There are several different diagnosis we can consider when a patient comes in with these symptoms.

Oct 9, 2022

Learning Goal: I’m working on a nursing discussion question and need an explanation and answer to help me learn.
Please reply to discussion below using APA 7th edition, 3 references dated less that 4 years, and 1 interactive question.
“Sickle cell disease (SCD) is an autosomal-recessive genetic disorder that affects approximately 100,000 people in the United States and millions worldwide” (Sundd, P. et al. 2020) This disease is primarily in people of African American decent. “SCD occurs among about 1 out of every 365 Black or African-American births.” (CDC, 2022) It can also occur in Hispano-Americans as well but is not as common.
Pathophysiology
“In sickle cell disease, a single amino acid substitution in the β-globin chain leads to polymerization of mutant hemoglobin S, impairing erythrocyte rheology and survival.” (Sundd, P. et al. 2019) Because of this, some of the red blood cells look like a sickle, hence “sickle cell”. Because of their shape, they often get stuck and can slow or stop blood flow to the rest of the body. “For a child to be affected, both mother and father must carry one copy of the sickle cell gene — also known as sickle cell trait — and pass both copies of the altered form to the child.” (Mayo Clinic, 2022)
Epidemiology
“Sickle cell anemia is the most common monogenic disorder.” (Sedrak, A. et al. 2021) There are a couple genotypes of sickle cell and the most common in the US is Homozygous Hemoglobin SS or HbSS. “People who have this form of SCD inherit two genes, one from each parent, that code for hemoglobin “S.”(CDC, 2022)
Physical Findings
Many times, these patients will present asymptomatic. They can also present with a slew of symptoms ranging from diffuse pain to shortness of breath. During the first 6 months of life, patients who have sickle cell are completely asymptomatic. Because of the different “crisis” you can be in with sickle cell, the clinical presentation is vast. The most common presentation would be a patient in a vaso-occlusive crisis. “Patients complain of severe debilitating pain in any part of the body but typically in the long bones, back, pelvis, chest and the abdomen. Symptoms may start as early as six months of age with pain and swelling in both hands and feet (dactylitis).” (Sedrak, A. et al. 2021)
Differential Diagnosis
There are several different diagnosis we can consider when a patient comes in with these symptoms. First, we can consider acute anemia. In acute anemia, a patient can complain of shortness of breath as well as fatigue. They may be pale or complain of weird cravings. Some others would be, rheumatoid arthritis, leukemia or even a pulmonary embolism. All of these have similar symptoms.
Plan
The management and treatment of this disease is based on the crisis that presents. If a patient presents with the most common crisis, vaso-occlusive, our first job is to immediately assess pain, treat the pain and get it under control and hydrate. Unfortunately, these crisis’ can happen more than one time and so a patient can become used to the pain medications and need a change occasionally. It would also be important to use a pain scale that is specific to the patient so that you get an accurate description of their pain.
Centers for Disease Control and Prevention. (2022, May 2). Data & statistics on Sickle Cell Disease. Centers for Disease Control and Prevention. Retrieved September 19, 2022, from https://www.cdc.gov/ncbddd/sicklecell/data.html
Mayo Foundation for Medical Education and Research. (2022, March 9). Sickle cell anemia. Mayo Clinic. Retrieved September 19, 2022, from https://www.mayoclinic.org/diseases-conditions/sic…
Sedrak A, Kondamudi NP. Sickle Cell Disease. [Updated 2021 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482384/
Sundd, P., Gladwin, M. T., & Novelli, E. M. (2019). Pathophysiology of Sickle Cell Disease. Annual review of pathology, 14, 263–292. https://doi.org/10.1146/annurev-pathmechdis-012418…

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