Done by: nursing institutes fourms Evaluated by: prince of nursing

Introduction xxxx is a 26 years old male who was admitted in MMW on xx/xx/xxxx at 9:08 am with the chief complaints of sever back and leg pain and. He is unconscious. He was diagnosed as SCD with VOC.

Past Medical History xxxx is known case of SCD with VOC. G2 + 0 in first trimester. She was admitted to Bahla Hospital on xx/xx/xxxx, but discharged lama.

Definition of the disease Sickle cell disease is an inherited disease in which the red blood cells, normally disc- shaped, become crescent shape (sickle- shape). As a result, they function abnormally. Sickle cell is hard and sticky so they do not move easily through blood vessels so it can block the flow of the blood and sever pain occur.

Pathophysiology When cellular oxygen tension decreases, RBC distorts itself into sickle shape which increase viscosity of the blood, slowing circulation and causing increased cellular hypoxia and plugging of circulation to the organs, infarcts can occur in central nervous system, eyes, lungs, liver, spleen, kidney, joints and bones.

Etiology of the disease According to the books: Inheritance of abnormal hemoglobin. Black people. Decrease in O 2 concentration. Change of certain types of hemoglobin chains in RBC( the beta hemoglobin chains). In my patient: Inheritance of abnormal hemoglobin.

Clinical Manifestations According to the books: Pain (localized or generalized). Fever. Vasocclusive crises. Leg ulcers. Renal insufficiency, renal failure. Ocular problems. Tachycardia.

Clinical Manifestations Cardiac mumurs. Cardiomegaly. Dysrrhythmias. Heart failure. Pulmonary infarct. Autosplenectomy. Hepatomegaly. Bone and joints abnormalities.

Clinical Manifestations In my pt: Generalized bodyach. Vasocclusive crises. Tachycardia (pulse is 110/min).

Lab Investigations S.SR had two packed blood on 16/9/2006 at 4pm and 11pm. Many CBC done for her. The results of CBC before the blood transfusion: Normal ranges ResultsName of investigation (H) 3.76 (L) 8.87 (L) 26.8(L) WBC RBC HGB HCT

Lab Investigations The results of CBC after the blood transfusion: Normal rangesResultsName of investigation (N) 4.45(N) 10.7(L) 31.6(L) WBC RBC HGB HCT

Lab Investigations Urine c/s done for her on 19/9/2006. The result shows insignificant growth of bacteria. US shows osteomyelitis on top of a vascular necrosis of jaw, left knee effusion. Subcutaneous inflammation of the left lower thigh.

Medical Treatment Frequ ency RouteDoseClassificatio n Name of Drug ODOrally5mgFolic acid HSOrally670mgLaxativeLactulose BIDInjection500mgAntibioticCefuroxime ODOrally80mgLoop diureticFurosemide TIDOrally50mgAnalgesicTramadol BIDInjection500mgantibioticCeftriaxone SOSOrally1000mgAnalgesics Antipyretic Paracetamol

Medical Treatment Frequ ency RouteDoseClassificationName of Drug TIDInjection400mgAntibiotic Antibacterial Antiprotozoal Amebicide Metronidazole BIDOral application 1%Osmotic diuretic, hyperosmola r laxative. Glycerin of Borax

Nursing Care Plan Nursing diagnosis: Altered in comfort (leg and back pain) related to intravascular sickling with localized occlusion as manifested by: Subjective data: pt said “I have sever legs and back pain”. Objective data: pt looks tired. Goals: to relieve pain and provide rest and comfort.

Nursing Care Plan RationaleNursing Interventions Sickling of cells may lead to hypoxia which may lead to infarction of tissues resulting in pain. Assess pain and its characteristics (location, duration and intensity). Reduce edema, discomfort and risk of injury especially with osteomyelititis. Provide support for and carefully position affected extremities.

Nursing Care Plan RationaleNursing Interventions Helps in reducing muscle tension. Apply local massage gently to the affected area. Dehydration increases vaso-occlusion resulting in pain. Maintain adequate fluid intake.

Nursing Care Plan RationaleNursing Interventions These medications are analgesics used to relieve moderate to sever pain. Administer medication as indicated e.g. tramal and paracetamol.

Nursing Care Plan Outcome criteria: Pain is relieved and controlled. Pt is able to sleep appropriately. Pt reports comfort and less pain. Pt will not develop dehydration.

Nursing Care Plan Nursing diagnosis: Impaired physical mobility related to effusion of the left knee joint as manifested by inability to walk normally. Goals:  To maintain normal body function.  To participate in activities with absence or improvement in gait disturbances.  Increase joint ROM exercises.

Nursing Care Plan RationaleNursing Interventions Identifies the degree of intervention required. Determine functional ability and reasons for impairment. To increase joint ROM and improve mobility. Help the pt doing ROM exercise. Promote independence and self-esteem. Encourage participation in self care.

Nursing Care Plan Outcome criteria: Body function is normal. Joint ROM is increased. Gait disturbance is improved. Pt is able to walk normally.

Nursing Care Plan Nursing diagnosis: Risk for infection related to chronic disease process, inadequate secondary defenses (decreased hemoglobin). Goals: To prevent infection. To identify interventions to reduce risk for infection.

Nursing Care Plan RationaleNursing Interventions Reduce risk of infection. Promote good hand washing. To initiate treatment as soon as possible. Monitor pt for signs of infection e.g. fever and increased WBC. To prevent more serious complications. Monitor vital signs. To prevent infection.Administer antibiotic as indicated.

Nursing Care Plan Outcome criteria: Reduce risk for infection. Pt understands the importance of hand washing. Pt reports no signs and symptoms of infection. Infection is prevented.

Discharge Plan Pt discharge on 22/9/2006 at 11:03 am. Advice given to her about Diet. Rest. Exercises. Pregnancy. Medications. Follow up appointments:  Visit general medicine on 4/10/2006.  Visit OBS/Gyanology on 30/10/2006.

Discharge Plan Discharge medications: DaysFrequencyRouteDoseName of Drug 35ODOrally1 tabFolic acid 35SOSOrally1 tabParasetamol 35BIDOrally1 capsul es Hydroxyurea 35TIDOrally1 Tablet s Soduim Valproate

Discharge Plan Condition on discharge: K/C/O SCD with VOC, pregnant in four months, developed OM of RT mandible and knee effusion. Discharged in a satisfactory condition. Discharge status: Improved.

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