LABORATORYRESULTS

Includethosepertinenttonursingandmedicaldiagnoses.Includenormalvaluesandpatientresults.Includereason(s)forabnormalfindingsandnursinginterventionsfor
labpreparationandlabresultfollowup.
NAMEOFSTUDY

WBC

ReticulocyteCount

Hemoglobin

NORMAL
PARAMETERS

4.810.9K/uL

0.51.5%

12.015.5g/dL

PATIENTS
RESULTS

21.1K/uL

12.7%

8.6g/dL

RATIONALEFORRESULTS

NURSINGINTERVENTIONSFORTEST
PREPARATIONANDTESTFOLLOWUP

Leukocytesnormallyincreasewhen
infectionispresent.HighWBCcountmay
alsoindicateinflammation,tissuedamage,
stress,malnutrition,burnslupus,thyroid
glandproblems.

Observeandreportsignsofinfectionsuchas
redness,warmth,discharge,andincreasedbody
temperature.

Whenanemiaispresent(i.e.,lowRBCs,
lowHb,lowHct)andthebonemarrowis
respondingappropriatelytothedemandfor
increasednumbersofRBCs,thenthebone
marrowwillproducemoreandallowforthe
earlyreleaseofmoreimmatureRBCs,
increasingthenumberofreticulocytesin
theblood.

Monitorrespiratoryrateanddepth,useof
accessorymuscles,andareasofcyanosis.
Auscultatebreathsounds,notingpresenceor
absence,andadventitioussounds.Monitorvital
signs;notechangesincardiacrhythm.Investigate
reportsofchestpainandincreasingfatigue.
Observeforsignsofincreasedfever,cough,and
adventitiousbreathsounds.AssessLOCand
mentationregularly.

Alowhemoglobinlevelisreferredtoas
anemiaorlowredbloodcount.Lowerthan
normalnumberofredbloodcellsisreferred
toasanemiaandhemoglobinlevelreflects
thisnumber.

Monitorrespiratoryrateanddepth,useof
accessorymuscles,andareasofcyanosis.
Auscultatebreathsounds,notingpresenceor
absence,andadventitioussounds.Monitorvital
signs;notechangesincardiacrhythm.Investigate
reportsofchestpainandincreasingfatigue.
Observeforsignsofincreasedfever,cough,and
adventitiousbreathsounds.AssessLOCand
mentationregularly.

Medication
Trade/Generic
Names

Dosage
&
Frequency

Methodof
administrat
ion

Indication
Whyisthepatient
takingthemedication

Sideeffects
MostCommonfor
eachdrug

Indication:Moderateto
severepain(aloneandin
combinationwith
nonopioidanalgesics);
PATHOPHYSIOLOGY
extendedreleaseproduct
foropioidtolerant
Describe in as much detail as possible, thepatientsrequiringaround
pathophysiology, with reference, underlying the
CNS:confusion,
IV
patients medical diagnoses and relate it to nursing
needs (i.e. list five nursing interventions for
theclockmanagementof
sedationdepression.
2mgIV
Hydromorphone
diagnosis).
persistentpain.
CV:hypotensionGI:
(Dilaudid)
q4hPRN
Antitussive(lowerdoses).
constipation

PatientsIndication:
ManagementofPain

Contraindications
&
Nursingresponsibilities
Contraindicatedin:Hypersensitivity;Some
productscontainbisulfitesandshouldbe
avoidedinpatientswithknown
hypersensitivity;Severerespiratory
depression(inabsenceofresuscitative
equipment);Paralyticileus(extendedrelease
only);PriorGIsurgeryornarrowingofGI
PRIORITIZED LIST OF NURSING
tract(extendedreleaseonly);Opioidnon
DIAGNOSES
tolerantpatients(extendedreleaseonly);

LIST IN ORDER OF PRIORITY

(MINIMUM OF 3 NURSING DIAGNOSIS)

NursingImplications:AssessBP,
pulse,andrespirationsbeforeand
periodicallyduringadministration.If
respiratoryrateis<10/min,assess
levelofsedation.Dosemayneedto
bedecreasedby2550%.Initial
drowsinesswilldiminishwith
continueduse.

Sickle cell disease (SCD) is a group of disorders characterized by

the presence of an abnormal form of hemoglobinhemoglobin S (Hb S)
within the erythrocytes. Hb S is formed by a genetic mutation in
which one amino acid (valine) replaces another (glutamic acid). Hb S,
the so-called sickle hemoglobin, reacts to deoxygenation and
dehydration by solidifying and stretching the erythrocyte into an
elongated sickle shape. This change has a variety of pathologic
consequences, including hemolytic anemia. Formation of abnormal
hemoglobin chains containing hemoglobin S: When red blood cells
(RBCs) are exposed to low oxygen saturation states, hemoglobin S
causes the beta cells to contract and clump together inside the cell,
thus distorting its shape.

(Pathophysiology, McCance, page 1071)

1. Acute chronic pain r/t

Intravascular sickling with
localized stasis, occlusion,
infarction, and necrosisActivation
of pain fibers due to deprivation
of oxygen and nutrients,
accumulation of noxious
metabolites
2.
3. Knowledge deficit about condition,
prognosis, and treatment needs
r/t less exposure of information
4. Fear r/t threat to change in health
status.

