Management for sickle cell hospitalised patients during crisis.
How can nurses manage pain for sickle cell hospitalised patients during crisis.
NURSING MANAGEMENT SICKLE CELL PAIN IN HOSPITALISED PATIENTS DURING CRISIS
Proposed study aims to discuss efficacy and safety of infusion therapy in management of sickle cell pain. Sickle cell pain is a challenging clinical issue that complicates management of sickle cell disease during a crisis. The purpose of the study is to discuss how infusion therapy can be useful in management of sickle cell pain. A systematic review of literature will be conducted to help inform the topic. Identified sources to be reviewed as provided in the appendix section.
The purpose of the proposed study is to identify primary research articles that will help inform how nurses can use infusion therapy to manage sickle cell pain. Sickle cell pain is poses a challenge in management of patients experiencing sickle cell crisis. The scope of the study will include focus on infusion therapy for management of sickle cell pain. Infusion therapy with non-opioid medications is an effective therapy for management of sickle cell pain.
PICOT Question: In hospitalized patients with sickle cell crisis and pain (P), does intravenous infusions (I) compared to use of opioid medications (C) help improvement pain management outcomes (O) within 7 days of hospitalization (T)?
Refer to the appendix section for the 4 stages of PICOT development in the appendix section (Offondry & Vickers 2010).
Background, Rationale and Justification
Sickle cell disease was once a deadly disease of the childhood. However, due to advancement in supportive and preventive care in the developed countries, more than 95% of the people who are born with the disease as expected to survive into the adulthood. Current childhood mortality rate in the U.S. due the disease is 5% and life expectancy is 30 years (Meier & Rampersad 2017).
The management of chronic and acute pain for persons living with sickle cell disease remains a clinical challenge. Emergence of chronic pain associated with sickle cell disease tends to occur with increasing age. About 30% to 40% of adults and adolescents living with the disease suffer from chronic pain (Brandow et al. 2020). Pain has significant negative impact on an individual’s health related quality of life and cause significant morbidity in sickle cell patients (Brandow et al. 2020). Pain in young children with the disease can greatly impair their quality of life, including sleep, mood, school performance, and social development (Coco 2018). Pain associated with sickle cell disease spans the life course and may be experienced from the first year of life (Brandow et al. 2020). Pain in sickle cell disease begins at infancy and is typical severe and unpredictable. The pain requires hospitalisation and emergency department use (Coco 2018). Mechanisms of pain sickle cell disease pain include inflammation, hypoxia-reperfusion injury, nervous system sensitization, and elevated red blood cell adhesion (Brandow et al. 2020).
Individualized approach is considered as the optimal treatment of both chronic and acute pain. Treatment and management of sickle cell disease pain should involve interdisciplinary care. There are various non-pharmacological, pharmacological and integrative therapeutic interventions for optimal management of pain associated with the disease (Brandow et al. 2020). Chronic transfusion therapy is one of the non-pharmacological interventions for managing disease associated pain and it is the focus of the proposed study (Brandow et al. 2020). In a vaso-occlusive crisis, rapid administration of fluids for hydration and medications is essential (Lentz & Donald 2017). Low-dose ketamine infusion therapy has been demonstrated to result in significant relief of pain associated with sickle cell disease (Ahern, Herring,Miller, & Frazee
Aim: to identify infusion strategies for management of sickle cell pain.
- To contextualize the proposed research topic
- To identify develop the PICOT question for the proposed research topic
- To identify 10 primary research articles that will help inform the research topic
Search was conducted in Google Scholar and EbscoHost databases. Search terms that were utilized include infusion AND sickle cell pain, sickle cell pain AND nursing management, infusion therapy AND sickle cell crisis, and treatment AND sickle cell pain. Inclusion criteria included articles not older than 5 years, relevance, evidence-based sources, articles utilizing the scientific method, and journal articles from reputable sources. Exclusion criteria include sources older than 5 years, not relevant to the topic, and secondary sources.
Literature search yielded 10 sources. More details about the sources that will be used in the study are provided in the appendix section.
Sickle cell pain is a challenging clinical issue that complicates management of sickle disease. The proposed study aims to utilize sources provided in the appendix section to describe how infusion therapy with use of appropriate medication can help improve pain management outcomes among patients experiencing sickle cell crisis.
