CARING FOR SICKLE CELL PATIENTS E-LEARNING

This e-learning resource has been designed  to improve and promote better care from nurses looking after adults with sickle cell disease. The aim is to deliver information to enable nurses best manage painful episodes of sickle attacks present to hospital. 

LEARNING OBJECTIVES:

1. What is Sickle Cell Disease

What is Sickle Cell Disease

Sickle cell disease is the most common genetic passed down blood disease in the UK.  The abnormality in the oxygen carrying protein haemoglobin structure located in the red blood cells, causing acute painful episodes known as sickle cell crisis or vaso-occlusive crisis. This is due to a blockage in the blood vessels. This is a long-term condition that impact on morbidity and mortality.

(World Health Organisation, 2011) 

This condition occurs when a person inherits two abnormal copies of the haemoglobin gene, from parents who already carries the abnormal gene. A crisis can be triggered by temperature changes, environmental factor, stress or dehydration. To diagnosis this condition a blood test would need to be done. The Sickle cell and thalassaemia-screening programme is a programme that helps to diagnose more cases and identify families at high risk of this condition

(Public Health England, 2013). 

Sickle cell is a hereditary blood disorder passed down from each parent?

  • true
  • false

2. Who is affected

Who is affected

In the UK appoximately 12,500 to 15,000, people are affected predominately from the African and Caribbean backgrounds (National Institute for Health and Care Excellence, (NICE) 2012). The prevalence of this condition is increasing due to new births and immigrants to the UK. This is why more education for nurses are needed in order to best care for patients with the condition.

(Trueland, 2014)

3. Managing painful episodes of sickle cell crisis

Whats important!!

The aim in the management of an acute painful sickle cell episode in hospital is to quickly and safely achieve effective pain control to stabilise the patients painful symptoms.

The common source of complaints from patients are unacceptable delays in receiving analgesia, insufficient or excessive doses of medication and stigmatising the patient as drug seeking. These barriers effect the patient recovery, increasing their stay in hospital. it is important to be aware of the common barriers in order to change behaviour or practice.

Sickle cell crisis should be treated as an acute medical emergency following local protocol for managing the condition.

(Gillis et al, 2012)

Day to Day care

Individualised assessment

  •  listen to the patient they are the experts regarding their condition.
  •  assess pain using appropriate pain scoring tool.-
  • check vital signs.

Primary analgesia

  • follow patients protocol
  • ask patient about pervious analgesia taken already during this episode
  • use WHO analgesic ladder-(work your way down)
  • Follow the guidelines of medicine management

Reassessment and ongoing management 

  • assess every 30 minutes until acceptable pain control has been achieved then every 4 hours thereafter.

  • communicate with patient (asks question)

  • consider bolus if needed 

  • regular fluids must be prescribed

  • consider side effects of opioids (i.e. constipation, sickness)

  • encourage the use of non-pharmological intervention 

Possible complications

  • respiratory depression
  • chest pain
  • fever
  • signs of hypoxia

Discharge information

  • give patient information to continue managing the crisis
  • how to get more medication 
  • information about additional support

 (NICE, 2012)

 

4. QUIZ

What have we learnt so far

1. Is sickle cell a life long condition?

  • maybe
  • yes
  • no

2. What is the estimated prevalence of sickle cell disease in the UK?

  • 12,000 to 15,500
  • 13,500 to 15,000
  • 12,500 to 15,500
  • 12,500 to 15,000

3. Assess a patient pain using the numeric scale?

  • true
  • false

4. What happens to the blood vessels when a patient is having a crisis?

  • the lumen is enlarged
  • become narrow
  • become blocked
  • stays the same

5. What are the possible complications?(multiple choice)

  • excessive sweating
  • chest pains
  • reduced respiratory rate
  • flushed complexion
  • low oxygen saturation

6. What can trigger a sickle cell crisis? (Multiple choice)

  • stress
  • everything the patient does
  • temperature change

7. The main aim during a crisis is to hydrate the patient

  • true
  • false

8. insufficient dose of medication is one of the barrier patients complain about. which of these is another?

  • excessive dose
  • wrong medication

5. Resource

HERE ARE RESOURCES YOU CAN GAIN MORE INFROMATION

SICKLE CELL SOCIETY-http://sicklecellsociety.org

NICE GUIDELINES -https://www.nice.org.uk/guidance/cg143

WHO- http://www.who.int/mediacentre/factsheets/fs308/en/

GOV.UK-https://www.gov.uk/search?q=SICKLe+cell+and+thalassaemia+adults