Proposal for evidence-based managementDescription of PatientThe patient I have chosen to look at is a 35 year old male who I had recently seen on one of my home visits.He has a number of active problems, including: Vitamin D deficiency, Mitral valve disease, Debridement of organ NOC, Osteopenia, and Sickle Cell Anaemia. His past medical history includes a wide range of diseases affecting the cardiovascular system and abdominal region, including: left ventricular hypertrophy, subphrenic abscess, and psoas abscess.He is currently taking five drugs to cover his active problems. He is taking one 1.
25mg tablet of Bisoprolol daily to help control his heart rhythm and blood pressure. 250mg tablets of Phenoxymethylpenicillin are taken twice a day for his sickle cell anaemia. 1.25mg tablets of Ramipril are taken daily for his blood pressure. To help raise his vitamin D levels he is taking Calcichew tablets twice a day, these should help with his bone strength as well. Finally, he is taking 5mg Folic acid tablets daily.He has no recorded allergies.From speaking to him I discovered that he moved from Nigeria to the UK when he was a teenager to receive treatment for his sickle-cell anaemia, and has been a resident in the UK since.
He lives with his mother in a flat in North Greenwich, and enjoys where he is staying. Socially, he does not appear to have many people he speaks to other than his mum and spends most of his day in the flat, only going out for occasional walks or to do the shopping. Other than his mother, the rest of his family is still living in Nigeria, and at times he mentioned that he can feel a bit isolated.Description of the patient’s problemThe disease I am going to focus on is his sickle-cell anaemia, as it is the one that he is receiving the most treatment for and is potentially the most dangerous out of his active problems. It is a disorder of the blood that affects red blood cells, caused by an inherited abnormal haemoglobin.
This abnormality causes the cells to become deformed (sickle-shaped) and prone to rupture. They can also block blood vessels to cause tissue and organ damage.The patient contracted the disease at a young age while in Nigeria, and has experienced many sickle cell crises in the past, however has not had one in a few years. What struck me greatly is that despite everything he had a very calm manner and remained very positive about the future. I believe this is due to the fact that he is managing the disease very well, visiting a haematology lab a few times a year.
In addition, he keep meticulous records of all his hospital and GP visits as well as any medication he is prescribed, making it easier for him to manage his condition.In terms of how it affects his day to day life, he often complains that he becomes fatigued very easily in the day and finds it difficult to lift heavy objects. His fatigue impacts his ability to exercise, as he finds himself unable to leave the flat.From my perspective, I am pleasantly surprised by how well he is keeping on top of the disease. Compared to some of the more serious side effects, such as pain crises, ulcers, and lung/heart injuries, he is doing quite well.
However, in the long term a lack of exercise will become a problem as he may experience weight gain and put himself at risk of further cardiovascular conditions.Evidence-Based ResourcesThe main resource I used when looking at how to manage this conditions was the NICE (National Institute for Health and Care Excellence) guidelines. There were other resources I could have used, such as www.nhs.co.
uk, however I used this one as it gave clear step-by-step instructions for how best to manage the condition.Managing a sickle-cell crisis:ProposalI believe a key aspect of managing my patient’s condition is through looking at diet and exercise. When talking to him, he mentioned that he does not eat and drink as much as he should. This is a key aspect of management, as dehydration can lead to longer, more painful episodes. In addition, by eating foods rich in folic acid, he will reduce the impact of the disease as folic acid is used in the body to make new red blood cells.
Foods high in folic acid include: leafy green vegetables, beans, and cereals. He has no allergies and has not expressed a hatred for any particular foods so I believe he will be open to the recommendation.One thing mentioned in the management above is that excessive physical activity can trigger an acute crisis. While this is true, it does not mean you should ignore exercise altogether, and I believe recommending 30 minutes of walking a few times a week will be useful.