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            護理學Essay參考案例:Analysis of Sickle Cell Disease

            論文價格: 免費 時間:2021-12-13 09:03:51 來源:www.orient-thai.net 作者:留學作業網

            本文是護理學專業的留學生Essay范例,題目是“Analysis of Sickle Cell Disease(鐮狀細胞病分析)”,隨著來自發展中國家的人把加拿大當成自己的家,加拿大正變得越來越多元文化。隨著加拿大移民率的上升,以前不常見的疾病變得越來越普遍。例如,在加拿大所有地區,鐮狀細胞病等疾病正在增加(被忽視的情況,2014)。鐮狀細胞病是一種遺傳性疾病,會導致不良后果,降低個人的生活質量。本文的目的是分析鐮狀細胞病的病理生理,并研究基于證據的實踐,如管理和預防措施。首先,將簡要解釋所使用的搜索策略,然后詳細介紹鐮狀細胞病的流行病學。此外,本文將按以下順序討論疾病的各個方面:危險因素、臨床表現、診斷檢查、并發癥、循證治療和不同程度的預防措施。根據rao的說法,“知識是專業實踐的基礎,是專業精神的一個中心方面”(護理專業精神,第28)。顯然,護士需要批判性地分析疾病,如鐮狀細胞病,以便應用和提供稱職的護理。

             

            Safiullah Barat & Melissa Parker薩菲烏拉·巴拉特和梅麗莎·帕克

            Canada is becoming more multicultural as individuals from developing countries are making Canada their home. As the rate of immigrants in Canada is rising, diseases that were uncommon are becoming more prevalent. For instance, disorders such as sickle cell disease are increasing in all regions in Canada (Neglected Conditions, 2014). Sickle cell disease is genetic disorder that causes undesired effects which decreases an individuals quality of life. The purpose of this paper is to analyze the pathophysiology of sickle cell disease, and to research evidence based practice such as management and prevention measures. To begin, a brief explanation of the search strategy used will be discussed, followed by details on the epidemiology of sickle cell disease. Furthermore, aspects of the disorder will be discussed in the following order: risk factors, clinical manifestations, diagnostic tests, complications, evidence based treatment, and different levels of preventive measures. According to RNAO, knowledge provides the basis for professional practice and, is a central aspect of professionalism(Professionalism in nursing, pg. 28). It is evident that nurses need to critically analyze disorders, such as sickle cell disease, in order to apply and provide competent care.

             護理Essay范例

            Search Strategy搜索策略

            To help retrieve the most up to date, recent and peer reviewed articles, different search strategies have been used. Nursing databases such as ProQuest, CINHAL and MEDLINE were used to find the appropriate journal articles. After doing so, search limiters were used to narrow down the search. Peer reviewed, full text and published dates set from 2009 to 2014 were selected, as well as the availability of references was included. Boolean operators, andand or, were commonly used ; furthermore, search term sickle cell diseaseand Boolean phrases including complications, treatment, diagnostic test, pediatrics, prevention, etiology, and Canadawere combined to narrow the search.

            為了幫助檢索最新的,最近的和同行評審的文章,不同的搜索策略已經被使用。使用ProQuest、CINHALMEDLINE等護理數據庫查找相應的期刊文章。在這樣做之后,搜索限制被用來縮小搜索范圍。同行評議,全文和出版日期設定在2009年至2014年,并包括參考文獻的可用性。布爾運算符“和”和“或”是常用的;此外,搜索詞“鐮狀細胞病”和布爾短語(包括“并發癥”、“治療”、“診斷測試”、“兒科”、“預防”、“病因學”和“加拿大”)被合并以縮小搜索范圍。

             

            Epidemiology流行病學

            Sickle cell disease is prevalent in areas where malaria is common. This includes area such as the Caribbean, Nigeria, Middle East, Mediterranean, Indian sub-continent, Greek, Turkey, India, Pakistan, Ghana, and Far East China (Brown, M. 2012). A study conducted by Lanzkron et al (2013) took a look at mortality rates with individuals who had sickle cell disease over a time frame of thirty years. Over the course of thirty years, 16, 654 sickle cell-related deaths had occurred with a mortality rate of 0.7% each year (Lanzkron et al, 2013). In Canada, one in every 2500 babies will be born with sickle cell disease, and have a one in four chance (25%) of having sickle cell disease. Furthermore, they have a one in two chance (50%) of being a carrier for sickle cell disease (Sickle Cell Disease Association of Canada, 2013).

