Analysis of Sickle Cell Disease - Case Study Example

Case Study: Introduction: Sickle cell disease is one that affects mostly those of African American decent as well as a small group of those from theMiddle East. It is a disorder in which an individual’s hemoglobin is structurally abnormal. An scd patient will have dickle or crescenmt shaped hemoglobin instead of round hemoglobin. This becomes a problem in the process of normal circulation as the crescent shaped hemoglobin stick together when passing through the tiny capilaries causing problematic side effects such as infarctions which are extremely painful and damage healthy tissue. Abstract: Naomi is a girl of 20 who has sickle cell disease. She lives at home with her parents and siblings but is the only family member afflicted with SCD. She is currently hospitalized and is on a pain management regimen consisting of strong opiates. The management of her pain however, is dissatisfactory to her leaving the hospital staff to worry about her use of her pain medications at home. This situation is quite subjective in that no one can know what kind of pain Naomi is in except for Naomi. On the other hand, hospital personnel are obligated to monitor patients who seem to require heavy amounts of pain medicine for a euphoric effect as opposed to requiring increases in medication in order to treat severe pain, as this can be a sign of a substance abuse problem. Unfortunately however, a great deal of hospital personnel tend to be more concerned about a patient’s propensity to be addicted to pain medicine rather than on managing a patient’s pain. Hospital personnel must also be aware of the fact that patients suffering from SCD, typically are victim to episodes of excruciating pain as well as psychological repercussions from such chronic pain. Problems in Treatment: Most prescription pain medications are derived from opium of poppy plants. This is worth mentioning because the morphine as well as the codeine resin found in these plants, are the most effective pain remedies known of. Morphine is the main component in in medications such as oxycontin (hydra morphine) , percocet (oxycontin plus caffeine) and MS contin (morphine sulfate). Codeine is the main component of Tylenol 3 (Tylenol with codeine), vicodin (hydracodone). Non narcotic pain medication is available but is in no way as effective or really even comparable to the effectiveness of Morphine and codeine based pain medication. Sadly, patients suffering from SCD are often stereotyped as “addicts” because they present frequently in emergency rooms with acute pain, but then seem to recover quite quickly after the administration of opiate pain medication. Additionally, SCD is mostly prevalent in minority populations such as those with African or Caribbean ancestry. Minorities are twice as likely to be untreated for pain as non minorities. In other words, health care professionals are making ethnically or sociocultural based judgments on who should and who should not receive pain medication. It is alarming how prevalent patients suffering with SCD which are not treated appropriately for pain, that absolutely should be. Health care professionals are making assumptions about patients due to their ethnicity while ignoring their complaints of extreme pain. This may be a dilemma but the priority of things is severely backwards. Though substance abuse or addiction is considered to be a large sociocultural problem, it has been demonized to the point where many patients are denied medication that they desperately need, simply because of the fantastical stigma of drug addiction. The result of this is simply inhumane. Health care professionals should be primarily concerned with the patient’s physical health and quality of life before the concern of whether or not someone may be an addict. Allowing someone to suffer extreme pain is inhumane and much more detrimental over time to someone, than addiction to one’s medication would be. Additionally, if a patient becomes addicted to a necessary pain medication, than that is a side affect that should be considered and accepted by health care professionals. If someone is truly an addict, there are much simpler ways to achieve narcotics than in a hospital where dosages of pain medication is extremely monitored and controlled. Certainly, the management of pain is not only done with medication but can also be accomplished with cognitive behavioral therapy. The psychological stress encountered by SCD patients is astoundingly high. In the case of Naomi, she is an adult but is still living with her parents and siblings and is only 20. Research clearly indicates that SCD patients who are children or teens, are prone to a more negative attitude and a great deal of internalizing their illness. This can place Naomi is in the middle whereas physicians making a decision as to whether or not increase medications for pain for a patient, may consider her borderline youth to be a source of childhood related incapability to absorb and accept SCD. Naomi may also be judged based on her newness to adulthood, suggesting that as an adult, she is simply statistically more likely to acquire an opiate addiction due to long term and frequent use. Plan for Treatment: The type of health intervention which would be appropriate for Naomi’s case would first include a thorough evaluation of her physical and psychological condition. It is important to be sure that additional tissue damage or infarctions have not occurred due to her sickle cell condition. The only way to gain perspective on the level of pain that Naomi is experiencing, is by communicating with her. If she is complaining that she is not receiving adequate pain relief, than she should be given increased doses or more frequent doses of appropriate opiate analgesics, to meet her increased pain level. It is better to ensure that Naomi’s pain is minimized and run the risk of feeding an addiction, than to take the chance that perhaps Naomi is abusing drugs and therefore is simply seeking more medication versus experiencing true pain. The latter of the two is much less inhumane than the first. It