- Chronic Pain Related to Vaso-occlusive crisis and Splenic sequestration of Hyperhaemolysis crisis as evidenced by decreased red blood cells (anemia) and Painful swelling of affected areas
- Ineffective Tissue Perfusion related to Hyperhaemolysis crisis (rapid RBC destruction over a short period) and decreased blood supply in the affected area as evidenced by Decreased red blood cells (anemia) and tingling or numbness
- Risk for Decreased Cardiac Output related to Inadequate filling of blood in the heart and decreased oxygenated blood to the heart as evidenced by chest pain and changes in ECG
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: Verbalizes Pain in the splenic region Objective Data: -Painful swelling of affected areas -Pain in the back and chest -Abdominal pain -Elevated pain scale | Chronic Pain Related to Vaso-occlusive crisis and Splenic sequestration of Hyperhaemolysis crisis as evidenced by decreased red blood cells (anemia) and Painful swelling of affected areas | Patient will be able to verbalize decreased pain using a pain scale. Patient will demonstrate the ability to sleep and rest without interruptions. Patient will verbalize their prescribed pain medication regimen. | 1. Keep the patient hydrated. Give oral and intravenous (IV) fluid administration to maintain appropriate hydration and blood flow to control pain. Electrolyte replacement may also be required. 2. Administer pain medications. During an acute crisis, patients often require PCA administration as their pain is severe. 3. Review medications at discharge. Ensure patients understand their medication regimen. Educate them to manage breakthrough pain before it becomes severe. 4. Administer other medications. Hydroxyurea, l-glutamine, and crizanlizumab are common medications given to reduce the frequency of pain crises. 5. Encourage nonpharmacologic interventions. Heating pads can reduce pain in the back or extremities. Encourage relaxation, distraction, and movement if helpful. 6. Refer to a pain management specialist. Collaborate with pain management specialists for a treatment plan to assist patients with sickle cell anemia in controlling pain crises. | Patient verbalized decreased pain using a pain scale. Patient demonstrated the ability to sleep and rest without interruptions. Patient verbalized their prescribed pain medication regimen. |
| Subjective data: -Altered skin sensations -Claudication -Peripheral pain -Numbness and tingling Objective data: -Weak or absent peripheral pulses -Cool skin temperature -Thickened nails Skin discoloration: pallor when legs are raised and rubor when dependent -Loss of hair to legs -Delayed wound healing | Ineffective Tissue Perfusion Related to Hyperhaemolysis crisis (rapid RBC destruction over a short period) and decreased blood supply in the affected area as evidenced by Decreased red blood cells (anemia) and tingling or numbness | Patient will manifest haemoglobin levels at their baseline. Patient will be able to verbalize decreased pain or elimination of pain. Patient will not experience complications from sickle cell anemia | 1. Oxygenate as needed. During a vaso-occlusive crisis, sickle cells clump together and cannot carry oxygenated blood to the rest of the body. Administer oxygen as needed when oxygen saturation levels are low. Unnecessary oxygen administration can suppress the formation of new RBCs. 2. Transfuse PRBCs as prescribed. Transfusions of red blood cells enhance the quantity and quality of healthier, more flexible red blood cells to reduce complications. 3. Administer IV fluids. Hydration is another priority treatment for a vaso-occlusive crisis. IV fluids are often administered continuously. A 5% dextrose solution is recommended. 4. Administer hydroxyurea. Hydroxyurea is the most frequent medication prescribed to prevent sickle-shaped red blood cell formation and lower the occurrence of vaso-occlusive crises. 5. Instruct on sickle cell crisis and its prevention. Ensure the patient and family understand how to prevent vaso-occlusive crises: Drink plenty of water Do not smoke Avoid extremes in temperature Avoid stress Do not miss doses of medications Get adequate sleep 6. Prepare for possible splenectomy. The blood-filled spleen may enlarge during a severe sequestration crisis. For patients who develop recurrent splenic sequestration, a splenectomy may be required. 7. Discuss bone marrow transplants with the provider. Currently, stem cell and bone marrow transplants (BMT) are the only cure for sickle cell disease. | Patient manifested haemoglobin levels at their baseline. Patient verbalized decreased pain or elimination of pain. Patient relieved from complications from sickle cell anaemia |
| Subjective Data: Verbalizes pounding pulse and chest pain Objective Data: -Poor cardiac function -Low red blood cell count -Low haemoglobin levels | Risk for Decreased Cardiac Output Related to Inadequate filling of blood in the heart and decreased oxygenated blood to the heart as evidenced by chest pain and changes in ECG | Patient will demonstrate blood pressure and pulse rate within normal limits. Patient will manifest normal sinus rhythm in ECG. Patient will have no complaints of chest pain or dyspnea. | 1. Administer oxygen. Reduced cardiac output may cause symptoms of dyspnea and low SpO2. Apply oxygen as needed for hypoxia. 2. Prepare for blood transfusions or red blood cell exchange. A blood transfusion may be necessary to boost cardiac output and help the body’s circulation of oxygenated blood in cases of sickle cell crisis. Red blood cell exchange replaces the abnormal RBCs with normal blood cells and can reduce complications like acute chest syndrome. 3. Prepare for heart catheterization. A heart catheterization is required to diagnose pulmonary hypertension. A pulmonary artery pressure of ≥ 25 mmHg, determined by a right heart catheterization, defines pulmonary hypertension. 4. Administer medications as prescribed. The patient with pulmonary hypertension or heart failure may benefit from: Aspirin Diuretics Beta-blockers ACE inhibitors | Patient demonstrated blood pressure and pulse rate within normal limits. Patient manifested normal sinus rhythm in ECG. Patient has no complaints of chest pain or dyspnea. |