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Med Surg Case Study #10

Presenting Complaint: John, a 25-year-old African American male, presents to the emergency department with severe pain in his abdomen, back, and extremities. He describes the pain as sharp, intermittent, and rated as 8/10 on the pain scale. John reports that the pain began suddenly a few days ago and has been progressively worsening. He denies any recent trauma but mentions feeling fatigued and experiencing shortness of breath.

Patient Background: John has a known medical history of sickle cell disease (SCD) since childhood. He reports frequent episodes of pain crises in the past, usually managed at home with oral pain medications prescribed by his hematologist. He has a history of recurrent hospital admissions due to pain crises and has been compliant with his prescribed medications, including hydroxyurea. John's family history is significant for SCD in multiple relatives.

Assessment: Upon assessment, John appears uncomfortable and is in moderate distress due to pain. His vital signs show an elevated temperature of 38.5°C (101.3°F), tachycardia, and mild hypoxia. His abdomen is tender to palpation, and there is mild jaundice noted in the sclera of his eyes. Laboratory tests reveal a decreased hemoglobin level, elevated white blood cell count, and increased bilirubin levels. A peripheral blood smear shows sickled red blood cells.

1. Based on John's history and assessment findings, what is the possible diagnosis for his condition?

2. What diagnostics might be used to confirm the diagnosis?

3. What treatments might be needed for John's condition?

See answers below

Med Surg Notebook


1. What are the possible diagnoses for John's condition?

The possible diagnosis for Mr. John's condition is Acute vaso-occlusive crisis related to sickle cell disease, resulting in severe pain, tissue ischemia, and possible organ damage.

2. What diagnostics might be used to confirm the diagnosis?

Diagnostic tests:

  • Complete blood count (CBC) to assess hemoglobin levels and detect changes in white blood cells.

  • Reticulocyte Count: This test measures the number of young red blood cells (reticulocytes) in the blood. In a sickle cell crisis, there is often an increased production of reticulocytes as the body tries to compensate for the rapid breakdown of sickle-shaped red blood cells.

  • Imaging studies (such as ultrasounds) to evaluate for possible organ damage or infarction.

3. What treatments might be needed for John's condition?

Possible treatments may include Intravenous hydration and pain management with opioids or nonsteroidal anti-inflammatory drugs (NSAIDs). Oxygen therapy for hypoxia and blood transfusions if severe anemia is present. Antibiotics if there are signs of infection. Hydroxyurea to reduce the frequency of pain crises and complications in SCD.

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