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NUR 2214 Exam 3 2214c Study Guide{LATEST UPDATE}
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ONLY 2214|ONLY 2214 Exam 3 2214c Study Guide
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NUR2214 Study Guide SUM18 Exam 3Sickle Cell Anemia
Definition/Pathophysiology
o 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
o Pain is most common symptom
o Cardiovascular changes – risk for high cardiac output, SOB, general
fatigue, increase jugular venous distension, increase HR, low to normal
BP
o 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.
o 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.
, o 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.
o 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
o 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.
o 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.
o Aplastic crisis
Diminished RBC production usually triggered by viral infection
that may result in profound anemia.
o Hyperhemolytic crisis
An accelerated rate of RBC destruction characterized by
anemia, jaundice, and reticulocytosis
Precipitating factors for a crisis.
, 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.
o High Altitude
o Extreme stress
o Pregnancy
o Vigorous activities
Nursing care during a crisis
o Rest to minimize energy expenditure and to improve oxygen utilization
o Rehydration through oral and IV therapy (No caffeine)
o Electrolyte replacement because hypoxia results in metabolic acidosis,
which also promotes sickling
o Analgesia for the severe pain from vaso-occlusion
o Blood replacement to treat anemia and to reduce the viscosity of the
sickled blood
o Antibiotics to treat any existing infection
o Administer oxygen.(Remember ABC’s)
o Remove any constrictive clothing.
o Encourage the patient to keep extremities extended to promote
venous return.
o Do not raise the knee position of the bed. Avoid flexing knees and hips
o Elevate the head of the bed no more than 30 degrees.
o Keep room temperature at or above 72° F (22.2° C).
o Avoid taking blood pressure with external cuff.
o 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
o Interventions focus on preventing infection, controlling infection, and
starting drug therapy early when infection is present.
o Drink at least 3 to 4 liters of liquids every day.
o Avoid alcoholic beverages and smoking cigarettes or using tobacco in
any form.
o Contact your primary health care provider at the first sign of illness
or infection.
, o Be sure to get a “flu shot” every year.
o Ask your primary health care provider about taking the pneumonia
vaccine.
o Avoid temperature extremes of hot or cold.
o Be sure to wear socks and gloves when going outside on cold days.
o Avoid planes with unpressurized passenger cabins.
o Avoid travel to high altitudes (e.g., cities such as Denver and Santa
Fe).
o Ensure that any health care professional who takes care of you knows
that you have sickle cell disease, especially the anesthesia provider
and radiologist.
o Consider genetic counseling.
o Avoid strenuous physical activities.
o Engage in mild, low-impact exercise at least 3 times a week when you
are not in crisis.
Pt Teaching***
o Take all antibiotics as prescribed.
o Repot fever of 101.3 or higher to you PCP
o Report to PCP if S&S of a cold occur
Cancer
Primary prevention
o Wearing sunscreen even when cloudy
o Vaccination (HPV)
o Avoid sun from 10-2
o No tanning beds
o No tobacco uses
o Asbestos
o Avoid carcinogens
o Use PPE in workplace
o 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)
o Change in bowels or bowel habits
o A sore that doesn’t heal***
o Unusual bleeding or discharge***
o Thickening or lump in breast or elsewhere
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