Assignent Solutionnurs

History of present illness:
A 22-year-old African-American male with a history of sickle cell disease (Hemoglobin SS) is brought to the emergency room by his new wife. He is reporting a 1-day history of fever, moderate chest pain with SOB, severe right shoulder pain, and decreased oral intake. Past medical history: Multiple veno-occlusive events. Chronic blood transfusions from 4th to 5th grade. Multiple hospital admissions for sickle cell crisis. Social history: Newly Married. Patient smokes 1/4 pack of cigarettes daily (trying to quit, used to smoke 1 pack a day). Patient drinks two 12 oz. cans of beer daily after work. Denies illicit drug use. Physical exam: temp: 38.7, HR 115, RR 24 Oxygen saturation 90% on room air, BP 116/68. Complaining of 7/10 chest pain and 10/10 right shoulder pain. General: Awake + oriented X 3, in marked pain; mild respiratory distress. Cardiovascular: Tachycardic, no murmur, no gallop, pulmonary: Tachypneic, Bronchial breath sounds, Symmetrical expansionAbdomen: flat, soft, non-tender, BS+x4WBC: 12.4 (normal 4.0 to 10.0 × 109/L)Hemoglobin =7.5 g/dL (normal 11-13 g/dL)Manual differential = +2 sickle cellHemoglobin electrophoresis: 18.3% hemoglobin A, 3.9% hemoglobin A2, 2.4% hemoglobin F, 75.4% hemoglobin S. Urinalysis = normal. EKG: Tachycardia with mild ST depression. Chest X-ray indicates RUL infiltrate. Right Shoulder X-ray: indicates possible avascular necrosis of the humeral head. ESR and CRP pending. MRI ordered. Blood cultures sent.
Update: You admit the patient to ICU, on the Sickle Cell Crisis Protocol with Acute Chest Syndrome and suspected Avascular Necrosis of the Right Humeral Head.Once his wife walks out of the room, his mother comes in and tells you that she knows him best and can answer all of your questions about his health, she angrily states, “ I don’t trust that floozy, she doesn’t know him like I do, and if she had taken care of him we wouldn’t be here right now! ” (referring to his new wife).  
As the primary NP of the interprofessional team and lead provider of this patient answer the following:
1. What concerns do have about this patient? What will the sickle cell crisis protocol include? (be sure to address all suspected diagnosis)
2. Will you consult any specialists and if so, who should you consult and how will they be consulted? (be sure to address why and when for ALL consults)
3. What strategies will you employ to handle the family dynamics with mom, wife and patient? (being mindful of legal ramifications)
4. What education will you provide this patient and family regarding their diagnosis, prevention of crisis, and treatment? (remembering that stress can induce a crisis)
Please provide 3-5 peer-reviewed references to support answering the questions from 2017-2022.