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Running head: SICKLE CELL DISEASE IN AFRICAN AMERICANS 1
Sickle Cell Disease in African Americans: A Discharge Teaching Research Paper
Danielle Crich
National American University
NS4000D Transcultural Nursing
February 4, 2018
Used with Permission
SICKLE CELL DISEASE IN AFRICAN AMERICANS 2
Abstract
The understanding of culture, as it relates to African Americans and sickle cell disease, has many
variables. Trying to understand the impact that this genetically acquired disease has on a certain
population cannot be done without first understanding what culture means to the afflicted group.
This understanding is influential in being able to provide culturally competent discharge teaching.
Avoiding ethnocentrism, in discharge teaching, by focusing on the clients’ values and not ones’
own values, will create a foundation for learning and culturally competent nursing care and
teaching can take place. The ideas and decisions of cultural care allow the client and nurse to
work together to comprise a mutually agreed upon discharge plan. Incorporating the culture,
values, and beliefs in this plan will ultimately lead to the development of a strong nurse-patient
relationship, a stepping stone to culturally congruent care and a decrease in rehospitalizations in
African Americans with sickle cell disease.
SICKLE CELL DISEASE IN AFRICAN AMERICANS 3
Sickle Cell Disease in African Americans:
A Discharge Teaching Research Paper
The understanding of culture, as it relates to African Americans and sickle cell disease,
has many variables. Trying to understand the impact that this genetically acquired disease has on
African Americans cannot be done without first understanding what culture means to the
afflicted group. This paper will discuss cultural influences regarding the African American
community, the risk they face with sickle cell disease, culturally influenced discharge teaching
and avoidance of ethnocentrism. The African American culture emphasizes a great deal on their
religious and spiritual values. Unfortunately, this population has an increasingly large incidence
of sickle cell trait inheritance, with one in twelve African Americans being carriers (National
Human Genome Research Institute, 2016). This disease places those affected with sickle cell
disease in the African American population at a higher risk of mortality because of complications
leading to hospitalization, infections, or even death. An understanding of the African American
culture, and how it relates to their care with sickle cell disease, is influential in being able to
provide culturally competent discharge teaching.
Background
Sickle cell disease, inherited from both parents, produces abnormal red blood cells. These
red blood cells contain hemoglobin S, as opposed to the normal hemoglobin A, in non-afflicted
individuals (Appendix A). The problem arises when the hemoglobin S loses its oxygen, resulting
in a distorted shape, resembling a crescent or sickling appearance (National Heart, Lung, and
Blood Institute, 2012). When red blood cells sickle, while traveling through blood vessels, they
can clump or cause aggregation. This causes blood flow obstruction and leads to excruciating
pain, organ and joint damage in the afflicted individual know as sickle cell crisis (Center for
SICKLE CELL DISEASE IN AFRICAN AMERICANS 4
Disease Control and Prevention, 2017). The Center for Disease Control and Prevention goes on
to state that sickle cell crisis, and corresponding pain, is the number one reason individuals with
sickle cell disease go to the emergency room. It is impossible to determine the number one cause
of sickle cell crisis, so focus on specific triggers, including dehydration, infection, injury, cold
exposure, emotional stress, or strenuous exercise, as an integral part of discharge teaching, need
to be addressed. This will help in the proper management of sickle cell disease and prevent
hospitalization from sickle cell crisis.
Cultural Assessment of African Americans
Utilizing a cultural assessment tool allows care to be centered around a person’s culture,
to better assess the specific health needs of the individual (Boyle & Baird, 2016). According to
the National Institutes of Health’s Office of Communications and Public Liaison (NIH OCPL,
2017), cultural respect is important in reducing health disparities and enhancing access to care
that respects and responds to the needs of culturally diverse individuals. The NIH OCPL further
explains that positive health outcomes are supported and benefit the individual, community and
health care organization. Cultural assessment, with regard to African Americans, is an important
tool, because of health care professional suspicion. This suspicion tends to delay treatment and
care, often leading African Americans to choose home remedies to treat their specific conditions
(Campinha-Bacote, 2009). Cultural assessment allows nurses to truly know the client, to respect
their values, beliefs and customs and to treat them with compassion by suspending judgement
and bias.
