Nursing Diagnosis for Sickle Cell Anemia Care Plan

Day 1 

What four nursing diagnosis would you choose for the care plan? 

In the case of Mr. Smith, impaired gas exchange, acute pain, ineffective tissue perfusion and Deficient Fluid Volume will be used to diagnose him. 

Impaired gas exchange 

Impaired gas exchange will be used when there is a surplus or a deficit in oxygenation or carbon elimination at the alveolar-capillary membrane. 

Goal and time frame 

When conducting this nursing care plan to Mr. Smith, affliction in the respiratory should be avoided in the lungs and the active, alert and awake state of the patient need to be created. This will take between 2 to 4 hours. 

Interventions 

Measuring and noting standard depth rate and respiratory pattern of patients at specific time intervals 

Controlling oxygen quantity and concentration in COPD patients 

Encouraging deep breathing in patients using the incentive spirometer. 

Diagnostic tests 

The three diagnostic tests that should be done on Mr. Smith include 

Monitoring respiratory rate or depth to determine the adequacy of respiratory function 

Monitoring vital signs and noting changes in the cardiac rhythm which may reflect the effects of hypoxia on the cardiovascular system. 

Monitoring arterial blood gases to determine any sign of respiratory failure. 

The priority assessment of impaired gas exchange is assessing the level of consciousness. This will be done after every 30 minutes. Mr. Smith will show respiratory failure if the care plan does not its goal. 

Acute pain 

Acute pain is another nursing diagnosis that will be carried on Mr. Smith. Acute pain is the unpleasant sensory as well as an emotional experience that arises from actual tissue damage. The goal of acute pain is to display improved well-being such as BP, respirations and baseline levels for a pulse. This will be done on an hourly basis. 

Interventions 

Foreseeing the need for pain relief 

Acknowledging reports of pain 

Getting rid of additional stressors. 

Diagnostic tests 

The diagnostic tests of acute pain include 

Evaluating patient’s response to pain and management strategies 

Observing nonverbal pain cues 

Monitoring ischemic areas, bumps, and cuts. 

The priority assessments of acute pain include assessing pain, patient’s anticipation for pain relief and assessing patient’s willingness to explore a range of techniques. This will be conducted for 12 hours. 

Ineffective tissue perfusion 

Ineffective tissue perfusion is another nursing diagnosis that should be done on Mr. Smith. Ineffective tissue perfusion occurs as a result of a decrease in oxygen resulting in the failure to nourish the tissues at the capillary level. The goal of ineffective tissue perfusion is to maintain or increase the skin temperature, cognitive status and further decrease peripheral edema. The diagnosis plan will be done between 2 and 4 hours. 

Interventions 

The nursing interventions of ineffective tissue perfusion include 

Assessing pulse points of rate, volume and rhythm 

Monitoring level of consciousness 

Maintaining adequate fluid intake and monitoring urine output. 

Diagnostic tests 

The diagnostic tests include 

Monitoring intake and urine output to reduce renal perfusion 

Checking respirations and absence of work of breathing to determine respiratory distress 

Monitoring high functions to determine the degree of cerebral circulations. 

The priority assessments that will be carried out include assessing for signs of decreased tissue perfusion after every hour. The secondary problem that can occur as a result ineffective tissue perfusion is failure to nourish tissues at capillary level. 

Deficient fluid volume 

Mr.Smith will be subjected to a deficient fluid volume nursing care plan. Deficient fluid volume is a condition where the fluid output surpasses the fluid intake. This condition happens when water and electrolytes are lost as they exist in normal body fluids. The goal of deficient fluid volume is to monitor if water and electrolytes exist in normal fluid after every 30 minutes (Carpenito-Moyet, 2016). 

Interventions 

The nursing interventions of deficient fluid volume include 

Maintaining accurate I & O and weigh daily 

Noting urine characteristics and specific gravity 

Monitoring signs during blood transfusions and note the presence of crackles, wheezes, and jugular vein distention. 

Diagnostic tests 

The diagnostic tests include 

Monitoring BP for orthostatic changes 

Monitoring and documenting temperature 

Monitoring fluid status in relation to dietary intake. 

The priority assessment of deficient fluid volume is assessing skin turgor and oral mucous membranes for dehydration signs after every 10 to 15 minutes. 

Day 2 

Impaired skin integrity is another nursing diagnosis that alters the epidermis or dermis. The goal of impaired skin integrity is encouraging ambulation which decreases pressure on the skin from immobility (Ackley & Ladwig, 2019). The nursing interventions of impaired skin integrity include inspecting skin and pressure points regularly, protecting bony prominences and keeping the skin surfaces dry and clean. The other nursing diagnosis that will be applied for the care plan is deficient knowledge. Deficient knowledge is the absence of cognitive information that is related to a particular topic. The goal of this intervention is to verbalize the understanding of the disease process. The intervention of this condition is reviewing disease process and treatment needs, encouraging ROM exercise and reviewing the current diet of the patient. 

The disciplines that will be consulted include psychology for studying the mind and behavior of the patient, food, and nutrition for diet maintenance and immunology to prevent other diseases. The food and nutrition discipline will ask if Mr. Smith maintains a balanced diet. The most important things to be considered in Mr. Smith's discharge plan are his treatment, home care, and follow-up care. The patient will be communicated and informed of the known, suspected and preliminary diagnosis. As the nurse manager, it is important to demonstrate high ethical standards when dealing with patients of this kind. The main concern about this disease is that it is a generic disease that mutates each time. It is important for patients with this disease to drink plenty of water, take folic acid supplements and exercise regularly. I will talk to Mr. Smith about this disease so that he can be aware of his conditions. I will plan for unfamiliar cases such as Mr. Smith cases by evolving strategic planning in the emergency department. 

References 

Ackley, B. J., & Ladwig, G. B. (2019).  Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care . Elsevier Health Sciences. 

Carpenito-Moyet, L. J. (Ed.). (2016). Nursing diagnosis: Application to clinical practice. Lippincott Williams & Wilkins.