Sickle Cell Disease Scenario V.M. is a 39-year-old African-American...

Question Answered step-by-step Sickle Cell Disease Scenario V.M. is a 39-year-old African-American… Sickle Cell DiseaseScenarioV.M. is a 39-year-old African-American man who has sickle cell disease (SCD), sometimes called sickle cell anemia, marked by frequent episodes of severe pain. His anemia has been managed with multiple transfusions, and he shows signs of chronic renal failure. He is a nonsmoker and nondrinker and is on Social Security disability. His regular medications are pentoxifylline (Trental), oxycodone-acetaminophen, and folic acid. In the hematology clinic this morning, V.M.’s hemoglobin (Hgb) measures 6.7 g/dl. He received 2 units packed RBCs (PRBCs) over 3 hours and then went home. He developed dyspnea and shortness of breath (SOB) approximately 1 to 1½ hours later, and his wife called 911. The emergency medical system (EMS) crew initiated oxygen (O2) and transported V.M. to the emergency department (ED).1. What is SCD, and how is it related to race? 2. The stiff, sickled RBCs tend to cause vascular occlusions with subsequent local infarction. As a rule, the spleen suffers so many vasoocclusive/infarction episodes that it is greatly reduced in size and is rendered nonfunctional by the time the individual is 6 years of age. What are the implications of having a nonfunctioning spleen? 3. Identify two mechanisms that contribute to anemia in patients with SCD.4. When V.M. arrives at the ED, the physician asks him if he is in pain and if he needs a narcotic. V.M. answers no to both questions. Why did the physician ask these two questions? 5. V.M.’s arterial blood gases (ABGs) on 9 L O2 by simple face mask show PaO2 (partial pressure of oxygen in arterial blood) 74 mm Hg. Is V.M. being adequately oxygenated?6. V.M. complains of (C/O) being SOB. Do you believe his low Hgb level is responsible for his complaintsCASE STUDY PROGRESSYou perform a quick assessment and note a systolic murmur and crackles in V.M.’s bases bilaterally. Vital signs (VS) are 176/102, 94, 28, 97° F (oral). Acting according to the standing orders for your institution, you start an IV and draw blood for CBC with differential, basic metabolic panel (BMP), calcium, and phosphorus and send it for analysis.7.Your assessment findings are consistent with fluid overload. What four findings led you to that conclusion?8. What action would you expect the physician to take next, and why? CASE STUDY PROGRESSThe lab values return: Na 137 mmol/L, K 4.9 mmol/L, Cl 110 mmol/L, CO2 16 mmol/L, BUN 27 mg/dl, creatinine 2.7 mg/dl, Ca 8.2 mg/dl, phosphate 4.7 mg/dl, WBC 4.3 thou/cmm, Hgb 7.8 g/dl, Hct 20.9%, platelets 208 thou/cmm.9. What is the significance of the lab results, and why? CASE STUDY PROGRESSThe physician prescribes furosemide (Lasix) 20 mg IV push (IVP) now, methylprednisolone (Solu-Medrol) 125 mg IVP, and ceftriaxone (Rocephin) 1 g IV piggyback (IVPB) after the furosemide.10.What is the significance of each of these drugs? 11.Why is it difficult to crossmatch blood to transfuse V.M.? What precautions should be taken with each unit of blood? CASE STUDY PROGRESSAs V.M.’s SOB is relieved, he shakes the physician’s hand and thanks him for asking about the pres-ence of pain and the need for pain medication. V.M. states, “One of my biggest fears is that I’ll come in here in crisis and the doctor won’t treat my pain aggressively enough. I don’t want to be labeled as a drug seeker or an emergency room abuser.”12.Why would V.M. be concerned about obtaining adequate pain control in the ED? Health Science Science Nursing MED SURGIC nu2530 Share QuestionEmailCopy link Comments (0)