Family and kinship systems
When one thinks about family, a sense of belonging, safety, love and caring are felt.
Hecht, Jackson and Ribeau (2003) state that family, to the African American culture, is the
SICKLE CELL DISEASE IN AFRICAN AMERICANS 5
principle and paramount tradition to one’s culture. When looking at African American family
structure, a primarily matriarchal relationship is manifested. African American mothers feel a
responsibility to serve others, portray a sense of strength, withhold emotion and emanate a sense
of independence regarding success (Abrams, 2012). Abrams further states that African American
women are pressured to be strong and preserve unity in the family and community dynamic.
Edwards (2013) adds that this belief system helps to classify the African American family into
an extended family unit which incorporates both family and community.
African Americans prefer to be addressed formally and by their surname, because of the
pride they have for their family name (Campinha-Bacote, 2009). Referring to these clients with
Mr., Mrs., Ms., or Miss., demonstrates respect for the African American culture. Camponha-
Bacote (2009) continues by stating that non-verbal communication is used continuously during
conversation, and that African Americans level of volume is higher that other cultures. It is
important to not misunderstand this increased volume with a negative attitude while
communicating discharge teaching to these clients.
Social life and networks
Education to the African American community is an important part of life, with an
emphasis on equality and opportunity for social mobility and economic independence (Anderson,
2016). However, Anderson continues by stating that there are breaks in the African American
educational system which result in inadequate and insufficient learning opportunities for students.
Anderson’s study provides statistics showing 96 percent of African American families feel a
sense of disappointment with the educational system. This disappointment in the educational
system provides a barrier to optimal health care and contributes to low health literacy affecting
about forty-percent of African Americans (Campinha-Bacote, 2009).
SICKLE CELL DISEASE IN AFRICAN AMERICANS 6
Religious beliefs and practices
As humans, reliance on cultural influences helps to guide and mold one throughout their
growth and development. African Americans are statistically more active in their religion than
any other race in the US. For example, of all Christians in the US, 53 percent are African
American protestants, and 83 percent of African Americans believe in God (Pew Research
Center, 2018). A large emphasis is placed on their religious culture as being the focal point in
one’s life. This was brought about secondary to the experiences and hardships they endured
while under slavery.
Spirituality issues, according to Adegbola (2011), including hopelessness, negative self-
talk, and pessimism, often affect African American adults with sickle cell disease. The author
continues by stating African Americans feel that little can be done to change the course of sickle
cell disease, which is the cause of much despair. This despair is important to address during
discharge of patients with sickle cell disease. When patients are hospitalized, specific guidelines
and follow-up advice must be followed to prevent rehospitalization and further complications of
sickle cell disease. Cotton (2012) reports that adults with sickle cell disease who use positive
religious coping, like prayer, report a significant decrease in the amount of hospital admissions.
There was also a noteworthy decline in pain scores when African American attended church on a
regular basis.
African American churches serve as central institutions in the community and spiritual
aspects of these Christian lives (Taylor, Chatters and Brown, 2014). The church congregation
serves as an unwavering support system with many resources. According to Ehrmin (2016),
religion is viewed as the heart of the African American culture and is utilized to help achieve and
maintain optimal health. Individuals engaging in religious activities enhance their social support
SICKLE CELL DISEASE IN AFRICAN AMERICANS 7
systems and networks through increased exposure to church members. This in turn helps to
develop coping mechanisms through spirituality and religious bonding (Le, Holt, Hosack, Huang,
& Clark, 2015).
Health beliefs and practices
Health, to African Americans, is a road endured with God in one hand and medicine in
the other. Both entities must be present for true spiritual, mental and physical health to be
maintained. Health can be influenced through fellowship, trusting relationships, constructive
criticism and an exchange of emotional and physical support (Le et al., 2015). The African
American church helps to understand health as being a complete balance between physical,
mental, and spiritual well-being, making health promotion through church activities ideal
(Collins, 2015). African Americans view health care in a spiritual manner, and when it comes to
pain, like in sickle cell disease, they believe that evil forces or punishment from God are
responsible and require repentance (Campinha-Bacote, 2012).
