Mosher1

ErinMosher
NURS351
July13,2015
EBPPaper

ThearticleBreathingExercisesforInpatientswithSickleCellAnemia
discussespatientswithsicklecellanemiabeingopentotheideaoflearningvarious
breathingexerciseswhileinthehospitalandthatnursesneedtobeimplementingthese
breathingexercisesalongwitheducationforsicklecellpatients.

Althoughthechiefcomplaintwhenitcomestopatientswhoarehospitalizedwith

sicklecellanemiaispain,patientsalsocomplainfrequentlyofshortnessofbreath,
breathingproblems,andcoughing.Painmanagementisanextremelyimportantaspectof
caringforpatientsexperiencingproblemswithsicklecellanemiaandhasalwaysbeen
themainfocusoftreatment,butthisstudydiscussestherespiratoryissuesthatgoalong
withthediseaseandtheimportanceoftreatingtheseissuesaswell.
Sincepainmanagementissuchahugepartofcaringforapatientwhois
hospitalizedduetosicklecelldisease,opioidanalgesicsarealmostalwaysusedforrelief
ofpain.Duetothis,respiratorystatusismonitoredfrequently,andpatientsareassessed
forsymptomsofhypoventilationrelatedtoopioiduse.Thishypoventilationcanalso
contributetoacutechestsyndromewhichhappenswhenthelungsaredeprivedof
oxygenduringanacutepaincrisis(Nadine2015).Thisusuallyincludesaproductive
cough,chestpainanddifficultybreathing.However,sincepainreliefisalwaysthechief

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complaintandthereforethemainfocusoftreatment,theserespiratoryissuesareoften
pushedtothesideandnursesarenotbeingtaughttousebreathingexercisesasameans
ofpainreliefforsicklecellpatients.Forexample,althoughithasbeenreportedthat
usingincentivespirometryat10puffsanhourgreatlylessenstheriskofacutechest
syndrome,only56%ofpatientshavereceivedprotocolrecommendedspirometry
(Nadine2015).
Asampleofadultswithsicklecelldiseasewasrecruitedfromanoutpatientsickle
cellclinicattheUniversityofNorthCarolinaatChapelHill.Criteriatobeapartofthe
studyrequiredthepatientstobeatleast18yearsofage,fullyunderstandEnglish,and
haveapositivediagnosisofsicklecelldisease.
Participantswereaskedtocompleteasurvey,whichdiscussedcomplementary
strategiesformanagingpainrelatedtosicklecelldisease.Thesemethodsincludedprayer
andmeditation,yoga,guidedimagery,etcandpatientswerealsoaskedwhethertheyhad
discussedthesemethodsofpainreliefwiththeirHealthCareProviders.Regarding
breathingexercises,36%ofparticipantssaidtheyhadusedbreathingexercisestohelp
withpain,23%saidtheywerewillingtotrybreathingexercisesforpain,butonly4%
reportedeverybeingeducatedaboutusingbreathingexercisesforpainbytheirHealth
CareProvider(Nadine2015).
Inregardstolimitationsofthisstudy,thesamplegroupwassmallandallfroma
designatedconsistentarea,sousingalargergroupfromvariouslocationswouldhave
givenamorebroadspectrumofresultsandbeenmoreaccurateoverall.Thedatainthis
studywasalsoallselfreportedwhichalwaysleavesroomforerror.

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Onenursingdiagnosisthatrelatestosicklecellpatientsisineffectivetissue
perfusionrelatedtovasoocclusivecrisisandmyocardialdamagefromsmallinfarctsin
thebody(Vera2014).Interventionsincludecarefulmonitoringofvitalsigns,peripheral
edemaandpainandalsoprovidingadequatefluidintakeandmonitoringoutput.The
goaloftheseinterventionswouldbethepatientpresentingwithadequatetissue
perfusion,whichwouldbeshownbystrongperipheralpulses,strongvitalsignsand
adequatefluidintakeandurineoutput.
Asecondnursingdiagnosisrelatedtosicklecelldiseaseisriskforacutepain
relatedtoactivationofnervefibersbyoxygendeprivationandintravascularsickling
(Vera2014).Nursinginterventionsincludeadequateassessmentandmonitoringofpain
alongwithappropriateadministrationofpainmedicationsandeducationaboutalternative
methodsofpaincontrol.Thedesiredoutcomeforthesepatientsisthattheyverbalizea
decreaseinpainandanunderstandingofwaystomanageandcontroltheirpain.
Afinalandimportantnursingdiagnosisforsicklecellpatientsisriskfor
knowledgedeficitwhenitcomestowaystocontroltheirpainandavoidpainfulcrisis
episodes(Vera2014).Thiscanberelatedtoalackofeducationabouttheirdiseaseand
contributingfactors,orlimitedresourceswhenitcomestomanagingtheirdisease.
Nursinginterventionswouldincludeteachingaboutcontributingfactorssuchatstress
andinfectionandeducationaboutcomplementarytechniquesformanagingpainsuchas
meditation,yogaandbreathingexercises.Thedesiredoutcomewouldbethepatient
demonstratingincreasededucationabouthis/herdisease,waystocontrolpainandways
toavoidpainfuloutbreaks.

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Overall,thisstudyshowsthatpatientswhosufferfromsicklecelldiseasearefor
themostpart,opentolearningaboutbreathingexercisestohelpcontroltheirpain.Italso
showsthatnursesandotherhealthcareprovidersneedtobesuretheyareeducating
patientsontheimportanceandbenefitsofbreathingexercisesandalsothatthey
themselvesneedtobeeducatedaboutthisinordertopassitontopatients.Ifbreathing
exercisesweremadeanimportantpartofteachingandlearningaboutmanagementof
sicklecellanemia,itwouldnottaketoolongforittobeapartoftreatmentoveralland
thepositiveeffectswouldsoonbeobvious.

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Nadine, Matthie. "Breathing exercises for inpatients with sickle cell

disease." Medsurg Nursing 35 (2015). Web. 11 July 2015.

Vera, Matt. "6 Sickle Cell Anemia Nursing Care Plans."

NursesLabs. Ed. Vera Matt. Nurse Labs, 3 Apr. 2014. Web. 15 July 2015.
<http://nurseslabs.com/6-sickle-cell-anemia-crisis-nursing-careplans/>.