            鐮狀細胞病在瘧疾流行的地區流行。這包括加勒比地區、尼日利亞、中東、地中海、印度次大陸、希臘、土耳其、印度、巴基斯坦、加納和中國遠東地區(Brown, M. 2012)。Lanzkron等人(2013)進行的一項研究考察了30年來鐮狀細胞病患者的死亡率。在30年的時間里,發生了16654例鐮狀細胞相關死亡,每年的死亡率為0.7% (Lanzkron et al, 2013)。在加拿大,每2500個嬰兒中就有一個患有鐮狀細胞病,并且有四分之一的機會(25%)患有鐮狀細胞病。此外,他們有二分之一(50%)的機會攜帶鐮狀細胞病(加拿大鐮狀細胞病協會,2013)。

             

            Etiology/Risk Factors

            Sickle cell disease is an inherited autosomal recessive condition that causes an abnormal formation of hemoglobin. Different types of sickle cell disease includes sickle cell anemia (HbSS), sickle hemoglobin-c disease (HbSC), and sickle cell thalassemia (HbS) ( Brown, M. 2012).However, the most common is sickle cell anemia (Lewis, 2014). This inheritance occurs when both the mother and father pass on the defective gene to their child (Brown, M. 2012). Therefore, being a carrier of the sickle cell trail is a major risk factor. Individuals have an increased risk of developing sickle cell disease if residing in areas where malaria is endemic. Sickle cell disease puts individuals at risk whose ancestors came from West Africa, southern Italy, northern Greece, South and Central America, Middle East, Central India, southeast coast of Turkey and Mediterranean in Sicily (Pack-Mabian, A & Haynes, J.r. 2009).

             

            Clinical Manifestations臨床表現

            Although, each individual will display different signs and symptoms of sickle cell disease, they all display one similar characteristic: when exposed to factors that decrease oxygen, the hemoglobin forms into a sickle-shaped red blood cell which blocks the flow of blood. As a result, clinical manifestations often show anemia, jaundice and severe pain (Addis, G. 2010). Often, patients are asymptomatic except when experiencing a sickling episode (Lewis, 2014).

            雖然每個人會表現出不同的鐮狀細胞病的癥狀和體征,但它們都有一個相似的特征:當血紅蛋白暴露在降低氧氣的因素中,血紅蛋白會形成一個鐮刀狀的紅細胞,阻止血液流動。因此臨床表現常表現為貧血、黃疸和劇烈疼痛(Addis, G. 2010)。通常,患者無癥狀,除非經歷鐮狀發作(Lewis, 2014)。

             

            An individual with sickle cell disease may develop anemia due to the complete destruction of red blood cells or hemolysis (Addis, G. 2010). Normally, red blood cells live for 120 days in our body but sickle cells usually die within ten to twenty days (Addis, G. 2010). As a result, the bodys organs are not receiving enough oxygen. The body compensates as it increase heart rate, increase blood pressure to allow the oxygenated hemoglobin to reach the necessary organs. Furthermore, individuals will display signs and symptoms of SNS or fight or flight response. Increase pupil dilation, diaphoresis and tachypnea are evident in patients with sickle cell crisis (Tortora & Derrickson, 2012).

             

            In addition, the constant breakdown of hemoglobin produces bilirubin, a byproduct of hemoglobin, which cannot be processed by the liver. As a result, the bilirubin gets stored in the blood and connective tissue which results in yellowing of the eyes and the skin (Addis, G. 2010).

