6 Sickle Cell Anemia Crisis Nursing Care Plans

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Sickle cell disease (SCD), or sickle cell anemia (SCA) is a group of hereditary blood disorders characterized by an abnormality in the oxygen-carrying hemoglobin molecule in red blood cells. The most common forms of SCDs are: homozygous hemoglobin SS disease (sickle cell anemia), hemoglobin SC disease, and sickle [beta]-thalassemia.

Sickle cell anemia is a severe hemolytic anemia that results from the inheritance of the sickle hemoglobin gene. This gene causes the hemoglobin molecule to be defective. The sickle hemoglobin (HbS) acquires a crystal-like formation when exposed to low oxygen tension. The oxygen level in venous blood can be low enough to cause this change; consequently, the erythrocyte containing HbS loses its round, pliable, biconcave disk shape and becomes deformed, rigid, and sickle shaped. These long, rigid erythrocytes can adhere to the endothelium of small vessels; when they adhere to each other, blood flow to a region or an organ may be reduced. If ischemia or infarction results, the patient may have pain, swelling, and fever. The sickling process takes time; if the erythrocyte is again exposed to adequate amounts of oxygen before the membrane becomes too rigid, it can revert to a normal shape. For this reason, the “sickling crises” are intermittent. Cold can aggravate the sickling process, because vasoconstriction slows the blood flow. Oxygen delivery can also be impaired by an increased blood viscosity, with or without occlusion due to adhesion of sickled cells; in this situation, the effects are seen in larger vessels, such as arterioles.

Sickle cell anemia is most common in tropical Africans in in people of African descent; about 1 in 10 African-American carries the abnormal gene. If two parents who are both carriers of the sickle cell trait have an offspring, each child has a 25% chance of developing sickle cell anemia. However, sickle cell anemia also appears in other ethnic populations, including people of Mediterranean or East Indian Ancestry. Overall, 1 in every 400 to 600 black children has sickle cell anemia. The defective HbS-producing gene may have persisted because, in areas where malaria is endemic, the heterozygous sickle cell trait provides resistance to malaria and is actually beneficial.

Nursing Care Plans

Nursing care planning and goals for patients with sickle cell anemia include: providing relief for pain, decrease incidences of sickle cell crisis, enhanced sense of self-esteem and power, and absence of complications.

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Here are six (6) nursing care plans (NCP) and nursing diagnosis (NDx) for patients with sickle cell anemia:

  1. Impaired Gas Exchange
  2. Ineffective Tissue Perfusion
  3. Risk for Deficient Fluid Volume
  4. Acute Pain
  5. Risk for Impaired Skin Integrity
  6. Deficient Knowledge
  7. Other Possible Nursing Care Plans
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Risk for Deficient Fluid Volume

Nursing Diagnosis

Risk factors may include

  • Increased fluid needs, e.g., hypermetabolic state/fever, inflammatory processes
  • Renal parenchymal damage/infarctions limiting the kidney’s ability to concentrate urine (hyposthenuria)

Possibly evidenced by

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  • Not applicable. Existence of signs and symptoms establishes an actual nursing diagnosis.

Desired Outcomes

  • Maintain adequate fluid balance as evidenced by individually appropriate urine output with a near-normal specific gravity, stable vital signs, moist mucous membranes, good skin turgor, and prompt capillary refill.
Nursing InterventionsRationale
Maintain accurate I&O and weigh daily.Patient may reduce fluid intake during periods of crisis because of malaise and anorexia. Dehydration from vomiting, diarrhea, and fever may reduce urine output and initiate a vaso-occlusive crisis.
Note urine characteristics and specific gravity.Kidney can lose its ability to concentrate urine, resulting in excessive losses of dilute urine and fixation of the specific gravity.
Monitor vital signs, comparing with patient’s previous readings. Measure BP in lying, sitting, and standing positions if possible.Reduction of circulating blood volume can occur from increased fluid loss, resulting in hypotension and tachycardia.
Assess patient for fever, changes in level of consciousness, poor skin turgor, dryness of skin and mucous membranes, pain.Symptoms may indicate dehydration or hemoconcentration with consequent vaso-occlusive state.
Closely monitor vital signs during blood transfusions and note presence of dyspnea, crackles, rhonchi, wheezes, jugular vein distention, diminished breath sounds, cough, frothy sputum and cyanosis.The patient’s heart may already be weakened and prone to failure because of the chronic demands placed on it by the anemic state. The heart may be unable to tolerate the added fluid volume from transfusions or rapid IV fluid administration administered to treat crisis or shock.
Administer IV fluids as indicated.IV fluids replaces losses and fills deficit. It may reverse renal concentration of RBCs and presence of failure. Fluids must be given immediately to decrease hemoconcentration and prevent further infarction.
Monitor laboratory studies: Hb/Hct, serum and urine electrolytes.Elevation in Hb/Hct may indicate hemoconcentration. The loss kidneys’ ability to concentrate urine may result in serum depletions of Na+, K, and Cl, therefore necessitating replacement.
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Recommended Resources

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See also

Other recommended site resources for this nursing care plan:

Other care plans for hematologic and lymphatic system disorders:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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