A patient is admitted in sickle cell crisis with symptoms of dyspnea and leg pain. The patient's significant other asks, "I don't really understand why he is hurting so badly." Which of the following responses by the nurse is best?
a. "The pain is due to a disturbance in cellular metabolism."
b. "The bone marrow is expanding with the sickled cells and that causes pain."
c. "Clumping of abnormal red blood cells blocks the flow of blood through the capillaries."
d. "Bleeding in the joints occurs because red blood cells are being rapidly destroyed by the bone marrow."
ANS: C
As sickling occurs, blood becomes sluggish and does not flow easily. It tends to collect in the capillaries and veins of the organs of the chest and abdomen, as well as joints and bones, and can cause infarction (tissue necrosis resulting from lack of blood supply). Tissue necrosis results in pain, fever, and swelling. Pain from sickle cell anemia is not associated with changes in cellular metabolism or bone marrow pathology. Bleeding into joints is more common with hemophilia.
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