Question Answered step-by-step Vincent is a 29-year-old-African American married male who has… Vincent is a 29-year-old-African American married male who has sickle cell disease (SCD) / sickle cell anemia (SCA), marked by frequent episodes of severe pain. His anemia has been managed with multiple transfusions. Six months ago he started showing signs of chronic renal failure. His regular medications are: pentoxifylline oxycodone-acetaminophen hydroxyurea folic acid. In the hematology clinic this morning, Vincent’s hemoglobin measured 6.7 g/dL. He received 2 units of packed red blood cells (PRBCs) over 3 hours and then went home. He developed dyspnea and shortness of breath approximately 1 hour later, and his wife called 911. The EMS crew initiated oxygen at 8L per nasal cannula and transported Vincent to the emergency department (ED). What is SCD?Vincent’s hemoglobin measured 6.7 g/dL. Why is anemia common in a patient with SCD?Why is it difficult to crossmatch blood to transfuse Vincent?When Vincent arrives at the ED, the nurse perform a quick assessment and note a grade III systolic murmur, and crackles in Vincent’s lung bases bilaterally. Vital signs (VS) are: 176/102, 94, 28, 97.8?F (36.6?C), and SpO2 of 78%. Peripheral pulses are equal and 4+. Acting according to the standing orders for the nurse facility, the nurse start an IV line, obtain ABGs and draw blood for CBC with differential and basal metabolic panel. The physician asks him whether he is in pain and needs pain medication. Vincent answers no to both questions. Why did the physician ask these two questions?Vincent’s ABGs on 8L via simple face mask show: PaO2 = 74 mmHg, Is Vincent being adequately oxygenated? Why or why not?the nurse assessment finding are consistent with fluid overload. What 5 findings led the nurse to that conclusion? Laboratory Test Values Sodium 137 mmol/L Potassium 4.9 mmol/L Chloride 110 mmol/L CO2 16 mmol/L BUN 27 mg/dL Creatinine 2.7 mg/dL WBC 4300/mm3 Hemoglobin 7.8 g/dL Hematocrit 20.9% Platelets 208,000/mm3 7. Interpret Vincent’s lab results.8. Vincent complains of (c/o) being short of breath. Do the nurse think the low hemoglobin is responsible for his complaints? Defend answer.The physician prescribes: furosemide 40 mg IV push (IVP) now methylprednisolone 75 mg IVP now ceftriaxone 1 g IV piggyback after the furosemide. 9. Indicate the expected outcome for Vincent that is associated with each of the medications he is receiving. Vincent voids 1900 mL within 2 hours of the furosemide administration. As his dyspnea is relieved, he shakes the physician’s hand and thanks him for asking about the presence of pain and the need for pain medication. Vincent states, “One of my biggest fears is that I will come in here in crisis and the doctor won’t treat my jpain aggressively enough. I don’t want to be labeled as a drug-seeker, or as an emergency room abuser.”10. Why would Vincent be concerned about obtaining adequate pain control in the ED? How can the nurse, as the nurse, be an advocate for all sickle cell crisis patients when they present to the ED? Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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