             

            However, the most common manifestation individuals with sickle cell disease experience are pain as a result of vaso-occlusive crises, also known as sickle cell crisis. Pain related to sickle cell disease accounts for ninety percent of hospital admissions (Musumadi, L. et al. 2012). This is mainly due to episodes of sickling that prevents oxygenated blood reaching organs, which results in ischemia and gradual deterioration of tissue and organ function (Musumadi, L. et al., 2012).

             

            Diagnostic Tests診斷測試

            Diagnostic tests to diagnose sickle cell disease involve blood work. Often, individuals who have sickle cell disease are best diagnosed with the use of a peripheral blood smear test which reveals sickle cells (Lewis, 2014). In addition, sickle hemoglobin tests involve taking red blood cells, and expose them to factors that deoxygenate the blood, and determines if there is hemolysis (Lewis, 2014). Furthermore, a test known as the hemoglobin electrophoresis helps to differentiate sickle cell trait between sickle cell disease. It works by identifying various types of hemoglobin within a blood specimen to confirm the diagnosis of sickle cell disease (Randolph & Wheelhouse, 2012).

            鐮狀細胞病的診斷檢查包括血檢。通常,鐮狀細胞病患者最好的診斷方法是使用外周血涂片檢查,發現鐮狀細胞(Lewis, 2014)。此外,鐮狀血紅蛋白檢測包括采集紅細胞,將其暴露于使血液缺氧的因素中,并確定是否有溶血(Lewis, 2014)。此外,一種被稱為血紅蛋白電泳的測試有助于區分鐮狀細胞病和鐮狀細胞病的特征。它通過識別血液標本中的各種類型的血紅蛋白來確認鐮狀細胞病的診斷(Randolph & Wheelhouse, 2012)。

             

            Additionally, secondary diagnostic tests could be used to diagnose complications that arise with sickle cell disease. Individuals may require a chest x-ray, skeletal x-ray, magnetic resonance imaging (MRI), and a Doppler ultrasound (Lewis, 2014). Skeletal x-rays are used to determine bone and joint deformities whereas chest x-rays are used to diagnose chest infection (pneumonia). MRIs are used to aid in the diagnosis of a stroke caused by blocked blood vessels from sickled cells Likewise, a Doppler ultrasound may be used to diagnose deep vein thrombosis (DVT) (Lewis, 2014).

             

            Course of the disease and complications病程及并發癥

            Sickle cell disease causes a wide range of complications that begin at infancy and worsen with age when not controlled. Complications develop when sickling episodes causes vaso-occlusion which leads infarction of body tissues and organs (Lewis et al., 2010), and with increasing age, causes end-organ complications (Miller & Meier, 2012). At age 2, children begin to experience dactylitis, pain in small bones of hands and feet (Miller & Meier, 2012). Vaso-occlusive pain involving the back, chest, abdomen, or extremities continues to occur throughout the lifespan of an individual with sickle-cell disease (Pack-Mabien, 2009). Furthermore, both pediatrics and adults encounter the difficulty of anemia as it leads to other complications such as bone marrow suppression, renal insufficiency, and splenic or hepatic sequestration (Pack-Mabien, 2009). The infarction of the spleen can begin in infancy and causes another major complication: infection. The dysfunction of the spleen and its inability to phagocytize foreign objects can cause major infection in both children and adults and is the leading cause of morbidity and mortality in patients with sickle cell disease(Miller & Meier, 2012). Additionally, sickling episodes can affect the pulmonary system in all affected age groups and causes acute chest syndrome, a disorder that includes pulmonary complications such as pneumonia, fat embolism, systemic infection, pulmonary infarction, and if not treated, can lead to respiratory failure (Miller & Andrew, 2012). Unfortunately, children and adults are also at risk for stroke due to cerebral infarction (Miller & Meier, 2012). Other complications include gallstones, kidney failure, priapism or involuntary erection, delayed sexual development, delayed growth, bone necrosis, and leg ulcers (Brown, M. 2012).

