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8/14/2019 Nursing in the Hospital- Presentation for Haem Course Ppthe
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Nursing Children with SCD:Nursing Children with SCD:
the Nurse Specialists Rolethe Nurse Specialists Role
Helen Appleby
Paediatric Sickle Cell NurseSpecialist
23rd Sept 2008
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ContentContent
Introduction.
Role of CNS.
Audit of Paediatric A&E Visits to ECH.
Case Studies.
Summary.
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SCD: Nursing issues in the hospitalSCD: Nursing issues in the hospital
Common problems Pain
early childhood- dactylitis, then abdominal pain
Adolescence- backache and menstrual pain Infection- especially the 1st 5 years, parents check temp.
Acute Chest Syndrome- over 25% initially VOC
Splenic Sequestration- the benefits of parental surveillance
Priapism, under-reported, encourage family discussion
Stroke- TCD, watch for headaches
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Introduction: Sickle CrisesIntroduction: Sickle Crises
Children usually present to A&E with either;
Pain in the joints, back, shoulders or abdomen.
Fever. Feeling unwell
Working Diagnosis made after examination &
investigations.Treatment & management planned.Encourage discussion with Sickle Team.
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Role Of Paediatric Sickle CNSRole Of Paediatric Sickle CNS
Support; children & parents
Telephone advice (avoid diagnosis)
Improve care of children with SCD.
Improve patient experience.
Teaching.
Liaison with MDT.
Protocols and guidelines.
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Audit of Visits to A&EAudit of Visits to A&E
Record of all children visiting A&E since Aug07.
Relevant facts obtained;
Reasons for visit
Multiple visits
Percentage of admissions
(Inappropriate visits.)
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A&E visits to Evelina since Jan 08A&E visits to Evelina since Jan 08
0
2
4
6
8
10
12
14
16
18
20
Jan Feb Mar April May June July
pain
fever
pain +fever
low hb
other
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Admissions from A&EAdmissions from A&E
General admissions from Paediatric A&E
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and admissionsand admissions
0
5
10
15
20
25
30
35
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
April
May
June Ju
ly
Visits
Admissions
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Children with Multiple VisitsChildren with Multiple Visits
Jan-July 08Jan-July 08No of patients
0
2
4
6
8
1012
14
16
2 3 4 5 6 7
No of patients
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CNS InterventionCNS Intervention
Follow-up all visits by phone.
Discuss any concerns with A&E staff.
Review on ward.
Involve MDT.
Support child and family.
Education
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Case Study 1Case Study 1
6yr old boy (CD)- HbSS
7 visits to A&E since January
5 admissions
Splenic sequestration x 4
D&V x1
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Case Study 1Case Study 1
Diagnosed at age 3 at ECH.
Born in Germany
Numerous admissions since arrival.
Only child.
Behavioural difficulties for last 2yrs.
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Case Study 1Case Study 1
CNS intervention;
Support & education from first admission.
Advice giving.
Regular telephone contact.
Explanation & discussion re surgery (Parents very
reluctant)
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Case Study 1Case Study 1
Referral to MDT
Nurse Therapist for Behaviour issues
Registrar review in Day Care.
Sickle Consultant for discussion re surgery.
Surgical consultant for review on ward.
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Splenic SequestrationSplenic Sequestration
Common in SCD in children 2-6yrs.
Often re-occurs.
RBCs pool in Spleen.
Causes pain.
Enlarged spleen.
Treatment includes blood transfusion.
Splenectomy for recurrent episodes.
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Case Study 2Case Study 2
12yr old girl (CP) HbSS
Multiple admissions since Dec 07
A&E visits x 7 (6 x admissions)
Admitted x 2 in previous year
Presenting with chest pain
Delay in discharge.
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Case Study 2Case Study 2
Housing difficulties.
Single mother, younger siblings.
Child staying with grandmother for school.
Mum distracted with housing/social issues
Mum away.
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Case Study 2Case Study 2
CNS Intervention
Concern of ward staff noted.
Discussion with child & Mum
Advice and support.
Refer to play specialist.
Refer to Therapist.
Telephone contact with family for support
No visits for >3/12
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Other Reasons for Visits to A&EOther Reasons for Visits to A&E
Wheezy episodes
Allergy
Head injury
Foreign body (in ear) Crying (4/12 old)
Falls
Epistaxis
Headache
Vomiting
PV bleed
FractureDysuria
Blood test (Pre-tx)
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CNS InterventionCNS Intervention
Telephone visits.
Discuss concern about visits with CommunitySickle Nurses.
Refer families who require support.
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Case Study 3Case Study 3
Baby girl 1yr (EAM). HbSS
First baby.
Three visits to A&E in 4/12
Crying
Itchy Eyes
Dactilytis
No admissions
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Case Study 3Case Study 3
Diagnosed in newborn screening
Seen by community sickle counsellor
Difficulty in accepting diagnosis.
Father unaware of diagnosis.
Refer to Health Visitor & Sickle CaseManager for ongoing support.
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SummarySummary
SCD is a complex disease.
Complications are not always clinical innature.
Requires multidisciplinary support.Sickle CNS co-ordinates the multidisciplinary
approach.
Work closely with the community- Seamlessservice
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Thank YouThank You
Acknowledgement
Baba Inusa, Luhanga Musumadi, Sickle Team
Questions??