Case study - Sickle cell anemia: Nursing

Nurse Maggie works in a pediatric hematology unit and is caring for Marcus, a 9-year-old with a history of sickle cell disease who was admitted for a vaso-occlusive crisis, or VOC. After settling Marcus in his room, Nurse Maggie goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Marcus’ care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.   

First, Nurse Maggie recognizes important cues, including Marcus’ vital signs which are temperature 99.0 F or 37.2 C, heart rate 104 beats per minute, respiratory rate 22 breaths per minute, blood pressure 122/72 mmHg, and oxygen saturation 97 percent on room air. She notices that Marcus’ hands and feet are edematous, and that he’s grimacing.  

Nurse Maggie: Marcus, you look uncomfortable. Can you rate your pain from zero to ten, zero being no pain and ten being the worst pain you’ve ever felt? 

Marcus: It’s about an eight in my hands and feet.  

Nurse Maggie: When did your pain start? 

Marcus: It started yesterday when I was playing in the snow, and it got worse this morning. 

Nurse Maggie then speaks with Marcus’ mother, who’s at the bedside. 

Nurse Maggie: Has Marcus taken any medications to help with the pain? 

Marcus’ mother: Not since we were in the emergency department a few hours ago.  

Nurse Maggie then analyzes these cues. She understands that VOC occurs when rigid, sickled red blood cells tangle together, adhere to blood vessel endothelium, and block vascular blood flow, causing inflammation, tissue ischemia, and necrosis, as well as pain and swelling in Marcus’ hands and feet. She understands that the cold temperature likely triggered the episode. Nurse Maggie recognizes that Marcus needs effective pain management.