Long et al., (2011) describe common health disparities and misconceptions among the
African American community as it relates to sickle cell disease. Some of these themes include
limited prominence of sickle cell disease and trait health awareness, stigma associated with
sickle cell disease in the African American community, and a desire for compassionate and
culturally competent care from health professionals.
Research shows that African Americans number one restaurant choices usually fall in the
fast food category with a twenty-nine percent statistic, second being sit-down restaurants at
twenty-sex percent and third being soul food establishments at twenty-two percent (Mandal,
2013). A study done by Savoca (2011), on food choices of young adult African American males,
shows an “eat and run” approach to meal planning leading to increase intake of sugar and fat,
SICKLE CELL DISEASE IN AFRICAN AMERICANS 8
and poor intake of healthy foods. These participants had an extremely high intake of fast food
meals and infrequently cited eating healthy meals containing whole grains, nuts, seeds, or
legumes. Smoking is shown to be higher in the African American culture as opposed to any other
population and accounts for 45,000 deaths per year from smoking related diseases (Mandal,
2013). A study done by Cohen et al., (2010) indicates that active and passive cigarette smoke
exposure increase vascular inflammation, platelet aggregation and expression of endothelial
adhesion molecules that increase risk for sickle cell crisis.
Discharge Teaching for Sickle Cell Disease
Nurses can provide culturally competent care in hospital settings and community settings
regarding education and discharge teaching to help reduce risks associated with this population
(Boyle et al., 2016). Discharge teaching, for African Americans, should encompass the
community cultural assessment referenced earlier in this paper. Also, it helps to establish a
working nurse-patient relationship for mutually agreed upon discharge teaching plans and
instructions. Appendix B provides a detailed brochure, from the Indiana Hemophilia and
Thrombosis Center (2015), for managing sickle cell disease at home. Appendix G demonstrates a
sample discharge summary for a 24 y/o male with a hospital admission for sickle cell crisis and
dehydration.
Managing sickle cell disease
Discharge planning will address the most common causes that precipitate acute sickle cell
crisis including dehydration, infection, extreme changes in temperature, smoking and reduced
oxygen availability. Preventing infections, in persons with sickle cell disease, requires strict
adherence to handwashing as the best defense against pathogens (National Center on Birth
Defects and Developmental Disabilities, 2017, Appendix D). Food safety involves washing fruits
SICKLE CELL DISEASE IN AFRICAN AMERICANS 9
and vegetables and avoiding all raw and unpasteurized food products. Reptiles can harbor
harmful pathogens and should be avoided, included but not limited to, turtles, snakes and lizards.
Vaccinations given at regular developmental growth periods with boosters will help decrease
infection risk.
The National Heart, Lung, and Blood Institute (2014) describe coping with pain in sickle
cell crisis as a difficult endeavor. However, pain management will most likely involve prescribed
or over the counter medications. Collaboration with a health care provider to develop a pain
management plan is of the upmost importance (Appendix E). Soe et al., (2017) report about a
study done with the administration of vitamin D, showing 10 fewer days of pain when compared
to the placebo group. Other alternatives to pain medications, as mentioned by the NHLBI,
involve heating pads, warm baths, massages, acupuncture, physical therapy, chiropractic and
distracting or relaxing activities. Some of these activities include listening to music, talking on
the phone or watching TV.
Living with a chronic disease can be stressful and cause emotional problems. Support
services that may help include counseling, psychiatry, church congregations and support groups
(National Heart, Blood and Lung Institute, 2014). Visit American Sickle Cell Anemia
Association (2010) for support groups near you at http://www.ascaa.org/support-groups.php .
The National Heart, Lungs and Blood Institute (2014) advocate for the maintenance of a healthy
lifestyle to help reduce risk for infections and crisis. Attention to a nutritious and well-balanced
diet, sleep, regular physical activity and hydration is key to a healthy lifestyle.
