Introduction
A 5-year-old, Brittany, suffers from inborn sickle cell anemia and was recently hospitalized with acute pain. It is the most prevalent form of sickle cell disease, characterized by vascular inflammation and accelerated blockage by sickled red blood cells. As a result, there is no blood flow to nearby tissues, leading to local hypoxia and subsequent cellular death (Sundd et al., 2019).
It is possible to identify four nursing diagnoses based on the patient’s sickle cell anemia. They include accurate diagnosis focusing on the problem, a risk diagnosis, a wellness diagnosis, and a health promotion diagnosis (Sundd et al., 2019). Medical diagnosis and the child’s developmental stage determine the actions the nurse should take in preventive care, ensuring the patient’s safety, and considering the existing medical considerations.
Wellness Diagnosis
The critical detail is that the patient is a child, and the nurse should communicate with Brittany according to her level of cognitive development. First, the last connection with the child is to propose a toy animal she likes and ask her questions about it. It might be easier for the patient to talk about her symptoms and conditions when distracted by the toy, which could reduce her stress in the hospital environment. The girl might find it easier to talk about the pain in the animal’s leg by associating herself with her favorite toy.
The second pediatric technique the nurse can use is proposing to the patient to make bubbles. It has two goals: to distract the girl in the game and to slow and balance her breathing (Tisdale et al., 2020). These actions are consistent with the wellness nursing diagnosis and facilitate further interaction with the child. The third possible method of working with the child is asking her parent to stay behind her when the nurse asks questions. Brittany’s mother or father can tell her the story or speak to the girl, holding her hand as a sign of support. Combining these techniques is vital while interacting with the pediatric patient and establishing emotional contact with her.
Problem-Focused Diagnosis
The focus on problem diagnosis involves understanding the patient’s disease history, including prior pain episodes, hospital stays, trigger incidents, medical care, and home pain management. Sickle cell crisis management aims to improve circulation and control discomfort. Deep breathing, applying heat, and providing a toy are recommended to effectively manage pain. Vasoconstriction is induced by immobilization, pressure, and cold compresses, which can obstruct blood flow and are not recommended during sickle cell crises (Tisdale et al., 2020). Encourage family members to be present at the patient’s bedside to provide support and lessen the anxiety associated with being in a medical facility.
Risk Diagnosis
A risk diagnosis is consistent with the need to educate the patient and, in Brittany’s case, her parents about the disease. As sickled cells aggregate in the microvasculature, they obstruct blood flow rather than promote it, leading to sickle cell vaso-occlusive pain crises. Due to the reduced flow to the affected area, this condition leads to local tissue hypoxia, which develops into ischemia and causes excruciating agony. The pathophysiology of vaso-occlusive pain emergency does not include immune system or bone marrow reduction (Tisdale et al., 2020). In simple language, it is essential to convey how sickled cells aggregate and thicken blood, blocking blood flow through smaller capillaries and increasing pain and oxygen deprivation in the affected area.
Health Promotion Diagnosis
A health promotion diagnosis assumes that a nurse is educating the family members of a patient with sickle cell disease about the causes and consequences of vaso-occlusive pain crises. Given the patient’s age and cognitive development, parents should be instructed on how to assess a child’s pain. In particular, using the FACES pain rating scale is recommended for 5-year-olds who are developmentally appropriate. The user must be at least 7 or 8 years old when using visual analog and numerical scales (Tisdale et al., 2020).
Parents should also be instructed regarding possible strategies to cope with pain. When in pain, the patient may use quiet rest or sleep as a coping mechanism, indicating how weary she is. Parents can indirectly evaluate the child’s state by these signs or help Brittany relax.
Health promotion nurse diagnosis also supposes instructing parents and children on how to take the prescribed medication. According to the information from the case study, Brittany takes such drugs as Ibuprofen, Morphine, Acetaminophen, Codeine phosphate, and Docusate to decrease the pain syndrome, which is typical for this diagnosis (Tisdale et al., 2020). She also takes Folic acid regularly to cope with the disease. The nurse must explain which medications the girl should bring when she feels pain and which drugs should be taken daily.
Conclusion
Four nursing diagnoses can be formulated based on the patient’s sickle cell anemia. These comprise problem-focused, precise diagnoses, as well as risk, wellness, and health promotion diagnoses. Even though the patient is only five years old, Brittany should be aware of the actions that determine her health. However, due to her age, her parents should be responsible for taking the prescribed medications, and the nurse should remind them of it in a polite and empathetic manner.
References
Sundd, P., Gladwin, M. T., & Novelli, E. M. (2019). Pathophysiology of sickle cell disease. Annual Review of Pathology, 14, 263–292.
Tisdale, J. F., Thein, S. L., & Eaton, W. A. (2020). Treating sickle cell anemia. Science, 367(6483), 1198–1199.