            鐮狀細胞病引起各種并發癥,這些并發癥始于嬰兒時期,如果不加以控制,隨年齡增長而惡化。當鐮狀鐮狀發作導致血管阻塞導致機體組織和器官梗死時,就會出現并發癥(Lewis等,2010),并且隨著年齡的增長,會導致末端器官并發癥(Miller & Meier, 2012)。在2歲時,兒童開始經歷指關節炎,手和腳的小骨頭疼痛(Miller & Meier, 2012)。涉及背部、胸部、腹部或四肢的血管閉塞性疼痛在鐮狀細胞病患者的整個生命周期中繼續發生(Pack-Mabien, 2009)。此外,兒科和成人都面臨貧血的困難,因為它會導致其他并發癥,如骨髓抑制、腎功能不全和脾或肝隔離(Pack-Mabien, 2009)。嬰兒期可發生脾梗塞,并引起另一主要并發癥:感染。脾臟功能障礙及其無法吞噬異物,可引起兒童和成人的重大感染,“是鐮狀細胞病患者發病和死亡的主要原因”(Miller & Meier, 2012)。此外,鐮狀鐮刀發作可影響所有受影響年齡組的肺部系統,并導致急性胸部綜合征,這種疾病包括肺部并發癥,如肺炎、脂肪栓塞、全身感染、肺梗死,如果不治療,可導致呼吸衰竭(Miller & Andrew, 2012)。不幸的是,由于腦梗死,兒童和成人也有中風的風險(Miller & Meier, 2012)。其他并發癥包括膽結石、腎衰竭、陰莖勃起或不自主勃起、性發育遲緩、生長遲緩、骨壞死和腿部潰瘍(Brown, M. 2012)。

             

            Treatments

            The treatment of sickle cell disease involves the reduction of symptoms and complications. Treatment includes pain management involving opioid or non-opioid analgesics, anti-inflammatory drugs, and NSAIDS (Addis, 2010). Also, cognitive behavioural therapy and non-pharmacological approaches can benefit patients with chronic or acute pain (Addis, 2010). Another treatment includes RBC transfusion and is required as an emergency measure or to prevent short or long-term complications.(Addis, 2010). Furthermore, a medication called hydroxyurea is a major advancement in the management of sickle cell disease and is available in Canada (Canadian Association of Sickle cell). Hydroxyurea increases the level of fetal hemoglobin that results in an overall decrease in circulating sickle cells (Smith et al., 2011). A clinical study conducted by Smith et al (2011), has proven a decrease in pain intensity in patients undergoing hydroxyurea therapy, as well as a decrease in analgesic use and a significantly lower reduction in crisis and mortality. Moreover, multiple studies have shown bone marrow transplant as a potential cure of sickle cell disease; however, further studies are needed for this treatment to be recommended as a standard treatment for sickle cell disease (Thompson, 2012).

             

            Preventive Measures

            Primary Preventive Measures

            Although genetic risk factors are non-modifiable, there is a preventive measure for sickle cell disease: genetic counselling. Genetic counselling should be encouraged in patients with the sickle cell trait especially when planning to have a child. This preventive measure helps patients understand and adapt to the implications of genetic contributions to the disease and offers counselling to promote informed choices and adaptation to the risk or condition(Lewis, 2014. p. 787). A 6-year study in Saudi Arabia, a country of high prevalence of sickle cell disease, showed a significant decrease in the genetic disease through the use a genetic counselling program as it decreased the number of at-risk marriages (Memish, 2011).

             護理Essay怎么寫

            Secondary Preventive Measures二級預防措施

            Prevention measures in the secondary level focuses on diagnostic tests and screening for sickle cell disease. Newborn screening is the earliest way to detect whether the child has sickle cell disease in time to prevent serious complications from occurring (Newborn Screening Ontario, 2013). According to the Newborn Screening Ontario (2013), newborn screening can prevent infection and sepsis, growth delay, painful sickle crisis, tissue ischemia and organ damage.