Ahern, TL, Herring, AA, Miller, S, & Frazee, BW 2015, ‘Low-dose ketamine infusion for emergency department patients with patients with severe pain’, Pain Medicine, vol. 16, no. 7, pp. 1402-1409. https://doi.org/10.1111/pme.12705
Alshahrani, MS, Asonto, LP, El Tahan, MM, Sulaibikh, AH, Faraj, SZ, Al Mulhim, AA, Abbad, MF, Al Nahhash, SA, et al. 2019, ‘Study protocol for a randomized, blinded, controlled trial of ketamine for acute painful crisis of sickle cell disease’, Trials, vol. 20, Article number: 286. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3394-4#citeas
Brandow, AM, Carrol, CP, Creary, S, Edwards-Elliott, R, Glassberg, Hurley, RW, Kutlar, A, Seisa, M, Stinson, J, Strouse, JJ, Yusuf, F, Zempsky, W, & Lang, E 2020, ‘American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain’, Blood Adv., vol. 4, no. 12, pp. 2656-2701. https://dx.doi.org/10.1182%2Fbloodadvances.2020001851
Brosseau, DC, Scott, JP, Badaki-Makun, O, Darbari, DS, Chumpitazi, CE, Airewele, GE, Ellison, AM, Smith-Whitley, K, et al. 2015, ‘A multicenter randomized controlled trial of intravenous magnesium for sickle cell pain crisis in children’, Blood, vol. 126, no. 14, pp. 1651-1657. https://doi.org/10.1182/blood-2015-05-647107
Coco, M 2018, ‘Topics in pain management’, Lippincott NursingCenter, vol. 34, vol.5, pp. 1-8. https://www.nursingcenter.com/journalarticle?Article_ID=4837228&Journal_ID=3402523&Issue_ID=4837227
Gimovsky, A, Fritton, K, Viscusi, E, & Roman, A 2018, ‘Evaluating the use of ketamine for pain control with sickle cell crisis in pregnancy: A report of 2 cases’, A&A Practice, vol. 10, no. 1, pp. 20-22. https://journals.lww.com/aacr/Abstract/2018/01010/Evaluating_the_Use_of_Ketamine_for_Pain_Control.6.aspx
Lentz, M, & Donald, K 2017, ‘Acute vaso-occlusive crisis in patients with sickle cell disease’, Nursing2020, vol. 47, no. 1, pp. 67-68. https://www.nursingcenter.com/journalarticle?Article_ID=3933782&Journal_ID=54016&Issue_ID=3933474
Manwani, D, Chen, G, Carullo, V, Serban, S, Olowokure, O, Jang, J, Huggins, M, Cohen, HW, Billett, Atweh, GF, Frenette, PS, & Shi, PA 2015, ‘Single-dose intravenous gammaglobulin can stabilize neutrophil Mac-1 activation in sickle cell pain crisis’, American Journal of Hematology, vol. 90, no. 5, pp. 381-385. https://doi.org/10.1002/ajh.23956
Meier, ER, & Rampersad, A 2017, ‘Pediatric sickle cell disease: past successes and future challenges’, Pediatric Research, vol. 81, pp. 249-258. https://www.nature.com/articles/pr2016204
Nguyen, NL, Kome, AM, Lowe, DK, Coyne, P, & Hawks, KG 2015, ‘Intravenous lidocaine as an adjuvant for pain associated with sickle cell disease’, Journal of Pain & Palliative Care Pharmacotherapy, vol. 29, no. 4, pp. 359-364. https://doi.org/10.3109/15360288.2015.1082009
Offredy, M, & Vickers, P 2020, Developing a healthcare research proposal: An interactive student guide, Wiley-Blackwell, Hoboken.
Puri, L, Morgan, K J, & Doralina, L 2019, ‘Ketamine and lidocaine infusions decrease opioid consumption during vaso-occlusive crisis in adolescents with sickle cell disease’, Current Opinion in Supportive and Palliative Care, vol. 13, no. 4, pp. 402-407. https://journals.lww.com/co-supportiveandpalliativecare/Abstract/2019/12000/Ketamine_and_lidocaine_infusions_decrease_opioid.21.aspx
Quimby, KR, Hambleton, IR, & Landis 2015, ‘Intravenous infusion of haptoglobin for the prevention of adverse clinical outcome in sickle cell disease’, Medical Hypotheses, vol. 85, no. 4, pp. 424-432. https://www.sciencedirect.com/science/article/abs/pii/S030698771500242X
Whiteman, LN, Lanzkron, S, Stewart, RW, Haywood Jr., C, Strouse, JJ, & Felman, L 2015, ‘Quality improvement process in a sickle cell infusion center’, The American Journal of Medicine, vol. 128, no. 5, pp. 541-544. https://www.sciencedirect.com/science/article/abs/pii/S0002934314011486