is also entirely too difficult to confirm within patients suffering from SCD. Secondly, a psychological evaluation can determine the types or magnitude of psychological impact that Naomi has experienced from being afflicted with SCD. Gaining perspective on Naomi’s coping style can also be paramount to her treatment. SCD patients with positive attitudes and active styles of coping, tend to experience much less pain than those who cope with their pain and disease passively and tend to think more negatively, “The poorly adjusted individuals are often anxious and depressed and have become overly dependant on health care services for pain management”(Thomas et al, pp.3). The intervention which would take place to assess Naomi’s pain management regimen applies to the health psychology theory because pain and perception of pain have been closely linked to psychological coping skills. Those with healthy coping skills are more equipped to deal with physical pain, but in those that are poorly equipped with healthy psychological faculties, pain management can be much more difficult to achieve. This particular aspect of treating pain (from a psychological approach) can be specifically applied to SCD patients because SCD patients notoriously suffer from regular episodes of acute pain and are chronic as opposed to being ill for a short period of time. The two givens in the case of an SCD patient is that they suffer from these episodes of severe pain which often require a hospital stay in order to manage the severity of the pain and that they are going to require narcotic pain medication to control such severe stints of pain. By addressing the aspect of pain from a physical and psychological angle, this plan of action is very specific to the SCD client group. If Naomi is to be given in hospital opiate medication for her pain, she will most likely receive it intravenously as opposed to orally. Intravenous drips will ensure a quicker and more potent delivery of pain relief. Hematologists treating SCD patients typically employ either morphine, hydra morphine or meperidine. Naomi will most likely need to have a round the clock drip in order to adequately control her pain. The secondary aspect to her treatment should then be the psychological evaluation which may determine her coping styles as well as her overall attitude about her illness. By allowing Naomi to receive the pain medicine she so desperately needs, she will be more comfortable and therefore more receptive to discussing psychological coping mechanisms one can employ to help with the pain caused by SCD. Naomi is in a state of worry about her college courses due to being hospitalized. This only adds to the psychological distress she is experiencing which accompanies her pain. Hospital personnel should also consider helping Naomi make arrangements via phone from the hospital, for her missed college classes. By offering solutions to the patient’s problems (within reason) the hospital staff may notice a decrease in Naomi’s cried of pain or the frequency of when she requests more medication. It is also important to address Naomi’s home medication schedule and dosing. If it Is suspected that Naomi is abusing her medication, they should first consider whether or not she is being given enough medication to manage her pain levels. Once that has been established, communicating with Naomi about the larger picture surrounding her pain management plan at home, is integral to her overall wellbeing and may help her to avoid excessive self medicating or deviations from specified dosages and frequency of dosages. Based on research conducted by James Elander, hospital staff are more likely to perceive a patient’s complaints of pain associated with SCD, as an indication of addiction. In fact, many of the hospital personnel involved in Elander’s study were less likely to reevaluate a patient’s need for more analgesic pain medicine when behavior associated with pain and/or addiction presented. Unfortunately, the symptoms of pain affiliated with SCD is entirely similar to the symptoms of addiction, thus often times causing hospital staff to automatically assume that the patient was merely exhibiting narcotic seeking behavior. One example of this is frequent disputes with staff members over whether or not they should be given more medication. Naturally, if someone is in a great deal of pain and is then told that the mode in which to eliminate that pain is being denied them, one is most likely going to become agitated and perhaps a bit hostile, “Judgments about people with pain are influenced by contextual factors that can lead to stigmatization of patients who present in certain ways. Misplaced staff perceptions of addiction may contribute to this, because certain pain behaviors superficially resemble symptoms of analgesic addiction”(Elander, 2006). Truly, the most important aspect of this case is to make sure that Naomi is treated with complete unbiased as any other human being should be treated. This means that regardless of her financial means, ethnicity, religion, sexual orientation or otherwise, Naomi should be heard when she voices the intensity of her pain and consequently, she should be treated accordingly. In other words, If Naomi is exhibiting what could be either a response to pain or a sign of addiction, judgment on the part of the hospital staff should be completely conducive to unbiased treatment which addresses her persistent pain. Additionally, Naomi is in a hospital setting where all medication administrations are closely monitored. For this reason, Naomi should be believed and treated for pain specifically because making assumptions in this situation, could potentially leave a young girl in a 7 day stretch of excruciating pain thus doing more psychological harm than even being dependant on opiates. If a psychological evaluation is deemed necessary in order to ascertain Naomi’s coping ability with her disease as well as her patterns of medicating for pain management, sociocultural and family dynamic issues can be discussed. Naomi lives with her parents and siblings which means she most likely has a support