prevention, coordination of specialty services, and pain management (Burns et al., 2016). Childhood immunizations should be done on time including the flu vaccine, growth should be closely monitored, a cbc and reticulocyte count should be done every few months, prophylaxis penicillin should be given between 2 months and 5 years to prevent a bacterial infection, annual stroke prevention and screening should be done with transcranial Doppler ultrasounds, and patient and family education is most important to prevent episodes of hypoxia and dehydration which could lead to a sickle cell crisis (Burns et al., 2016). Education should include: the need toseek medical care for fevers, chest pain, productive cough, shortness of breath, weakness, dizziness, abdominal pain with nausea and vomiting, symptoms of a urinary tract infection, and severe headaches (National Heart, Lung and Blood Institute, 2014). Additional education should be provided on how to manage pain and hydration. Pain control should first be attempted with nonsteroidal anti-inflammatories and acetaminophen, in conjunction with physical therapy and alternative interventions such as rest, heat therapy, relaxation and distraction (National Heart, Lung and Blood Institute, 2014). Pain uncontrolled by these interventions warrants medical attention for the possible initiation of short term narcotic therapy and intravenous hydration or blood replenishment. Patients and families should be taught to always maintain adequate hydration and to avoid dehydration by drinking water before, during and after physical activity (National Heart, Lung and Blood Institute, 2014). Education is also needed on lifestyle management to avoid a sickle cell crisis by minimizing stress, exhaustion, dehydration, and temperature extremes, and using the techniques of moderation and slow progression when attempting any physically demanding activities (National Heart, Lung and Blood Institute, 2014).What physical exam findings and diagnostic results would be concerning to you and why? What would be three differentials in this case?Physical exam and diagnostic results that are concerning to me are the swelling and warmth of the left hand and right foot known as dactylitis, the scleral icterus, the splenomegaly, the antalgic gait, systolic murmur and the abdominal pain and distension. These findings are concerning to me because put together, they paint the picture of a patient in sickle cell crisis. The
dactylitis occurs when microinfarcts occur in the phalanges and metetarsals causing painful swelling of the extremities (Ravikanth, Abraham & Alapati, 2017). When dactylitis occurs in the lower extremities, an antalgic gait can can be observed as the patient attempts to avoid the pain involved with weight-bearing. The scleral icterus indicates that liver dysfunction is occurring. The spleenomegaly occurs due to sickle cell pooling in the spleen causing a fluid overload which
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- Summer '17
- Sickle-cell disease, National Heart, Blood Institute