SICKLE CELL PAIN NURSING STANDARD OF CARE

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Goal for Pain Management

The patient's pain will be kept as low as possible, to a level they find acceptable.

Expected Results for the Patient

The patient will have good pain relief. Their reports of pain will be believed, checked, and acted upon.

Nurse's Actions

The nurse will do the following:

  • Check sickle cell patients for pain every 4 hours or as needed, using the correct pain scale, and write down the results.

  • Understand that pain in sickle cell patients has unique causes, feels different, and needs specific treatments.

  • Get help from other teams when needed, like Child Life, Rehab Services, or Social Work.

  • For a new, severe pain episode, check pain levels again 30 minutes after the first pain medicine is given.

  • Tell the doctor or nurse practitioner 30 minutes after that check and expect an order for more pain medicine.

  • Give pain medicine as ordered and prepare for the patient to use a Patient-Controlled Analgesia (PCA) pump.

  • Use non-medicine treatments like heat packs, warm baths, or warm blankets when helpful.

  • Give intravenous (IV) fluids as ordered. Dehydration often causes pain in sickle cell patients.

  • Know the right medicines for sickle cell pain. For example, know that ketorolac should only be used for a maximum of 5 days in a 30-day period (check with the pharmacy).

  • Request a stomach-protecting medicine for patients taking ketorolac.

  • Know how to care for patients on strong pain medicine (opioids), like asking about medicines for constipation, itching, or nausea.

  • Teach the patient and family about how pain medicines are used.

  • Encourage the patient to use an Incentive Spirometer or do deep breathing exercises 10 times every hour while awake, and write down that it was done.

  • Help the patient sit up or get out of bed for 1-2 hours at a time, with a goal of doing this 4 times a day (at least 6 total hours out of bed).

  • Encourage the patient to walk at least 4 times a day.

  • Check and record oxygen levels every 4 hours with other vital signs. Watch oxygen levels closely if the patient is using a PCA pump.

  • Tell the doctor or nurse practitioner if the patient's oxygen level drops below 93% or falls 3% below their normal level.

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