Question

Give the following for Sickle cell disease.

Inter- disciplinary Care

Collaborative care

Nursing Intervention

Safety consideration

Care after discharge/ Education

Answer 1

Answer

Interdisciplinary care

The interdisciplinary care cover all the areas of symptoms due to sickle cell Anemia.

Treatments that may be needed to manage complications of sickle cell anemia with indiscipilnary care that are :

• Dialysis or kidney transplant for kidney disease
• Counseling for psychological complications
• Gallbladder removal in people with gallstone disease
• Hip replacement for avascular necrosis of the hip
• Surgery for eye problems
• Treatment for overuse or abuse of narcotic pain medicines
• Wound care for leg ulcers
• Bone marrow or stem cell transplants can cure sickle cell anemia. However, they are currently not an option for most patients. Sickle cell anemia patients are often unable to find well-matched stem cell donors.

• People with sickle cell disease must reduce their risk of infections. This includes receiving certain vaccinations, including: Haemophilus influenzae vaccine(Hib),Pneumococcal conjugate vaccine(PCV), Pneumococcal polysaccharide vaccine(PPV)

Collaborative care

The majority of people who have a sickle cell crisis do not need to be admitted to hospital for treatment. Treatment usually involves:

• Painkillers. Depending on the amount of pain, you can take various types of pain medication. Mildpainkillers are paracetamol or ibuprofen. Moderate ones are codeine or dihydrocodeine. A strong painkiller such as morphine may be needed for severe pain - this is usually given in hospital.
• Good hydration. This usually means drinking extra fluid, or sometimes a drip into one of your veins,which is needed if you are more unwell or cannot drink.
• Oxygen. This is usually given to you through a face mask in hospital. If you are not getting enough oxygen then more of your red cells may become sickle-shaped.
• Antibiotics. These are used if you have an infection, or when infection is suspected. (You will normally be taking a regular preventative antibiotic already, as explained above. However, if an active infection is suspected, you will need a different antibiotic in a higher dose.)
• People with SCD should try to avoid any potential triggers for a sickle cell crisis as much a possible. For example, try to keep warm in cold weather, try to avoid becoming dehydrated and take precautions if undergoextreme exercise.
• Blood transfusions-The blood transfusion is a useful treatment for some situations, such as acute chest syndrome or severe anaemia. It can also be used to help prevent or treat certain complications. The transfusion helps because it adds normal red blood cells to the blood. This corrects anaemia and reduces the effects of sickling. There are potential side-effects from blood transfusions. Therefore, transfusions are given for a specific need, rather than routinely.
• Treatment of acute chest syndrome For acute chest syndrome, some of the treatment is the same as for sickling episodes (above) - painkillers,hydration and antibiotics. Also, you may need a blood transfusion and oxygen. Atype of chest physiotherapy called incentive spirometry also helps.
• Hydroxycarbamide-The hydroxycarbamide (also called hydroxyurea), taken regularly, may help to reduce the amount of symptoms such as pain episodes and acute chest syndrome. Hydroxycarbamide can have serious side-effects and needs monitoring with blood tests. It may be an option, but you and your doctor need to think about the pros and cons of taking it.

Nursing interventions

• Assess the patient general conditions
• Position the patient in a sitting position/change position
• Remove constructive clothing
• Give frequent and small feeding
• Assess the level of pain
• Observe the signs of infection
• Administer pain killers
• Administer prescribed medications as per doctors order
• Maintain o2 therapy
• Assess the complications

Safety Consideration

Water Safety

• Avoid cold water temperatures (below 84◦). Cold temperatures are known to start pain crises.
• Observe your client facial and skin color for any signs of chilling.
• Always have an watch over client closely around water (even if a lifeguard is present).
• Have the client to wear a life vest each time they are on a boat, on a dock and near open water like rivers or lakes.

Preventing Vaso-occlusive Pain Crisis

• Fly only in pressurized planes.
• Observe the client rest when fatigued.
• Make sure the client gets all the advised immunizations. This includes a yearly flu shot.
• Try to reduce stress for client.
• Give your client all the medicines they have been prescribed.
• Have ensure the client drink lots of fluids to avoid dehydration.

Care after discharge/Health eduction

• Notify any possible signs of infection, such as fever or shortness of breath,Swollen, painful, red, or hot hands and feet,Swollen belly,Signs of fluid loss (dehydration),Sores (ulcers) on your child's legs.
• Get treatment right away if your child has a fever of 100.4°F (38°C) or higher, pain, infections, illnesses, or other health problems. Do's and don'ts once your child is home:

• Encourage the patient to get plenty of activity, but not to the point of becoming overly tired. Be sure client taking plenty of water during activity.
• Provider which sports and what type of exercise are appropriate.
• Encourage patient to drink plenty of liquids, especially during warm weather. This helps to prevent dehydration.
• Dress in warm clothes if he or she will be outside during cold weather. Or if he/she will be in air-conditioned buildings during hot weather.
• Don't allow to swim in cold water.
• If the client must travel by air, he or she should fly in pressurized aircraft only. Talk with healthcare provider about extra safety steps.