Chamberlain NR 507 Week 3 TD and Quiz

NR 507 Week 3 TD and Quiz PART 1: A 17-year-old African American from the inner city complains of severe chest and abdominal pain. Upon examination the attending physician performs and EKG, chest x-ray, and an abdomi ...

NR 507 Week 3 TD and Quiz PART 1: A 17-year-old African American from the inner city complains of severe chest and abdominal pain. Upon examination the attending physician performs and EKG, chest x-ray, and an abdominal and chest clinical examination and finds nothing. Assuming, she is drug seeking he sends her home. She comes back to the ER four hours later and now you see the patient. She explains that she was running track this past afternoon at school and that despite being very hot (100 F) she pushed on. Afterwards, she starts feeling extensive pain in her chest and abdomen. She has jaundiced eyes, her blood pressure is 98/50, pulse is 112, T = 99.9 F, R = 28. The pain seems out of proportion to the physical findings. What is your list of differential diagnoses in this case and explain how each of these fits with the case patient as described above. Be sure to list at least three (3) pertinent differential diagnoses. Indicate which of these you would select as the most likely diagnosis and explain why. Now, as she is in the ER she begins to exhibit stroke like features. ? Does this change your differential? How do you treat this patient now? Are they any preventative actions that could have been taken? 1. Sickle Cell Crisis. Sickle cell disease (SCD), which is an inherited autosomal recessive disorder, that originates from a genetic mutation in the hemoglobin (Hgb) beta globin gene to the formation of the abnormal erythrocyte Hemoglobin S (HbS), which replaces the normal Hgb (Peres de Olivera, Leão Santos, de Lourdes Silva, Quadros Dias, de Silveria, & de Azevedo Guimarães, 2017). Another name for HbS is sickle hemoglobin; this type of hemoglobin (Hgb) responds to dehydration and lack of oxygen by “hardening” and stretching into long, crescent, sickle cell shaped erythrocytes (McCance, Huether, Brashers, & Rote, 2013). Depending on ones genetic inheritance of SCD, the disease can take 3 forms: Sickle cell anemia, sickle cell-Hb C disease, or sickle cell-thalassemia disease (McCance et al., 2013). Sickle cell trait is where one carries the sickle cell gene but typically does not have any complications of the actual disease. SCD has a tendency to affect certain people who originate from central Africa, parts of India, the Mediterranean, and the Near East (McCance et al., 2013). As of 2013, 1 in 500 African American children and 1 in 36,000 Hispanic American kids are born with sickle cell anemia (McCance et al., 2013). Extensive sickling of cells, also referred to as sickle cell crisis, can cause a number of acute clinical manifestations. Crisis is typically triggered by stress, cold, hypoxemia, and/or decreased plasma osmolality or volume (McCance et al., 2013). When sickling occurs, sickle cells clog vessels, some of which can cause hypoxemia and others that can cause much worse, such as a splenic or hepatic infarct and even an MI or CVA; these are just a few of many serious complications that can occur (Ward, Simpson, & Verhovsek, 2016). Clinical manifestations of crisis include jaundice, fatigue, pallor, and severe pain that may not match physical findings (McCance et al., 2013). Treatment during crisis includes oxygen, hydration via intravenous fluids, analgesics, and as long as blood counts are acceptable, some patients may receive hydroxyurea (McCance et al., 2013). While in the ER, if the patient began exhibiting stroke like symptoms, it would not change my differential. CVA is a possible serious complication of SCD. I would immediately get the patient to CT in order to confirm CVA and distinguish between hemorrhagic or embolism. If the patient were positive for CVA, I would treat according to the type of infarct. Preventative actions so that the patient did not end up back in the ER in sickle cell crisis and possibly positive for a CVA would be education. The previous provider should have never sent the patient home, had he recognized the signs and began treatment then, the patient may not be experiencing her current complications.