Sickle Cell Anemia Case – Cardiovascular System Example

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"Sickle Cell Anemia Case" is a wonderful example of a paper on the cardiovascular system. The patient is a 21 year single male with Sickle Cell Anemia. He is a Jehova's witness and doesn’ t believe in blood transfusions. His mom and dad are separated. They both carry the trait of sickle cell. He has two brothers and two sisters. He’ s a high school graduate of Milford Mill high school. He has an unsteady gait/walk. A nursing care plan was done for him in the previous order. His mental state is like a teen.

He's never had a relationship. He can’ t receive blood transfusion because of his religion. He is constantly in pain. Family Assessment GuideIdentifying Data Location during the interview: Healing Heart City hospital Ward Number 17, Wing A. Bed No. 3 Child (initials, age, diagnosis, grade): NAME:   Mr. XR  Sickle cell Anemia Grade 3 Aged: 21 Dx- Pain, Jaundice,   Walking difficulties Mental   All indicative of Sickle cell Anemia.   Family members (initials, relationship, sex, age, occupation, education): Father                     Mr. R                          Aged 57                  Male                            sales man              First degrees Mother                   Ms. SR                        Aged 43          Female          Teacher                 Diplomas Brother                 Mr.

FR                      Aged19                    Male                            Student          College Brother                  Mr. GR                        Aged 14                  Male                            Student          High schools Sister                          Ms. JR            Aged17                    Female          Student          College Sister                          Ms. CR            Aged 12                  Female            pupil                            Elementary School Household: All the children live with their mother. They live in a five-bedroomed house in a middle-class estate. Extended: Both grandparents are deceased. Uncles and Cousins leave in a different state. Recent additions or loss of members: NAD Ethnicity: Native English speaking Religion: Christian Financial data (sources of income, financial assistance, medical care, expenditures): Income sources Temporary Employment      US$        1,560          per month Parents’ contribution          US$        3,450        per month Expenditure Medical Care        Medical Insurance cover            US$        100,000 Sources of medical and dental care: The insurance covers the contributors being both parents. Source of referral and/or reason for child’ s hospitalization: Referred by a family doctor Need for blood transfusionIndividual Health Needs for every family member (household and extended-three generations) Identified health problems or concerns: Sickle cell anemia Traits in both paternal and maternal    family Medical diagnoses: Sickle cell anemia Recent surgery or hospitalizations: NAD Medications and immunizations: Immunizations: DPT/Measles/Hepatitis B Emotional and cognitive functioning: Dysplastic personality, Not Aggressive Coping strategies used: Psychotherapy Substance abuse: NAD Health screening practices: Laboratory tests, Imaging tests, ECGs Monthly Checkups including Bp, Dental, and Visual Prenatal care (current and/or past):   NAD Family planning used (past or present): NAD III.

Interpersonal Needs Parent-child interactions: Parents separated when young disrupting the development of a child Spousal relationships: NAD Sibling relationships: Two brothers and two sisters with good interaction Concerns about elders: Indifferent Are parents/grandparents caring for other dependent members? None Significant others: NoneFamily NeedsDevelopmental Parents’ report of children’ s development: Children’ s milestones well documented, apart from the patient aged 21, whose mental state is still like a teen.

Are children responsible for other family members? Siblings’ emotional support for each other Developmental tasks that need to be accomplished: Age delayed norms Daily health-promotional practices for nutrition, sleep, leisure, child care, hygiene, socialization: NADLoss or Illness Events or illnesses: Sickle cell anemia and delayed development in 21yr old child Adjustments family has made: Mother and fathers’ separation does not enable any adjustments Roles and tasks being assumed by members: Siblings assume the role of parents Anyone individual bearing most of the responsibility: No information provided Level of anxiety now and usually: frequent anxiousness by both mother and patientResources and Support The general level of resources and economic exchange with the community: NAD External sources of instrumental support (money, home aides, transportation, medicines, etc. ): Medicaid from a local hospital Internal sources of instrumental support (available from family members): Mothers assumes all roles External sources of affective support (emotional and social support, help with problem-solving): Moral and emotional support from extended family and community counselors Internal sources of affective support (who in the family is most helpful to whom? ): Not given Is the family more open or closed to outside?

More open, the community is aware of the patient Is the family willing to use external sources of support? YesEnvironment Type of dwelling: Permanent Building, Townhouse Number of rooms, bedrooms (2), bathrooms(1), stairs(none), refrigeration (fridge in kitchen), cooking: Gas cooker in the kitchen Water and sewage: Public septic tank Sleeping arrangements: Three children share the same room, the youngest child sleeps with mother Types of the job held by members: Mother, elementary school teacher, father, banker Exposure to hazardous conditions at the job: NAD Level of safety in the neighborhood: Proper Level of safety in a household (violence or aggression, smoke detectors, CO detectors, age of the house, the safety of the house, child-proofed): NAD Involvement in the community: Teaching is a service by mother Compliance with rules and laws of society: NAD How are values similar to, or different from those of the immediate social environment?

How are these values taught to children? Cosmopolitan type of environment. Children are taught through schools and churchInternal Dynamics Roles of family members clearly defined? Mother provides day-to-day and food to the children, Father provides financial incomes even though they are separated. Authority and decision-making rest where?

Both parents make independent decisions about the family. Typical patterns of interaction between family members: Moral and emotional support from extended family. Communication, including verbal and nonverbal: Children communicate well. Expression of affection, anger, anxiety, support, etc. : anger between parents, anxiety in children Problem-solving style: Frequent counseling by community counselors and the church Degree of cohesiveness and loyalty to family members: a  family has accepted to live with parents separately. Conflict management: the conflict is mainly between parents who seem not to be interested in reconciliation. Analysis What stage is this family in? What data supports this conclusion?

Separated parents and one child with a mental state coupled with sickle cell. At what level is this family functioning? Dysfunctional family processes related to parents' separation and lack of emotional support of a child by one of the parents. What data supports this conclusion? Five children, sickle cell, and separated parents Identification of family strengths: Parents provide for contributed incomes and insurance in support of family What needs are identified by the family? Immediate religious counseling to allow for blood transfusion services to save the patient. What needs are identified by the nurse?

Development delayed risk for one or more social and self-regulatory behavior inpatient. Family nursing diagnoses (NANDA format): Dysfunctional family with immediate religious intervention  

References

Hummel J., Evans PC & Lee, H. (2010). Medication Reconciliation in the Emergency Department: Opportunities for Workflow Redesign. Quality & Safety in Health Care; 16, 531-535.
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