyte Balance
Clinical Judgment
Patient Education
Communication
Sickle Cell Crisis
, History of Present Problem:
Anthony Perkins is a 15-year-old African American male who was at a medically monitored summer camp and
participated in several sports activities when the outside temperature was greater than 90 degrees. He began having pain in
his knees and was evaluated by the camp nurse. After evaluation, he was transported to his primary care provider and
evaluated. Anthony was transferred as a direct admit to the pediatric floor of the community hospital where you are the
primary nurse responsible for his care. He weighs 154 lbs or 70 kg.
Personal/Social History:
Anthony was diagnosed with sickle cell anemia at birth during a routine newborn screening. He was a term newborn with
normal childhood illnesses. He has been hospitalized with pneumonia four times – at age 8, 9, 11, and 14. He is up to date
on childhood immunizations, and recently received his pneumococcal and influenza vaccines.
Anthony has had multiple hospitalizations for sickle cell crises and transfusions. He lives with his parents and two
siblings, a younger brother (9 years old), and sister (4 years old). His family lives in a three-bedroom, two-bath home.
Anthony’s father is an accountant and the sole financial provider of the family. Anthony’s mom stays home, raising the
children. The family is covered by a private medical insurance PPO through Anthony’s father’s employer.
1. What data from the histories are important and RELEVANT and have clinical significance for the nurse? (5 points)
RELEVANT Data from Present Problem: Clinical Significance:
-Participated in several sports activities -Generally sport activities involve being physically active, running
-Outside temperature was greater than 90 around, and getting the blood pumping. Activities like this will
degrees increase the oxygen demands of the body which can trigger the
sickling of red blood cells.
-The high outdoor temperature indicates the patient probably was
sweating a lot will he was engaging in the activities. This could lead to
a decrease in fluid volume which increases the viscosity of the blood
and the chance for clotting,
RELEVANT Data from Social History: Clinical Significance:
-Hospitalized with pneumonia four times -This is likely due to the patients increased risk for infections. Proper
-Up to date on childhood immunizations infection control steps should be taken to prevent any hospital
and recent pneumococcal and influenza acquired infections.
vaccines. -Being up to date on immunizations and vaccinations is very important
-Multiple hospitalizations for sickle cell for people with sickle cell due to the increased risk for infections. The
crisis and transfusions pneumonia vaccine is particularly important because he has been
hospitalized four times in the past 7 years.
-Multiple hospitalizations could indicate the patient does not have a
good handle on his disease and may need more education. The
patient has required transfusions during his previous crisis which may
indicate the need for a transfusion to correct his current crisis.
2. What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect.) (5 points)
PMH: Home Meds: Pharm. Expected Outcome:
Classification:
*Sickle cell anemia 1. Folic Acid 1 mg po 1. Water soluble 1. Increase the number of red blood cells
daily vitamin produced.
2. Antimetabolite 2. Decrease the formation of sickle-shaped
2. Hydroxycarbamide red blood cells.
200 mg po daily
