Davis Advantage Sickle Cell Disease

The nurse is explaining to the nursing student why the patient with sickle cell disease is at risk for thrombi forming in the capillary beds in the circulatory system. What is the nurse's best explanation for why this occurs? The sickle-shaped red blood cell is more stiff and fragile. Because of this, the cells can more easily hemolyze and clump in the capillary beds. The sickle-shaped red blood cell is flexible and has a sticky, gummy surface. Because of this, the cells clump in the capillary beds. The sickle-shaped red blood cells stick to the wall of the larger blood vessels. Thrombi are formed in the large vessels and move into the small capillary beds. The sickle-shaped red blood cells are larger and as the cells move into the smaller vessels, such as the capillary beds, the cells block the blood flow.

A

The patient states she wishes to do anything that she can to avoid getting an infection when she is discharged from the hospital. What information would you share with her about avoiding infection? Select all that apply. "Wash your hands frequently." "Plan to receive an influenza vaccine every year." "Avoid eating raw fruits and vegetables." "Be sure to get 8 hours of sleep each night." "Avoid childhood vaccinations."

A B D You would educate the patient to wash her hands frequently, plan to receive an influenza vaccine every year, and get 8 hours of sleep each night. Getting enough sleep helps strengthen the immune system. All childhood vaccines and boosters are especially important for people with sickle cell disease.

The patient states that she has been very busy with school lately. She reports that instead of water, she recently began drinking soda and coffee to have enough energy to complete her homework in the evening. Which of the following statements is the appropriate patient education to provide? "It is best to avoid caffeine, which is found in both soda and coffee. Caffeine causes vasoconstriction, which causes problems with your sickle cell disease." "As long as you drink approximately 2 liters of fluid a day it does not matter what the fluid is that you are drinking." "Caffeine does not impact your hydration status. Are you sure that you are drinking at least 2 liters of fluid?" "Caffeine causes vasodilation, and this is not good for your disease process."

A Caffeine is a vasoconstrictor, which can lead to a sickle cell crisis like the patient is experiencing. It also causes dehydration. A patient with sickle cell disease should primarily drink water. It is the best fluid for the body and is free of calories.

With the patient's complaint of pain of 9 on a 0-10 scale and oxygen saturation of 92%, a priority nursing diagnosis would be which of the following? Impaired tissue perfusion Activity intolerance Acute pain Knowledge deficit

A. Although all of the above nursing diagnoses could be appropriate, the priority one would be impaired tissue perfusion, which has to do with circulation. The pain and oxygen saturation she is experiencing are related to hypoxic tissue

A teenage female patient with sickle cell disease has been admitted to the nursing unit with a diagnosis of sickle cell crisis. The patient is complaining of severe pain in her joints and shortness of breath, and has a temperature of 101.2°F. The patient's oxygen saturation on admission was 92%. She rates her pain at a 9 on a 0-10 scale, and What explanation do you give the patient when she asks what causes the pain she is feeling? Inflammation of nerve endings related to fever Lack of blood circulation and oxygen into part of the body Presence of lactic acid in the muscle tissue Physical activity related to disease process

B When sickle cells clump together and block capillaries, blood circulation to certain parts of the body is blocked. This decreased blood flow causes pain.

The nurse is speaking to the patient diagnosed with sickle cell disease about lifestyle changes to prevent sickle cell crisis. What would be the most important to include in the education plan? Increase dietary intake of fresh fruits and vegetables. Take medications only when you cannot manage your symptoms. Avoid dehydration, cold temperatures, infection, and high altitudes. Attempt to sleep 10-12 hours a night.

C

The patient who has sickle cell anemia developed the condition of hand-foot syndrome because of what physiological process? Repeat crisis and infarction of the bones leading to uneven development of fingers and toes Damage to the liver related to repeat sickle cell crisis Repeat crisis and infarction involving the circulatory system of the arms and legs Damage to the kidneys related to repeat sickle cell crisis

C

The nurse is talking with the patient about possible complications of sickle cell disease. What possible complications would the nurse include? Select all that apply. Chronic kidney disease Diabetes Cerebrovascular accidents Infection Pulmonary infarctions

C D E

The nurse is caring for a patient with sickle cell disease who presents to the hospital in sickle cell crisis. What is the priority nursing action? Start an intravenous site and administer fluids per healthcare provider order. Medicate the patient that has pain with an opioid pain medication per healthcare provider order. Push oral fluids per healthcare provider order. Administer oxygen per healthcare provider order.

D

The patient asks to talk with you privately. She tells you that all of the other girls in class have started their periods "years ago," and she is concerned that "something is wrong with me." What would be your best response about her concerns? "Everyone develops in their own way. You are fine." "That is a great question for you to ask your doctor." "It is common for teens with sickle cell disease to have a delay in their development." "Something must be wrong because most teens your age started their periods years ago."

c.It is common for puberty to be delayed in teenagers with sickle cell disease. You should let the patient know if she is concerned. If so, she could speak further with her doctor about the concern; however, it is normal for patients with sickle cell to start menstruating later than their peers. You should acknowledge the patient's concerns and not dismiss the concerns as though everything is fine because the patient does not understand this common side effect of her disease.