Sickle cell crisis case study help

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    I am assigned to take care of Reggie a 10 year old male who is admitted with a dx. of Sickle Cell Crisis. His orders are as follows:
    Admit to pediatrics with a diagnosis of Sickle Cell Crisis.
    Diet as tolerated.
    IV: D5.2NS with 20 meq/kcl to infuse at maintenance rate.
    Labs: CBC with Retic count, BMP in am
    Medications: Tylenol and Motrin per Unit protocol for temperature greater than 101.
    Vital signs on admission are: HR 140, RR. 18, with pulse ox of 92% on room air B/P 85/40. His verbal pain rating is an 8 on a scale of 10.

    This is all of the information that I'm given. I'm being asked several question, a couple of which I'm having difficulty with. I'm going to answer the questions myself, but I'm mainly looking to see if I'm even in the right ballpark with my answers.

    1. When preparing his room, what kind of equipment would I want?
    2. What safety issues should I consider when providing care for this child?
    3. What anticipatory guidance would be appropriate for this child?
    4. Are the medications listed appropriate? Why or why not?

    Any help would be most appreciated. Thanks in advance!
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  3. 3 Comments so far...

  4. 0
    I would definitely give something more for the pain if it were my pt.
  5. 0
    I agree about more pain medication. Sickle Cell Crisis patients can experience severe pain. Your main concerns with this patient are fluids and pain meds.
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    Pain is number one sickle cell crisis, 8 out of 10 is very high. For t-max tylenol or ibuprofen is ok. Most sicle cell patients take toradol rt inflammation. This temperture will definitely send him into a crisis, so we need a pca pump. respitaory equipment, airway first. Also keep in mind there is a high probability for acute chest, blood transfusion or even echange which means more than one unit of blood given. Monitor vitals every 4hr, montior pain and response to pain medication closely. BP is low probable sepsis due to infection, antibiotics and hydration.Spleenomegaly can occur this is where the cell are broken down, chest xray to ro acute chest. Monitor cbc,retic and BMP. Patient low pressure due to low volume possible dehydration. Also how you can tell if a true sickle cell crisis is happening, look at the sclera of the eyes, bili and liver enzymes are elevated during crisis. Cold wheather, low hbg 7-8 is baseline and infection send them into crisis. I hope this helps! Tiana ONC RN
    Last edit by tmwilliams84 on Apr 22, '11 : Reason: errors


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