Case Study, Chapter 32, 33 & 34 Management of Patients With Hematological Disorders     V

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Case Study, Chapter 32, 33 & 34 Management of Patients With Hematological Disorders

 

 

V.M. is a 39-year-old black man who has sickle cell disease (SCD) 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, nondrinker, and is on Social Security disability. His regular medications are pentoxifylline (Trental), oxycodone/acetaminophen (Roxicet), and folic acid (Folvite). In hematology clinic this AM, V.M.'s Hgb measured 6.7 g/dl. He received 2 units PRC (packed rerd cells) over 3 hours and then went home. V.M. developed dyspnea and shortness of breath approximately 1 to 1 ½ hours later, and his wife called 911. The EMS (emergency medical system) crew initiated oxygen and transported V.M. to the ED.

 

1)What is sickle cell disease, and how is it related to race?(2.5 points)

 

2)    Identify 2 mechanisms that contribute to anemia in patients with SCD.(2.5 points)

 

3) V.M.'s ABG's on 9 L O2/ simple face mask are pH 7.34, PaO2 74mmHg, Pa CO2 33mmHg, HCO3 18 mEq/L, BE -6. Is V.M being adequately oxygenated, why or why not?(2.5 points)

 

 

 

As V.M's SOB is relieved, he shakes the physician's hand and thanks him for asking about the presence of pain and the need for pain medication. V.M states, "One of my biggest fears is that I'll come 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 emergenecy room abuser."

4) Why would V.M. be concerned about obtaining adequate pain control? And especially in the E.D?(2.5 points)