nursing in the hospital- presentation for haem course ppthe

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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Diagnosed at age 3 at ECH.

Born in Germany

Numerous admissions since arrival.

Only child.

Behavioural difficulties for last 2yrs.


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CNS intervention;

Support & education from first admission.

Advice giving.

Regular telephone contact.

Explanation & discussion re surgery (Parents very

reluctant)


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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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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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Housing difficulties.

Single mother, younger siblings.

Child staying with grandmother for school.

Mum distracted with housing/social issues

Mum away.


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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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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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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??

nursing in the hospital- presentation for haem course ppthe

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