system at home as well as individuals around her enough to possibly notice if she has a drug problem or is simply treating her severe SCD pain. In some cases, a hospital liason may meet with a patient’s family (with the patient’s permission0 in order to develop a home care plan. This may mean that the family is advised to use communication techniques with Naomi, that will give her the opportunity to not only voice her discomfort but also allow her to feel that she is not alone and therefore avoid negative thinking. The centrifugal part of Naomi’s intervention or management plan, is to first enable her with psychological coping mechanisms which are conducive to reducing physical pain. Additionally, the reduction of her discomfort demands adequate analgesic treatment while the possibility of addiction to opiates remains secondary. The fact that Naomi has a disease which causes her a great deal of pain managed mostly by narcotics, dictates a relatively high probability of dependence or even addiction. Based on most studies involving SCD related pain however, Naomi’s demand for more medication is much more likely to be from legitimate pain while the risk of addiction is virtually impossible to prove. It is not any one person’s place to decide what level of pain another human being is in. As hospital personnel, one should be extremely careful not to make judgments which are unfair for anyone to make. This again is related to possible stereotypes which can cause health care professionals to simply assume one is an addict based on ethnicity or socioeconomic variables. Age is often another factor which may lead to poor judgment and biased decisions on the part of hospital staff. Adolescents with SCD are less likely to be addicted to pain medication than adults. This means that the hospital staff is more inclines to closely observe the behavior of adults for indications of drug seeking behavior, more so than would be looked for in a teen or child. Naomi is twenty and therefore she falls into at least one category with a propensity for addiction. This is just one of the factors which may influence the decisions of the hospital staff as to whether to increase Naomi’s medication or not. Future Improvements in Treatment: Primarily, the first step to creating a better future in the area of treating SCD, is to retrain medical personnel on being extremely cautious to not treat patients with an attitude of social classing and exclusion. This is probably the biggest problem in the treatment of SCD patients. Ultimately, finding a pain medication which will work effectively in managing the severity of pain felt by SCD patients. Once implementing a new regimen of medication which will hopefully be more successful in Naomi’s pain management, Naomi can be taught a myriad of coping tools to aid her in times of acute pain. Naomi has been in the hospital 5 times in the past year, if she shows a decline in ED visits, it will be safe to deduce that the methods employed to treat Naomi’s pain, have been successful. On the inverse, if a decrease in ED visits is not observed in Naomi’s case, than it will be obvious that the psychological and physical pain management plan implemented for Naomi was unsuccessful. If Naomi’s ED visits increase in frequency, than it may be possible that Naomi is returning to the hospital for an increase in medication to feed an addiction more so than to treat acute pain. Similarly, If Naomi is observed as improving in her overall outlook before leaving the hospital, it may be clear that she is responsive to utilizing new coping mechanisms such as positive thinking and a hopeful outlook in general. The long term behavior however, will determine how successful the implementation actually was. Conclusion: The method by which this paper suggests to go about Naomi’s care could be improved upon by somehow successfully retraining hospital personnel and health care professional I general to unlearn biases while considering the patient’s pain before assuming that the patient is addicted to a necessary evil. Another aspect of the staff’s responsibility is to make sure that they are doing their part such as delivering Naomi’s regular medicine on time instead of allowing her anxiety and frustration to elevate over an unnecessary long wait. The fact that Naomi is made to wait for long periods of time for her medication, only allows the pain level to elevate to a point where a normal dose of medicine will not be as effective as it would otherwise be if it was given prior to the onset of breakthrough pain. Giving Naomi and other patients like her the benefit of the doubt, should be ret aught to health care workers. Additionally, establishing clear directives for treating pain based on the patient’s communication about their pain and the disese with which they are effected, should be the sole bias of treating both acute and chronic pain. There is entirely too much of a degree of freedom to judge or subconsciously act on bias, among health care professionals and pain management. The implications for this approach geared towards the improved standard of life of Naomi, is that health care professional simply respond to the patient’s needs requiring pain control instead of isolating possible addicts. Additionally, attitude changes among health care professionals may result when they are taught to avoid all types of bias and judgment of the patient’s actual pain level versus drug seeking behavior. The room for speculation may very well be gapped with this above method of synergized pain management coupling psychological coping training for the patient as well as a direct response to the treating of chronic pain suffers with SCD. Lastly, perhaps if individuals who are seriously in pain (even based on their word prior to any diagnosis) were given the pain medicine they require, there would be a decrease in the illegal trade of narcotic pharmaceuticals. Truly, there are some individuals who may acquire black market medication in order to treat their painful symptoms because health care professionals refused to grant that individual an effective pain medication. Read More