Question

Read the following case study and answer the questions below. Provide evidence with correct citations to support your answers.

V.M. is a 29 year old African American married man who has sickle cell disease (SCD) marked by frequent episodes of severe pain. His anemia has been managed with multiple transfusions. Six months ago he started showing signs of chronic renal failure. His regular medications are pentoxifylline (Trental), oxycodone-acetaminophen (Percocet), hydroxyurea (Droxia), and folic acid. In the hematology clinic this morning, V.M.’s hemoglobin measured 6.7 g/dL. He complains of severe pain in his joints and back. His vital signs are BP 150/98, HR 100, RR 22, and Temperature 102.8  degrees Fahrenheit. The nurse started V.M on oxygen at 8 L per nasal cannula and transported V.M. to the emergency department (ED).

1. What is SCD?             

2. True or False: Only African Americans get SCD. Explain your response.

3. Which statement is true about the inheritance pattern of SCD?

a. If V.M.’s wife has sickle cell trait, each child will either have SCD or be a carrier.

b. If V.M.’s wife does not have sickle cell trait, each child has a 50% risk of having SCD.

c. If V.M.’s wife has sickle cell trait, each child will either have SCD or be normal.

d. If V.M. has children, each child will automatically have SCD regardless of his wife’s status.

4. V.M.’s hemoglobin measured 6.7 g/dL. Why is anemia common in patients with SCD?

5. What are the hallmark signs of sickle cell crisis?

6. What conditions/situations can trigger a sickle cell episode?   

7. What role does folic acid play in managing V.M.’s SCD?

8. What causes clients like V.M with SCD to develop renal failure?

9. What would be interprofessional focuses of care for V.M?

Answer 1

1)

Sickle cell disease is a genetic disorder where hemoglobin A is replaced with an abnormal sickle shaped hemoglobin S.

Individual with SCD have both abnormal genes producing hemoglobin.

2)

Yes statement is true.

African Americans have higher risk of getting SCD.

3)

Statement B is true.

If wife does not have sickle cell trait then each child has a 50% risk of getting SCD.

4)

Because of insufficient oxygen supply to the cells, these turn into a sickle shape and become rigid.

This leads to clumping of cells and obstruct the blood flow.
These cells also gets trapped and leads to destruction of the cells. This I turn leads to anemia.