Clinical Case Study
Julian Jenson is a 35year old man who has sickle cell disease. He is manged at a sickle cell centre, at hospital in a neighbouring town. Generally, his sickle cell has been managed really well and he is reviewed every six months. Recently he has become very tired and is struggling to undertake any of his usual activities outside of work. Julian has 2 young kids and thinks that this is the cause of his tiredness. This morning Julian was admitted to his local hospital with uncontrolled pain. Any ongoing pain relating to his sickle cell is usually controlled with paracetamol and co-codamol, but he has taken this, and the pain is still severe. Julian thinks he is having a sickle cell crisis. He has flair ups usually once a year and this sometimes results in admission to hospital for symptom control.
Julian was at work when the pain became uncontrollable and his boss sent him to hospital. Julian did not have any of his management plan documents with him when he arrived.
The local hospital where Julian went to did not have a sickle cell centre and there was no local guidelines on management of this. He was initially reviewed; bloods were taken to confirm sickle cell crisis and morphine was prescribed for pain relief. Julian told the doctor and the nurse that this has no effect on his pain relief, and he needs to be given an infusion of morphine. He was given the morphine and they said they would review his pain again. After 1 hour of being in A&E, Simon a student nurse approached Julian and did a pain assessment on him. His score was 9/10. He spoke to Julian about what his usual plan of care was and escalated this to his mentor. It was confirmed shortly after that he had sickle cell and was in sickle cell crisis. His usual plan of care was identified from the sickle cell centre where he usually attends, and his pain was managed with the appropriate dose of morphine.