6 Sickle Cell Anemia Crisis Nursing Care Plans

ADVERTISEMENTS

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.

ADVERTISEMENTS

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
ADVERTISEMENTS

Acute Pain

Nursing Diagnosis

May be related to

  • Intravascular sickling with localized stasis, occlusion, and infarction/necrosis
  • Activation of pain fibers due to deprivation of oxygen and nutrients, accumulation of noxious metabolites

Possibly evidenced by

ADVERTISEMENTS
  • Localized, migratory, or more generalized pain, described as throbbing, gnawing, or severe and incapacitating; affecting peripheral extremities, bones, joints, back, abdomen, or head (headaches recurrent/transient)
  • Decreased ROM, guarding of the affected areas
  • Facial grimacing, narrowed/self-focus

Desired Outcomes

  • Patient shall verbalize relief or control of pain.
  • Demonstrate relaxed body posture, have freedom of movement, be able to sleep/rest appropriately.
Nursing InterventionsRationale
Assess for pain. Note location, duration, and intensity (scale of 0-10).Sickling of cells potentiates cellular hypoxia and may lead to infarction of tissues with resultant pain. Pain usually occurs in the back, ribs, and limbs and may last for days.
Observe nonverbal pain cues: gait disturbances, positioning of the body, guarding behavior, facial grimacing, reluctance to move, and physiological manifestations of acute pain (increased BP, tachycardia, increased RR).Nonverbal cues may aid in evaluation of pain and effectiveness of therapy since pain is unique to each patient. One may encounter varying description because of individualized perceptions.
Discuss what pain relief measures were effective in the past. Involve the patient and SO in care.Involve the patient or SO in care to allow for identification of effective remedies that have been found to relieve pain. This helps in establishing individualized treatment needs.
Teach and discuss alternative pain relief measures: relaxation techniques, biofeedback, yoga, meditation, progressive relaxation techniques, distraction techniques, guided imagery and breathing techniques.Cognitive-behavioral pain management may reduce reliance on pharmacological means of pain control. This also enhances the patient’s sense of control.
Provide support and carefully position affected extremities.To reduce edema, discomfort, and risk of injury, especially if osteomyelitis is present.
Massage gently affected areas.Helps reduce muscle tension.
Encourage ROM exercises.Prevents joint stiffness and possible contracture formation.
Plan activities during peak analgesic effect.Maximizes movement of joints, enhancing mobility.
Maintain adequate fluid intake.Dehydration increases sickling/vaso-occlusion and corresponding pain.
Apply warm, moist compresses to affected joints and other painful areas. Avoid use of ice or cold compresses.Warmth causes vasodilation and increases circulation to hypoxic areas. Cold causes vasoconstriction and compounds the crisis.
Administer medications as indicated:
  • Narcoticscontinuous infusion around-the-clock morphine (Astramorph, Duramorph), hydromorphone (Dilaudid).
Reduces pain and promotes rest and comfort. Note: Narcotics are the mainstay of pain control during crisis.
  • Nonnarcotic analgesics: acetaminophen (Tylenol).
Acetaminophen (Tylenol) can be used for control of headache, pain, and fever. Aspirin should be avoided because it alters blood pH and can make cells sickle more easily.
Meperidine (Demerol) should not be used because its metabolite, normeperidine, can cause CNS excitation.
Administer and monitor RBC transfusions.Frequency of painful sickle-cell crises may be reduced by routine partial exchange transfusions to maintain the population of normal RBCs.
ADVERTISEMENTS

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

ADVERTISEMENTS

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.
  • This website has really helped me to improve in writing nursing care plans , notes are well outline and explained , easy to understand .

  • >