Sickle Cell Disease: Complications and Nursing Interventions

Our cover photo this month features three-year-old twins Ava and Olivia. Both have sickle cell disease. In this tender shot, one twin is comforting her sister during treatment at Akron Children’s Hospital in Akron, Ohio.

How much do you know about sickle cell disease (SCD)?

Did you know:

  • that children with SCD can experience “silent strokes” that become clinically evident only as progressive neurocognitive deficits?
  • that renal complications account for 16%-18% of overall mortality?
  • or that SCD-induced priapism in boys and men is not only excruciatingly embarrassing and often painful but may require emergency treatment?

Recognizing common complications.

“Two of the greatest challenges faced by clinicians caring for patients with SCD are the lack of evidence-based guidelines…and the underuse of the few recognized disease-modifying therapies.”

In “Understanding the Complications of Sickle Cell Disease,” a CE feature in this month’s AJN, Paula Tanabe and colleagues provide us with readable and practical information about the complications of SCD.

If, like me, you are not an expert in SCD, this article is an excellent primer on how to recognize the most common complications of the disease, what treatments that are available, and […]

2019-06-03T08:22:06-04:00June 3rd, 2019|family caregiving, Nursing, patient experience|0 Comments
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When Children Hurt

As an ER nurse, I saw a lot of people in pain, either arriving at our door to have their pain relieved or enduring the pain of needed treatments, knowing that the interventions were necessary. In my experience, though, there’s nothing worse than seeing a child in pain, and the younger the child, the more awful it was.

You began the encounter with a sick or injured child who was already frightened by the circumstances that had caused their parents or guardians to bring them to the hospital. It’s hard to get past the frightened eyes and tears, the little ones trying to burrow into their mother’s shoulder and not wanting to be put down on a paper-covered table. And this was before even attempting any assessment.

Nurse uses Wong–Baker FACES Pain Rating Scale to help assess patient’s pain. Photo by Gerry Melendez/The State/MCT via Getty Images.

Factors to consider in assessing a child’s pain.

We were taught that “pain is what the patient says it is,” and that still seems to be true of children’s reports of pain. But there are many factors that need to be considered, such as […]

2019-05-23T10:18:37-04:00May 23rd, 2019|Nursing, patient experience, Patients|0 Comments
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Daughter or Nurse? Caught Between Roles When a Father Is Hospitalized

“Word moves quickly that a patient on the unit has a daughter who is an RN.”

That’s from this month’s Reflections essay, “The Other Side,” in which a nurse struggles with her own mounting helplessness as her father’s hospital stay following surgery is unexpectedly prolonged.

On the other side.

The author finds herself in an uncomfortable in-between position, one that may be familiar to other nurses who have had family members in the hospital.

“I am an outsider, a family member on the other side. I know there is information not shared with me, information the health care team keeps to themselves. These conversations take place in whispered voices outside the room—conversations I have been a part of in the recent past, on my unit.”

[…]

2019-05-02T10:59:38-04:00May 1st, 2019|family experience, narratives, Nursing, nursing perspective, writing|0 Comments
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The ECRI Top 10 Patient Safety Concerns of 2019

A list grounded in data and expert opinion.

Atlantic Training/Wikimedia Commons

Each year, ECRI Institute creates a list of top 10 patient safety concerns in order “to support organizations in their efforts to proactively identify and respond to threats to patient safety.”

The list isn’t generated out of thin air. The ECRI Institute relies both on data regarding events and concerns and on expert judgment. Since 2009, ECRI and partner patient safety organizations “have received more than 2.8 million event reports.”

2019 Top 10 Patient Safety Concerns

  1. Diagnostic Stewardship and Test Result Management Using EHRs
  2. Antimicrobial Stewardship in Physician Practices and Aging Services
  3. Burnout and Its Impact on Patient Safety
  4. Patient Safety Concerns Involving Mobile Health
  5. Reducing Discomfort with Behavioral Health
  6. Detecting Changes in a Patient’s Condition
  7. Developing and Maintaining Skills
  8. Early Recognition of Sepsis across the Continuum
  9. Infections from Peripherally Inserted IV Lines
  10. Standardizing Safety Efforts across Large Health System

[…]

2019-04-15T08:16:15-04:00April 15th, 2019|digital health, Nursing, patient safety, Patients|0 Comments
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Are Your PCA Pumps Accurate, and Working?

Device malfunction happens.

After orthopedic surgery several years ago, I awoke in the PACU to find nurses working frantically on one side of my stretcher. Simultaneously, I realized that my leg hurt. A lot. And with another moment’s awareness—awake enough now for my nurse’s brain to begin to kick in—I understood that all of the activity concerned my PCA pump.

neeta lind/flickr creative commons

One of the nurses noticed that I was stirring. “Your pump has malfunctioned. We can’t get the replacement to work. A third pump is on the way. I’m so sorry!”

The scramble for a replacement, and then another, probably lasted less than five minutes, but it was a pretty wild ride. My deep breathing in an attempt to control the pain gave me something to focus on, but it was a pretty weak effort up against bone pain in the immediate post-op period. I’m grateful that my nurses—there were at least three involved at that point—regarded the pump failure as an emergency.

But operator errors are more common.

Needless to say, then, I was particularly interested in a new study that appears in this month’s AJN. In “Errors in Postoperative Administration of Intravenous Patient-Controlled Analgesia: A Retrospective Study,” Yoonyoung Lee and colleagues […]

2019-04-10T09:29:43-04:00April 10th, 2019|Nursing, nursing research, patient experience, Patients|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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