Medication used to treat sickle cell disease
Hydroxyurea is used to decrease the number of crisis encountered by those afflicted with
sickle cell disease (Rodgers & George, 2017). It works by increasing production of Hemoglobin
SICKLE CELL DISEASE IN AFRICAN AMERICANS 10
F which helps to inhibit sickling (Maakaron, 2017). The medication is dosed based on weight,
initially 15mg/kg/day taken in one daily dose. After low dose initiated and titrated to reduce
crisis, blood counts are monitored every 2 weeks to prevent toxicity. Dose may be increased by 5
mg/kg/day every 12 weeks until the maximum tolerated dose of 35 mg/kg/day is achieved
(Lexicomp, n.d.). Once the dose is determined, the available form for adults in 200-500 mg
capsules are provided. Side effects to be aware of include nausea, vomiting, diarrhea, loss of
appetite, weight gain, sores in mouth, constipation, rash, pale skin, dizziness, hair loss and
darkening of skin and nails (The American Society of Health-System Pharmacists, 2015).
The U.S. Food and Drug Administration [FDA] (2017) approved Endari (L-glutamine)
Oral Powder to reduce acute complications of sickle cell disease, including sickle cell crisis.
RxList (2017) claims that L-glutamine may improve the nicotinamide adenine dinucleotide
(NAD) redox potential in sickle red blood cells by increasing the availability of reduced
glutathione. This helps reduce cellular damage and decrease chance of hemolysis and sickle cell
crisis. Adult dosage is based on weight less than 30kg (5g dose BID), 30-65kg (10g dose BID),
and greater than 65kg (15g dose BID). The powder is mixed in 8 oz of fluids or 4-6oz of pureed
food prior to ingestion. The FDA (2017) list the side effects as follows, constipation, nausea,
headache, abdominal pain, cough, pain in the extremities, back pain, and chest pain.
Activity level and restrictions
Gradual mild to moderate exercise may reduce risk of crisis, decrease pain and increase
respiratory muscle strength. Moderate exercise, 50 percent of maximal aerobic power, should be
included 2-3 days per week for 10-30 minutes at a time (Connes, Machado, Hue, & Reid, 2011).
Special consideration for one’s aerobic level in important in determining the amount of time
spent exercising, so as not to induce a sickle cell crisis. Some exercises may include strength
SICKLE CELL DISEASE IN AFRICAN AMERICANS 11
training, endurance exercises, gymnastics, stationary bicycle riding, games, aquatic rehab,
kinesiology, stretching, aerobics and relaxation like yoga or Pilates. It is extremely important to
rest every 20 minutes of exercise to avoid dehydration and lactic acid accumulation which can
precipitate crisis. Drinking water during and after exercising, preventing cold or heat stress with
outdoor activities and avoid any strenuous activity will help in avoiding a crisis.
Nutritional needs
Nutritional needs for those with sickle cell disease include eating a nutritious and
balanced diet (Appendix C). This includes whole fruits, varied vegetables, whole grains, varied
proteins, dairy and oils (United States Department of Agriculture [USDA], 2017). Special
attention to the vitamins and minerals, especially folic acid, can be accomplished by
incorporating extra leafy green vegetables to help counter micronutrient deficiencies (Mandese et
al, 2016). Some foods that contain folic acid include leafy greens, asparagus, broccoli, citrus
fruits, beans, peas, lentils, and brussel sprouts (National Institutes of Health, 2016). Dehydration
is a main contributor to sickle cell crisis and drinking minimum 8-10 glasses of water daily will
help prevent this complication (National Center on Birth Defects and Developmental Disabilities,
Division of Blood Disorders, 2011). Pells et al., (2005) state that a majority of the African
American participants with sickle cell disease report eating less and significantly decreasing their
intake of fats and proteins during episodes of pain.
