Discussion: Factors Influencing Pain Perception in Sickle Cell Crisis

This discussion post analyzes the case of a 13-year-old female, Justice, diagnosed with sickle cell anemia and admitted in crisis. The assignment requires identifying factors influencing Justice’s pain perception, including the blockage of blood vessels, bone infarction, and developmental delays. It a...Read More

Running head: DISCUSSION
Nursing
Name of the Student
Name of the University
Author Note

1DISCUSSION
Answer 1
Sickle cell disease (SCD) is an umbrella term for a group of blood related disorders
that are inherited from the parents, with sickle cell anemia being the most common. The
condition is typically characterized by an abnormality in hemoglobin, the oxygen carrying
component found in the red blood cells, which eventually leads to the development of a
sickle-like and rigid shape of the red blood cells. Pain manifested by Justice is a major
symptom of SCA, commonly known as crisis, and can be accredited to the blockage of tiny
blood vessels that are located in the abdomen, chest and the joints (Ballas, 2015). The sickle-
shaped red blood cells block the flow of blood, thus causing pain, which generally varies in
intensity and can last from few hours to several days. She must have demonstrated a joint
pain severity of 6-8/10 due to bone infarction that generally refers to osteonecrosis within
the diaphysis or metaphysis of a bone. Blockage due to the affected red blood cells might
have interrupted the flow of blood to the joints, thus causing infarction.
Upon establishment of the infarction, there occurred the development of a central
necrotic zone, surrounded by the hyperemic ischemic zone (McBride, Mai & Kumar,
2016). Hence, absence of collateral vascularization and reduced diameter of terminal vessels
created an impact on the convex articular surfaces. In addition, delay in growth can be
associated to the fact that healthy red blood cells supply nutrients and oxygen that are
imperative for normal growth and development of the body (Ladwig, Ackley & Makic,
2019). Therefore, shortage of red blood cells slowed down the growth process and resulted in
a delay in puberty, thus making her behave as an 8-year old.
Answer 2
Physiological response to pain are based on the integrated defense response of the
body, encompassing the fight or flight mechanism. The two primary systems that are

2DISCUSSION
involved in this response include the Hypothalamic-Pituitary-Adrenal (HPA) system and the
Sympatho-Adrenal (SA) system. One of the most common physiologic response comprises of
alteration in heart rate and blood pressure. Justice also demonstrated similar symptoms,
owing to the fact that acute pain increased the blood pressure and pulse by augmenting the
sympathetic activity, while simultaneously increasing the release of adrenal hormones
(Inagaki et al., 2018). Pain is influenced by feelings and the cycle of sentiment and pain are
interrelated. Owing to the fact that Justice was anxious, the mental condition might have
triggered the muscles to tighten, thus creating a physical change that directly contributed to
an increase in pain (Treas et al., 2018).
In addition, crying for prolonged time after hospitalization resulted in the release of
endogenous opioids and oxytocin, also referred to as feel-good chemicals that facilitated ease
of physical and emotional pain. Therefore, in order to treat the existing condition, analgesic
therapy should be immediately commenced within few minutes of the patient’s arrival
(Hinkle & Cheever, 2018). Administration of non-steroidal anti-inflammatory drugs
(NSAIDs) such as, ibuprofen and diclofenac would prove imperative. Furthermore, muscle
relaxation therapy and massage might also be used for supporting pharmacological pain
therapy. Regardless of her state of hydration, routine administration of fluids will also help in
effective management of the acute pain episodes.

3DISCUSSION
References
Ballas, S. K. (2015). Sickle cell pain. Lippincott Williams & Wilkins.
Hinkle, J., & Cheever, K. (2018). Brunner and Suddarth’s textbook of medical-surgical
nursing (14th ed.). Philadelphia, PA: Wolters Kluwer.
Inagaki, T. K., Jennings, J. R., Eisenberger, N. I., & Gianaros, P. J. (2018). Taking rejection
to heart: Associations between blood pressure and sensitivity to social
pain. Biological Psychology, 139, 87-95.
Ladwig, G., Ackley, B., & Makic, M. (2019). Mosby’s guide to nursing diagnosis (6th ed.).
St. Louis, MO: Elsevier Health Sciences.
McBride, C. L., Mai, K. B. T., & Kumar, K. S. (2016). Orbital infarction due to sickle cell
disease without orbital pain. Case reports in ophthalmological medicine, 2016.
Treas, L., Wilkinson, J., Barnett, K., & Smith, M. (2018). Basic nursing: Thinking, doing,
and caring (2nd ed.). Philadelphia, PA: F.A. Davis