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Terms in this set (157)

Dactylitis (early sign seen in babies at 6 months): hand-foot syndrome....blood flow being blocked to hands and feet...will be swollen and fever present

Pain (very severe)....back, joints, chest etc. comes in episodes

Anemic: RBC dying too soon: fussiness, tired, tachycardia, jaundice or pale (for dark skinned patients assess mucous membranes), delayed growth, shortness of breath

Infection risk: spleen recycles old RBCs and helps us fight infection by filtering out foreign invaders....sickled RBCs become trapped in spleen and this leads it to swell and not work properly.....at risk for infection, especially pneumonia (needs pneumococcal vaccine and flu, meningococcal)....some patients need a splenectomy

Gallstones: WHY? sickled RBCs are constantly breaking down and releasing bilirubin, which leads to gallstones because there is too much bilirubin for the gallbladder to manage

Stroke: if sickled RBCs stick together and block blood flow to the brain...blood supply is limited to the brain leading to a decrease in brain blood supply....can cause mental and physical disabilities....NEURO checks very important.

Eye problems: vision issues due to the blockage of blood flow to eye vessels from sickled cells (needs eyes checked regularly)

Risk for abnormal clotting due to an increase in blood coagulation: at risk for DVT or PE

Leg ulcers (older children and adults): lack of blood flow...painful and very slow healing

Acute chest syndrome (happens due to infection like pneumonia or embolism or sickled cells blocking perfusion to lung tissue): chest pain, cough, fever, low oxygen saturation, new chest x-ray infiltrate....very deadly...monitor respiratory status

Also, damage to the organs that depend on high blood flow: kidneys, liver, heart...blood flow limited
Sickling of RBCs occuring: focus hydration, oxygen, pain, at risk for infection, monitor
respiratory status, neuro checks, at risk for acute chest syndrome, prevention of future crisis episodes, medications, ​blood transfusions

Pain: opioids around the clock (PRN not the best at this time until crisis over)

IV fluids​ and oral fluid: dilutes blood and helps kidney function (blood flow is being limited because RBCs are sticking together)

Oxygen: remember RBCs are stressed because of the lack of oxygen....this helps with alleviating the sickling

Penicillin: prevents infection or other antibiotics to treat (some MDs will order some patients to take prophylactic doses of PCN to prevent infection because their risk).... if patient develops acute chest syndrome due to pneumonia may be ordered antibiotics.
Blood transfusion to replace RBCs and helps with anemia and increases oxygen levels in the body.......for multiple transfusions watch for iron overload

Bed rest

Educate about preventing infection (needs vaccines to be up-to-date, hand hygiene, avoid extreme weather and physical activities, mental/physical stress, staying hydrated, avoiding smoking, high altitudes)

Keep extremities elevated and extended to prevent swelling and helps blood flow

Remove restrictive clothing because it decreases perfusion

Warm compresses (not cold leads to sickling) for painful areas

Folic acid administration: helps make RBCs.....​NOT iron​....this doesn't help with this type of anemia but can actually build up in the body causing toxicity and harm to organs
Limit the client's nonessential activities.
Distribute essential tasks over a long period.
Provide periods of rest.
Administer supplemental oxygen during periods of rapid breathing or tachycardia.
Monitor the results of CBC, especially RBC count and H&H levels.
Assess vital signs every 2-4 hrs or more often if indicated.
Report systolic blood pressure below 90 mm Hg and heart rate above 100 bpm.
Monitor I&O accurately each shift or every hour.
Report urine output less than 30-50 mL/hour.
Use standard precautions to examine and test stool and body fluids for evidence of blood.
In cases of traumatic hemorrhage, apply direct pressure to the bleeding site.
If an IV solution is infusing, increase the rate of flow if the client is bleeding profusely.
Place the client in a modified Trendelenburg position is hypovolemic shock develops.
Notify the physician and be prepared to administer blood or blood products.
Supplement parenteral fluids with oral fluids.
Prepare the client with gastric bleeding for an endoscopy.
Monitor oxygen saturation continuously with a pulse oximeter.
Report a sustained oxygen saturation below 90%.
Give oxygen per nasal cannula or simple mask to maintain oxygen saturation at or above 90%.
Prevent drafts.
Provide additional layers of clothing or cover with warmed blankets.
Increase the room temperature and add humidity.
Offer warm oral fluids.
Explain that aspirin and other NSAIDS decrease the production of prostaglandins.
Prepare to teach the client about self-administration of medications such as a proton pump inhibitor, for example, omeprazole; an H2-receptor antagonist such as ranitidine.
Advise the client to avoid combining an NSAID such as ibuprofen with aspirin, drinking alcohol, or ingesting other stomach-irritating substances when taking aspirin or NSAIDs.
Tell the client to take aspirin or other NSAIDs with food or milk.
Recommend that the client inform any and all physicians about a history of gastric bleeding related to aspirin or other NSAID therapy.