Question 1
An RMI of the patient’s legs should be done. Moreover, although not directly related to the symptoms described, the patient should also be assessed for the following sickle cell disease-related risks (CDC, 2020):
Risk of stroke, which involves measuring the flow of blood in the brain using Doppler ultrasonography;
Delegate your assignment to our experts and they will do the rest.
Pulmonary hypertension, which is done using an ultrasound technology-based machine called echocardiogram that checks both blood-flow and heart rhythm; and,
Iron overload using MRI, in case the patient may be undergoing chronic transfusion therapy.
Question 2
Generally, there are four types of pain: musculoskeletal pain, visceral pain, neuropathic pain at the lesion level, and neuropathic pain below the lesion level. Musculoskeletal pain arises from overuse or damage in such structures as muscles, ligaments, facet joints, bones, and intervertebral discs (Ashburn et al., 2012). Visceral pain is one that results from the activation of pain receptors of body organs, and are identifiable by location and pain features (Ashburn et al., 2012). Neuropathic pain is the type that results from sensory disturbance, can be located in the body, and is identifiable by such features as stabbing, electric, sharp, shooting, or burning (Ashburn et al., 2012). It is divided into neuropathic at level pain, where the pain is experienced at the region of sensory disturbance; and neuropathic below level pain, which occurs at three segments below the level of injury (Ashburn et al., 2012).
Question 3
The patient is experiencing a musculoskeletal type of pain. In the case report, the patient describes experiencing “deep muscle pain” in his legs. Considering the patient’s rating of the pain as eight out of ten, it may also be considered a sharp pain.
Question 4
One way of assessing pain is to ask the patient. Another way is to observe how the patient’s behavior. However, the two ways have limitations in that such emotional effects of pain as depression, anxiety, and fear influence how an individual copes with pain and hence his/her experience of pain (Gregory, 2019), but they can be used as starting points. SOCRATES is a pain assessment tool that can be used to overcome the foregoing limitations.
SOCRATES provides a structured and systematic physical pain assessment approach without considering the emotional effects of pain (Gregory, 2019). It is mnemonic for whose elements are summarized as follows in Table 1 below (Gregory, 2019):
| S ite | Where in the body is the pain located? |
| O nset | When did the pain start and was it gradual or sudden? |
| C haracter | What would your description of the pain be, for instance in terms of sharpness or dullness |
| R adiation or referred pain | Is the pain in the same place or does it spread to any other area of the body |
| A ssociation Symptoms | Are there any symptoms or signs that you would associate with the pain, for example sweating or nausea? |
| T iming | Does the level of pain vary with the time of the day, and if yes, when does it increase/decrease? |
| E xacerbating or relieving factors | Is there anything or any activity that alters the pain, for example resting, eating, etc? |
| S everity or intensity | How severe or intense is the pain? A pain measuring tool/scale is used here. |
Table 1 : SOCRATES pain assessment tool
The patient’s pain can also be assessed using pain scales, which include the Numerical Rating Scale (hereafter NRS), Verbal Descriptor Scale (hereafter VDS), and Numerical Verbal Descriptor Scale (hereafter NVDS). With NRS, the patient rates the pain from 0-10, where 0 is ‘no pain’ and 10 is ‘worst pain’ (Gregory, 2019). With VDS, the patient uses words to describe pain, “which commonly include: ‘no pain’, ‘mild pain’, ‘moderate pain’, and ‘severe pain’” (Gregory, 2019, p. 72). NVDS adds a number to a verbal description of pain, "whereby 0 is no pain, 1 is mild pain, 2 is moderate pain and 3 is severe pain” (Gregory, 2019, p. 72).
Question 6
Immediate intervention should be aimed at reducing the pain resultant from sickle cell disease. The nurse may use intravenous hydration and analgesics to control the patient’s pain (Turaga et al., 2017). The nurse may also administer hydroxyurea. Hydroxyurea is a drug that increases the quantity of fetal hemoglobin in both adults and children, and thus reduces the occurrence of painful crises ( Sarri et al., 2018 ). Aggressive physical therapy and oro-systemic pain control will also alleviate pain ( Tageja et al., 2010). All three interventions may be used at the same time.
References
Ashburn, M. A., Fine, P. G., & Stanley, T. H. (Eds.). (2012). Pain Management and
Anesthesiology: Papers Presented at the 43rd Annual Postgraduate Course in Anesthesiology, February 1998 (Vol. 33). Springer Science & Business Media.
CDC. (2020). Sickle Cell Disease (SCD) . Center for Disease Control and Prevention. https://www.cdc.gov/ncbddd/sicklecell/index.html
Gregory, J. (2019). Use of pain scales and observational pain assessment tools in hospital
settings. Nursing Standard (Royal College of Nursing (Great Britain): 1987) .
Sarri, G., Bhor, M., Abogunrin, S., Farmer, C., Nandal, S., Halloway, R., & Revicki, D. A.
(2018). Systematic literature review and assessment of patient-reported outcome instruments in sickle cell disease. Health and Quality of Life Outcomes , 16 (1), 99.
Tageja, N., Racovan, M., Valent, J., & Zonder, J. (2010). Myonecrosis in sickle cell anemia—
overlooked and underdiagnosed. Case Reports in Medicine , 2010 .
Turaga, L. P., Boddu, P., Kipferl, S., Basu, A., & Yorath, M. (2017). Myonecrosis in sickle cell
anemia: case study. The American Journal of Case Reports , 18 , 100.