Criteria for notifying or following-up with physician
Ongoing medical care is essential to prevention of complications with sickle cell disease,
of an adult, by maintaining a good primary care doctor, hematologist, and keeping
immunizations up to date (CDC, 2017). Health maintenance requires routine medical evaluations
every 2-6 months, yearly HIV and hepatitis testing, and routine dental exams. Important
SICKLE CELL DISEASE IN AFRICAN AMERICANS 12
immunizations for the adult with sickle cell disease include tetanus, influenza, hepatitis and
pneumococcal.
Follow up after hospitalization is important to make sure recurrence of crisis does not
occur. In the meantime, see a doctor right away if you have any of the following serious signs or
symptoms, Appendix F, including severe uncontrolled pain, fever, stroke symptoms, difficulty
breathing, abdominal pain, increased fullness without eating or eating little, sudden vision loss,
pale skin, weakness, fatigue, shortness of breath, dizziness, tingling or crawling of skin, coldness
in hands or feet and chest pain (National Heart, Lungs, and Blood Institute, 2017).
Avoiding Ethnocentrism in Discharge Teaching
A culturally competent nurse can reflect on one’s cultural self-assessment and clinical
experiences to learn, grow, accept, and incorporate better nursing practices into culturally
competent nursing care for African Americans. This can be achieved by being consciously aware
of one’s own cultural influences to relay a positive, caring, and advocative attitude no matter the
situation or culture present. Avoiding ethnocentrism, in discharge teaching, by focusing on the
clients’ values, and not ones’ own values, will create a foundation for learning and culturally
competent nursing care and teaching to take place. It also helps to establish a strong nurse-patient
relationship, so mutual goals can be agreed and acted upon without bias or restraint. For this
cultural competence to work, a personal cultural self-assessment of one’s relatability to various
groups must be completed. Also, the African American client should be provided with cultural
care preservation or maintenance techniques, accommodation or negotiation techniques, and
repatterning or restructuring ideas. Practicing these assessments, decisions or actions, allows one
to participate in culturally competent decision making and care.
Self-Reflection
SICKLE CELL DISEASE IN AFRICAN AMERICANS 13
One step in cultural competent care is cultural self-reflection influenced by one’s
commitment to compassion, healing, advocacy, integrity, altruism and professionalism. Integrity
integrates one’s cultural and professional values, concern for the well-being of others and one-
self, and allows one’s emotions to help pave the way to a therapeutic nurse-patient relationship.
Reflection from Olsen (2014) helps to understand that developing acceptance, through cultural
self-reflection, requires gaining personal meaning from nursing encounters and interactions with
clients. The evolution of culturally competent care stems from reflection on previous clinical
experiences with African American, by understanding their cultural preferences, how they
communicate and how they incorporate their religion into their health practices. This helps in the
incorporation of true cultural acceptance after evaluation of one’s values, prejudices and beliefs.
This reflection helps in the development of a trusting nurse-patient relationship to decrease the
stigma African Americans have with health care professionals.
Cultural care preservation or maintenance
Providing cultural care preservation or maintenance allows nurses to suspend judgment
and accept that other cultural practices, along with traditional medicine, may be beneficial in
healing from illness or disease (Andrews and Murray-Wright, 2016). This allows one to preserve
and honor core values regarding personal cultural beliefs and practices. It is imperative to gain an
understanding of whatever the cultural, medicinal, or religious desires of the African American
client are to provide a trusting caring environment.
Cultural care accommodation or negotiation
Accommodation or negotiation help to promote acceptance of combined cultural
practices or folk remedies with the dominant culture’s medical practices and (Andrews and
Boyle, 2016). This combination helps clients, with a designated culture, to adapt to or negotiate
SICKLE CELL DISEASE IN AFRICAN AMERICANS 14
with the healthcare teams approach to include personal healing techniques used to maintain
health and well-being. The care plan should be a mixture of medications and health regimens that
incorporate both these practices.
