NUR 2214 Study Guide Summer 2020 Exam 3

NUR 2214 Study Guide Summer 2020 Exam 3 Latest 2023 /2024 Sickle Cell Anemia • Definition/Pathophysiology

• The clinical features of SCA are primarily the result of

▪ (1) obstruction caused by the sickled RBCs with other cells ▪ (2) vascular inflammation ▪ (3) Increased RBC destruction,****** abnormal adhesion, entanglement, and enmeshing of rigid sickle-shaped cells accompanied by the inflammatory process intermittently blocks the microcirculation causing vaso-occlusion.• The resultant absence of blood flow to adjacent tissues causes local hypoxia, leading to tissue ischemia and infarction (cellular death).• Pathologic changes

• Pain is most common symptom
• Cardiovascular changes – risk for high cardiac output, SOB, general

fatigue, increase jugular venous distension, increase HR, low to normal BP

• Respiratory changes – occur over time – usually pts develop pulmonary

hypertension, and all are at risk for recurrent pneumonia ▪ Acute chest syndrome is a common life-threatening condition that is usually associated with respiratory infection and can also be caused by fat embolism and pulmonary debris from sickled

cells. Symptoms are similar to pneumonia with:

• Cough, shortness of breath, abnormal breath sounds, and an infiltrate on chest x-ray, Chest pain, fever, cough, tachypnea, wheezing, and hypoxia • Fever may or may not be present.• Without intervention, this complication can lead to respiratory failure and failure of all other organ systems.

• Abdominal changes - damage to the spleen and liver, pain from

reduced PERFUSION is diffuse and steady, also involving the back and legs.▪ The liver or spleen may feel firm and enlarged with a nodular or “lumpy” texture in later stages of the disease. 1 / 4

• Musculoskeletal changes occur because arms and legs are often sites

of blood vessel occlusion.▪ Joints may be damaged from hypoxic episodes and have necrotic degeneration.

• Central nervous system (CNS) –

▪ During crises, patients may have a low-grade fever.▪ Long-term effects of reduced PERFUSION to the CNS may result in infarcts with repeated episodes of hypoxia, causing the patient to have seizures or symptoms of a stroke • Vaso occlusive crisis

• The clumped masses of sickled RBCs block blood flow and PERFUSION

leading to further tissue hypoxemia (reduced oxygen supply) and more sickle-shaped cells, which then leads to more blood vessel obstruction, inadequate perfusion, and ischemia in the affected tissues

▪ Manifestations:

• Fever, swelling of hands, feet, and joints, abdominal pain • Acute Exacerbation • Caused by hypoxia, exercise, high altitude, fever (temp extremes) • Pallor • Fatigue • Severe Pain (Due to micro-occlusions) • Client will have low RBCs.• WBC (leukocytes and neutrophils) will not be abnormal from the sickle cell crisis, neither will the platelets, which are used for clotting.

• Sequestration crisis

▪ A pooling of a large amount of blood usually in the spleen and infrequently in the liver that causes a decreased blood volume and ultimately shock.

• Aplastic crisis

▪ Diminished RBC production usually triggered by viral infection that may result in profound anemia.

• Hyperhemolytic crisis

▪ An accelerated rate of RBC destruction characterized by anemia, jaundice, and reticulocytosis • Precipitating factors for a crisis. 2 / 4

o DEHYDRATION: Encouraging fluids and hydration of the client

will help to prevent sickling of the cells. Because clients in sickle cell crisis are often dehydrated, the fluid of choice is a hypotonic solution such as 0.45% normal saline.

• High Altitude
• Extreme stress
• Pregnancy
• Vigorous activities

• Nursing care during a crisis

• Rest to minimize energy expenditure and to improve oxygen utilization
• Rehydration through oral and IV therapy (No caffeine)
• Electrolyte replacement because hypoxia results in metabolic acidosis,

which also promotes sickling

• Analgesia for the severe pain from vaso-occlusion
• Blood replacement to treat anemia and to reduce the viscosity of the

sickled blood

• Antibiotics to treat any existing infection
• Administer oxygen.(Remember ABC’s)
• Remove any constrictive clothing.
• Encourage the patient to keep extremities extended to promote

venous return.

• Do not raise the knee position of the bed. Avoid flexing knees and hips
• 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.
• Blood transfusions as ordered, be cautious to prevent iron overload

o Check circulation in extremities every hour:

▪ Pulse oximetry of fingers and toes ▪ Capillary refill ▪ Peripheral pulses ▪ Toe temperature • Prevention of crisis

• Interventions focus on preventing infection, controlling infection, and

starting drug therapy early when infection is present.

• Drink at least 3 to 4 liters of liquids every day.
• Avoid alcoholic beverages and smoking cigarettes or using tobacco in

any form.

• Contact your primary health care provider at the first sign of illness

or infection. 3 / 4

• Be sure to get a “flu shot” every year.
• Ask your primary health care provider about taking the pneumonia

vaccine.

• Avoid temperature extremes of hot or cold.
• Be sure to wear socks and gloves when going outside on cold days.
• Avoid planes with unpressurized passenger cabins.
• Avoid travel to high altitudes (e.g., cities such as Denver and Santa

Fe).

• Ensure that any health care professional who takes care of you knows

that you have sickle cell disease, especially the anesthesia provider and radiologist.

• Consider genetic counseling.
• Avoid strenuous physical activities.
• Engage in mild, low-impact exercise at least 3 times a week when you

are not in crisis.• Pt Teaching***

• Take all antibiotics as prescribed.
• Repot fever of 101.3 or higher to you PCP
• Report to PCP if S&S of a cold occur

Cancer • Primary prevention

• Wearing sunscreen even when cloudy
• Vaccination (HPV)
• Avoid sun from 10-2
• No tanning beds
• No tobacco uses
• Asbestos
• Avoid carcinogens
• Use PPE in workplace
• Modify behaviors that can cause cancer

▪ Limit intake of alcohol no more than 1 ounce per day ▪ Include more fruits and veggies and whole grains in diet (Fiber) ▪ Limit number of sexual partners and safe sex practices • Seven warning signs of cancer (CAUTION UP)

• Change in bowels or bowel habits
• A sore that doesn’t heal***
• Unusual bleeding or discharge***
• Thickening or lump in breast or elsewhere
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