Case Study On The Sickle Cell Crisis

Sickle Cell Crisis

Under hypoxic conditions, the abnormal hemoglobin start to change shape. They become sickled, stiff, and have greater difficulty moving though the blood vessels. As a result they begin to stick together and eventually block the tissues from receiving nutrients and oxygen. This causes the tissue to become infarcted and leads to pain. In a hypoxic states the cells are forced to make energy also known as adenosine triphosphate (ATP) without oxygen. This is called anaerobic glycolysis and results in the production of lactic acid as a byproduct (citation). The presence of lactic acid lowers the pH of the environment, the cells must recycle lactic acid back into the cells, and ATP production is significantly slowed. The cells

Sammy is rating his pain as a 10 out of 10 on a scale where 10 is the highest level of pain and 1 is the lowest. It is evident that some of the choices Sammy made prior to ending up in the emergency room were not beneficial to his health. Sammy has been discarding lunches and drinks as school, is feeling nauseas, having diarrhea, and was playing in 21 degrees Fahrenheit weather without a jacket. Sammy’s diarrhea may be explained by his electrolyte imbalance as a high potassium (K+) level can cause diarrhea. Due to the fact that sickled RBCs are blocking blood flow, oxygen cannot be delivered to the cells. As the cells produce lactic acid, the pH is lowered creating an acidotic environment. With an increase in hydrogen (H+) ions, K+ moves out of the cell into extracellular fluid (ECF) to maintain ionic balance, explaining a K+ level of 6.2 mEq/L (citation). Sammy’s arterial blood gas (ABG) results also play a role in determining Sammy’s condition. With a low pH of 7.28, PCO2 of 32, a PO2 of 64, and a HCO3 21 these results are indicative of metabolic acidosis. Sammy’s increased respiratory rate of 32 breaths per minute is the body’s was of compensating for increased levels of acid. The body increases respirations in order to excrete CO2 at a higher rate and increase the pH level. Unfortunately, the body can only keep this up for so long as this type of buffering system is physically

Dehydration increase the viscosity of the blood, creating an environment where the RBCs will have an increased tendency to stick together. As recommended by Brown (2012), intravenous (IV) fluids should be administered for rehydration with a close watch on electrolytes and kidney function to prevent under or over hydration. As the patient’s condition proves, the nurse should encourage an increased oral intake of fluids (Brown, 2012). Hydrating the patient will reduce the viscosity of the blood and prevent sickled RBCs from clumping and impeding proper circulation. Also, with improved circulation, tissue will receive adequate oxygen and nutrition, reversing tissue injury and reduce pain. Oxygen should also be administered to aide in increasing the amount of oxygen in circulations for individuals with an oxygen saturation below 95% (Reddin, Cerrentano, and Tanabe,