MMDSON
PLAN OF CARE
DATE: 02-09-15
STUDENT NAME: Vanessa Sanchez

PATIENTS INITIALS: J.A

AGE/SEX: 28/F

MEDICAL DIAGNOSIS: Sickle Cell Disease

PATTERN
MANIFESTATION

NURSING
DIAGNOSIS

N/A

Risk for social

isolation: altered
state of wellness

MUTUAL
GOALS
Client will identify a
stable support system
and supportive
individual(s) and use
resources for
assistance, as
appropriate before
discharge.

NURSING
INTERVENTION

SCIENTIFIC RATIONALES
REFERENCES

EVALUATION
(MODIFICATION)

Determine clients
response to condition,
feelings about self,
concerns or fears
about response of
others, sense of ability
to control situation,
and sense of hope.

How the individual accepts and deals

with the situation will help decide the
plan of care and interventions.
(Nursing Care Plans, Murr pg. 706)

Yes, patient verbalized a stable

support system before being
discharged.

Assess coping
mechanisms and
previous methods of
dealing with life
problems.

Clients with this illness, which

carries, face major problems with
possible loss of employment,
medical insurance, housing, and
care sources if they become unable
to independently care for
themselves.
(Nursing Care Plans, Murr pg. 706)

Discuss concerns
regarding employment
and leisure
involvement. Note
potential problems
involving finances,
insurance, and
housing.

May reveal successful techniques

that can be used in current situation.
(Nursing Care Plans, Murr pg. 706)

MMDSON
PLAN OF CARE
DATE: 02-09-15
STUDENT NAME: Vanessa Sanchez
MEDICAL DIAGNOSIS: Sickle Cell Disease

PATIENTS: J.A
AGE/SEX: 28/F

PATTERN
MANIFESTATION

NURSING
DIAGNOSIS

Subjective:
Rated Pain: 9/10
Patient states
having severe
pain over entire
body

Acute chronic pain

r/t Activation of pain
fibers due to
deprivation of
oxygen and
nutrients,
accumulation of
noxious metabolites
evidenced by
generalized pain
described as severe
and incapacitating

Objective:

Facial grimacing
upon entering
the room
Blood Pressure:
144/88
Pulse: 96
Respirations: 18
Temperature:
98.7 F
O2 SAT: 100%
on room air

MUTUAL
GOALS
1.

NURSING
INTERVENTION

SCIENTIFIC RATIONALES
REFERENCES

EVALUATION
(MODIFICATION)

1.

1.

Vasoocclusive pain is the most

common manifestation of sickle
cell crises, where sickling
potentiates cellular hypox- ia,
resulting in severe pain.
Typically, pain occurs deep in
the bones and muscles of back,
ribs, and limbs and lasts5 to 7
days. (Nursing Care Plans, Murr
pg. 509)

Yes, patient met the goal of pain

relief as evidenced by relaxed body
posture and verbalization of pain rate
of 2/10.

2.

Nonverbal cues may aid in

evaluation of pain and effectiveness of therapy. Pain is unique
to each client; therefore, one
may encounter varying
descriptions because of
individualized perceptions.
(Nursing Care Plans, Murr pg.
509).

3.

Cognitive-behavioral
interventions may reduce
reliance on pharmacological
therapy and enhance clients
sense of control. (Nursing Care
Plans, Murr pg. 509)

Client will
demonstrate
relaxed body
posture, freedom
of movement, and
ability to sleep
and rest
appropriately by
end of shift
2.

3.

Assess reports of
pain, including
location, duration,
and intensity
(scale of 0 to 10).
Have client help
differentiate
current pain from
typical or usual
pain problems.
Observe
nonverbal pain
cues, such as gait
disturbances,
body positioning,
reluctance to
move, facial
expressions; and
physiological
manifestations of
acute pain
elevated BP,
tachycardia, and
increased
respiratory rate.
Explore
discrepancies
between verbal
and nonverbal
cues.
Explore
alternative pain
relief measures,
such as
relaxation
techniques,

biofeedback,
yoga, meditation,
and distraction
visual, auditory,
tactile,
kinesthetic,
guided imagery,
and breathing
techniques.

Date

Progress Notes

02-09-15

28-year-old female was admitted on the 30th of January for chronic sickle cell exacerbations, complaining of generalized
body pain with worsening symptoms to her right lower extremity. She is on a regular diet and on Dilaudid 2 mg IV q4h. She
has a past medical history of significant sickle cell disease. She is alert and oriented x3, with mild distress. Neuro: Oriented
to place, person, and situation. PEERL at 4mm. Follows commands with handgrips and foot pushes. Pulm: Bilateral air entry
is fair. No rhonchi. Neck: Supple, No JVD. Heart: S1 and S2 are regular. No murmurs. Amdomen: Soft and nontender. Bowel
sounds present. Extremities: No cyanosis, clubbing or edema noted. Integumentary: Skin edges well approximated. V/S: 97.8
F (Temporal), Apical Pulse: 96 beats per minute, 18 RR, O2 SAT: 100%. Patient care is focused on Pain management. Review
of lab results will also be repeated.