NURS 6521 week 9.docx - NURS 6521 Advanced Pharmacology...

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NURS 6521 – Advanced Pharmacology Week 9 Sickle Cell Anemia It is one of the most common recessive disorders normally seen in people with African backgrounds (Berghs, Dyson, & Atkin, 2017). It is known for the existence of the abnormal beta-globin gene, where HbSS being the most common and severe genotype. Less commonly known genotypes include HbSC and HbS beta thalassemia (Lim, Welkom, Cohen, & Osunkwo (2012). Red blood cells become rigid with a sickle-shaped, in return, it obstructs blood flow creating a vaso-occlusive crisis -pain, jaundice, swelling of hands and feet, fatigue, acute chest syndrome, infection, delayed puberty, and short stature (Lim et al., 2017). Sickle cell trait, on the other hand, is where the person only carries one defective gene, but not the actual disease and can pass on the gene to their offspring (ASH, 2017). Currently, in the United States, it is required that all newborns are screened for SCD (NIH, 2017). Ethnicity and Sickle Cell Anemia According to the Centers for Disease Control and Prevention (CDC) (2016), SCD occurs in one out of every 365 Black or African American births, and one in thirteen African-American babies are born with the sickle cell trait. On the other hand, only 1 out of every 16,300 Hispanics has SCD and it mainly affects people of West African, African-Caribbean, Indian, Arabic, and Mediterranean descent (Berghs, Dyson, & Atkin (2017). Sickle Cell Anemia treatment The only cure for SCD is bone marrow or stem cell transplant (CDC, 2017). Since Sickle Cell Disease does not have a cure, prevention of complications is the number one key. Prevention strategies include getting vaccinated against the flu, pneumonia, and hepatitis B; as well as proper hydration and symptom management (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Medications: - Folic Acid: 1mg/daily for accelerated erythropoiesis - Hydroxyurea: reduces the number of acute chest syndrome. Dosage depends age and on co-morbidities such as chronic kidney disease. Adult dosage is 15mg/kg/day, infant and kids doses begin at 20mg/kg/day. A complete blood count with differential needs to be
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done every 4 weeks to monitor effectiveness. Doses of hydroxyurea cannot be missed since effects are seen within 3-6 months of treatment initiation. - Pain management: Analgesics: acetaminophen (max dose of 4g on healthy patients and 3g on liver disease or pregnant patients), NSAID’s Opiates: morphine and hydromorphone, 0.5 – 4 mg, IV or PO, every 3-8 hours (Arcangelo, et al., 2017) Reduction of negative side effects
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