            二級預防措施側重于鐮狀細胞病的診斷檢測和篩查。新生兒篩查是及時發現兒童是否患有鐮狀細胞病以防止發生嚴重并發癥的最早方法(新生兒篩查安大略省,2013)。根據安大略省新生兒篩查(2013),新生兒篩查可以預防“感染和敗血癥、生長遲緩、痛苦的鐮狀危機、組織缺血和器官損傷”。

             

            Secondary preventive measures also involve previously stated diagnostic testing for complications such MRI for stroke, the use of x-rays for chest infections, etc. Also, pain is a major complication in both adults and pediatrics and should be diagnosed; however, it is challenging to detect pain in unresponsive clients such as neonates. Registered Nurses Association of Ontario recommends the use of a validated pain assessment tool for neonates called Neonatal Infant Pain Scale (NIPS) due its evidence of reliability and validity. This tool includes components such as facial express, cry, breathing patterns, arms, legs, and state of arousal component (Assessment and Management of Pain, 2013).

             

            Tertiary Preventive Measures

            Tertiary preventive measures involve treatments that aid in regaining patients functional ability and the elimination of the disease. For individuals with sickle cell disease, preventive measures at this level include medical interventions to prevent and control symptoms and complications. For example, interventions are pain management, hydroxyurea, and transfusion therapies as mentioned earlier. Furthermore, penicillin can be given to children starting at 2 months of age, and vaccinations against pneumococcal infections, flu, meningitis, and hepatitis are important to prevent infections and early death (Addis, 2010).

             

            Conclusion結論

            In conclusion, sickle cell disease is one that affects the quality of life of affected individuals. The analysis focused on different aspects of sickle cell disease such as the epidemiology in which prevalence is high in areas where Malaria is predominant. Also, due to increasing immigration, the incidence of the disease is increasing in Canada. Furthermore, known risk factors have been identified such as genetic and environmental factors. In addition, the main clinical symptoms with sickle cell disease include pain as well as symptoms of anemia. Furthermore, a variety of tests which include blood work are the determinants of the presence of sickle cell disease. Sickle cell disease potentiates of a variety of complications, most commonly vaso-occlusive pain, acute chest syndrome, anemia and other major organ complications. Unfortunately, treatment only aids in controlling the complications and does not provide a cure for the disease. It is evident that the need for further research in stem cell transplant as a potential cure is highly needed. Lastly, genetic counseling, neonatal screening, diagnostic tests, and current evidence based treatment such as pain management, hydroxyuria and transfusion therapy, are all preventive measures of symptoms and complications of the disease. The findings in this analysis are significant for nurses to apply when having encountered a patient with sickle cell disease. Certainly, it is important for nurses to acknowledge the increasing diversity in Canada and to continue competency by constantly seeking new pertinent information to apply to everyday practice.

            總之,鐮狀細胞病是一種影響患者生活質量的疾病。分析側重于鐮狀細胞病的不同方面,例如在瘧疾占主導地位的地區流行率很高的流行病學。此外,由于移民的增加,加拿大的發病率也在增加。此外,已知的風險因素已被確定,如遺傳和環境因素。此外,鐮狀細胞病的主要臨床癥狀包括疼痛和貧血癥狀。此外,包括血檢在內的各種檢查是鐮狀細胞病存在的決定因素。鐮狀細胞病可加重多種并發癥,最常見的是血管閉塞性疼痛、急性胸綜合征、貧血和其他主要器官并發癥。不幸的是,治療只能幫助控制并發癥,而不能治愈這種疾病。顯然,需要進一步研究干細胞移植作為潛在的治療是非常必要的。最后,遺傳咨詢、新生兒篩查、診斷檢測和目前基于證據的治療,如疼痛管理、羥基尿和輸血治療,都是預防該病癥狀和并發癥的措施。這項分析的結果對于護士在遇到鐮狀細胞病患者時應用具有重要意義。當然,對護士來說,認識到加拿大日益增加的多樣性,并通過不斷尋求新的相關信息來應用于日常實踐,從而繼續勝任工作是很重要的。

             

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