Transcript الشريحة 1

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 discshaped, become crescent shape (sickleshape). 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 O2 concentration.
•Change of certain types of hemoglobin
chains in RBC( the beta hemoglobin
chains).
In my patient:
•Inheritance of abnormal hemoglobin.
Clinical Manifestations
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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: Name of
Results Normal
investigation
WBC
RBC
HGB
HCT
ranges
25.7 (H)
3.76 (L)
8.87 (L)
26.8(L)
4-11
3.8-5.8
12-15
36-46
Lab Investigations
• The results of CBC after the blood transfusion:
Name of
Results
investigation
9.82(N)
WBC
4.45(N)
RBC
10.7(L)
HGB
31.6(L)
HCT
Normal ranges
4-11
3.8-5.8
12-15
36-46
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
Name of
Drug
Classificatio
n
Dose
Route
Frequ
ency
Folic acid
Folic acid
5mg
Orally
OD
Lactulose
Laxative
670mg
Orally
HS
Cefuroxime
Antibiotic
500mg Injection
BID
80mg
Orally
OD
Orally
TID
Furosemide Loop diuretic
Tramadol
Analgesic
50mg
Ceftriaxone
antibiotic
500mg Injection
Paracetamol Analgesics
Antipyretic
1000mg
Orally
BID
SOS
Medical Treatment
Name of Drug Classification Dose
Route
Metronidazole Antibiotic
400mg Injection
Antibacterial
Antiprotozoal
Amebicide
Glycerin of Osmotic
1% Oral
Borax
diuretic,
application
hyperosmola
r laxative.
Frequ
ency
TID
BID
Nursing Care Plan
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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
Nursing Interventions
Assess pain and its
characteristics
(location, duration
and intensity).
Rationale
Sickling of cells may
lead to hypoxia which
may lead to infarction
of tissues resulting in
pain.
Provide support for
Reduce edema,
and carefully position discomfort and risk of
affected extremities. injury especially with
osteomyelititis.
Nursing Care Plan
Nursing Interventions
Apply local massage
gently to the affected
area.
Maintain adequate
fluid intake.
Rationale
Helps in reducing
muscle tension.
Dehydration increases
vaso-occlusion
resulting in pain.
Nursing Care Plan
Nursing Interventions
Rationale
Administer
medication as
indicated e.g. tramal
and paracetamol.
These medications are
analgesics used to
relieve moderate to
sever pain.
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
Nursing Interventions
Determine functional
ability and reasons for
impairment.
Help the pt doing
ROM exercise.
Encourage
participation in self
care.
Rationale
Identifies the degree
of intervention
required.
To increase joint
ROM and improve
mobility.
Promote
independence and
self-esteem.
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
Nursing Interventions
Promote good hand
washing.
Rationale
Reduce risk of
infection.
Monitor pt for signs of To initiate treatment as
infection e.g. fever and soon as possible.
increased WBC.
Monitor vital signs.
To prevent more
serious complications.
Administer antibiotic To prevent infection.
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:
Name of Drug
Folic acid
Parasetamol
Hydroxyurea
Soduim
Valproate
Dose
1 tab
1 tab
1
capsul
es
1
Tablet
s
Route Frequency Days
Orally
OD
35
Orally
SOS
35
Orally
BID
35
Orally
TID
35
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.
The End
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