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In clients with sickle cell anemia, achange in the gene that encodes thebeta chain of Hb results in a defect inHbS.
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Force the client to confront hermemories about the divorce in adirect, confrontational manner.
PMBrush up on key concepts29Cardiovascular refresher (continued)PERICARDITISKey signs and symptomsAcute pericarditis Pericardial friction rub (grating sound heard as the heartmoves) Sharp and usually sudden pain that usually starts over the sternum and radiates to the neck, shoulders, back, and arms (unlikethe pain of MI, pericardial pain is commonly pleuritic, increasingwith deep inspiration and decreasing when the client sits up andleans forward, pulling the heart away from the diaphragmaticpleurae of the lungs)Chronic pericarditis Pericardial friction rub Symptoms similar to those of chronic right-sided heart failure(fluid retention, ascites, hepatomegaly)Key test results Echocardiography confirms the diagnosis when it shows anecho-free space between the ventricular wall and the pericardium (in cases of pleural effusion).
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Excessive sleepiness is themost common complaint of clients affectedby breathing-related sleep disorder.
At any time, you can review the majorpoints of this chapter by consulting the Cheatsheet on pages 494 to 496.
Avoiding high altitudes Seeking early treatment of illness to prevent dehydration Avoiding aspirin use, which enhances acidosis and promotes sicklingThalassemiaINTERVENTIONS AND RATIONALES Administer pain medication and note theireffectiveness to promote comfort.
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Teach relaxation techniques and effectivecoping mechanisms and help the client identify areas of stress to help decrease symptoms.