question archive Case Study, Chapter 32, 33 & 34 Management of Patients With Hematological Disorders V
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)
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question 1. sickle cell disease is an inherited kind of disease in which a person has a sickled shaped red blood cells caused by a defective gene where an amino acid in the DNA is replaced by pan amino acid that is not part of the normal RBC. Sickle cell disease is more common in Hispanics and the the African descent race due to their inheritance of the defective gene.
question 2. one mechanism is the hemolysis of the red blood cells. the sickle cell RBC have a short lifespan and thus when hemolyzed, there would be less concentration of red cells hence anemia. another one is the increased viscosity of the blood due to formation of gel like substance when the cells combine due to its irregular shape. tis leads to little free hemoglobin present and thus anemia.
question 3. V.M is not adequately oxygenated considering that the pH is a little bit higher, the oxygen concentration id lower too. that means the body is not getting the required amount of oxygen.
question 4. this is because V.M believes that at ED, the doctor would consider resolving what is emergency. he has sickle cell which when in crisis causes severe pain and he does not want to undergo such acute pain, he needs the drugs to manage pain constantly.
Step-by-step explanation
sickle cell trait has its presentations such as sickle cell crisis which is severe, acute chest syndrome, priapism and anemia, thus patient needs a lot of near management.