Cultural care repatterning or restructuring
Open mindedness can help clients to repattern or restructure their way of thinking, or
lifestyle choices, for new, different, and beneficial health ideas that promote health maintenance
(Andrews and Boyle, 2016). In this restructuring, the care plan is taking into consideration
cultural and health-related beliefs, while assisting in the modification of beliefs and practices for
the promotion of health. This restructuring allows one to be open-minded and change their way
of thinking while also maintaining their personal beliefs and values. The nurse can use creative
ways of incorporating change without interfering in the clients’ cultural beliefs. This change is
usually geared toward practices or behaviors that may cause harm. An example of this may be
the use of prayers and blessings as a means of healing alone, and not allowing treatment
procedures and medications to be used. A second example is the use of nicotine via cigarette
smoking, which is highly prevalent in African Americans and increases risk for sickle cell crisis.
Conclusion
Being able to provide culturally competent care and discharge teaching is the goal for any
nurse and can be accomplished first by self-reflection of one’s culture, values and beliefs. Once
this reflection is done a true acceptance for others’ beliefs can begin and discharge teaching can
be molded to the client’s individual culture. Understanding one’s strengths and weaknesses,
when it comes to acceptance of various groups, will help in bias restraint by suspending
judgement. Finally, the nurse can utilize Leininger’s culture care decisions and actions to help
create a culturally competent discharge teaching plan which incorporates preservation or
SICKLE CELL DISEASE IN AFRICAN AMERICANS 15
maintenance techniques, accommodation or negotiation techniques, and repatterning or
restructuring ideas (Andrews & Murray-Wright, 2016). The ideas and decisions of cultural care
allow the client and nurse to work together to comprise a mutually agreed upon discharge plan.
Incorporating the culture, values, and beliefs in this plan will ultimately lead to the development
of a strong nurse-patient relationship, a stepping stone to culturally congruent care and a
decrease in rehospitalizations in African Americans with sickle cell disease.
SICKLE CELL DISEASE IN AFRICAN AMERICANS 16
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SICKLE CELL DISEASE IN AFRICAN AMERICANS 23
Appendix A
Hemoglobin A and Hemoglobin S (National Human Genome Institute, 2016)
SICKLE CELL DISEASE IN AFRICAN AMERICANS 24
Appendix B
Sickle Cell Disease Home Management (Indiana Hemophilia and Thrombosis Center, 2015)
SICKLE CELL DISEASE IN AFRICAN AMERICANS 25
SICKLE CELL DISEASE IN AFRICAN AMERICANS 26
Appendix C
My Plate (USDA, 2017)
SICKLE CELL DISEASE IN AFRICAN AMERICANS 27
Appendix D
Infection Prevention (National Center on Birth Defects and Developmental Disabilities, 2017)
SICKLE CELL DISEASE IN AFRICAN AMERICANS 28
Appendix E
Managing Sickle Cell Disease (National Center on Birth Defects and Developmental
Disabilities, 2017)
SICKLE CELL DISEASE IN AFRICAN AMERICANS 29
Appendix F
When to see a doctor (National Center on Birth Defects and Developmental Disabilities, 2017)
SICKLE CELL DISEASE IN AFRICAN AMERICANS 30
Appendix G
Sample Discharge Teaching
Discharge Summary
Patient Name: John Doe 24y/o M
Admission Date: 2/20/2018
Discharge Date:2/25/2018
Attending Physician: Smith, MD
Primary Care Physician: Wilke, MD
Referring Physician: Smith, MD
Consulting Physician(s): Hematologist Anderson, MD
Final Diagnosis: Acute Sickle Cell Crisis, Dehydration
Vital Signs:
Weight: 165lb; Oxygen Saturation: 93% RA
Pulse: 90; Respirations: 18
Blood Pressure: 128/84 (99); Temperature: 98.9 °F
Discharge Medications:
Hydroxyurea 1000mg- 2300mg/day capsules (blood draws every 2 weeks to determine
therapeutic dose)
Endari (L-glutamine oral powder)15g BID (Mix Endari immediately before ingestion with 8
oz of fluids or 4-6 oz of soft foods)
Ibuprofen 600mg tabs Q6 hours PRN for mild pain
Acetaminophen 500mg tabs Q4-6 hors PRN for mild pain
Oxycodone 10mg every 4-6 hrs as needed for severe pain
Discharge Instructions: Managing Sickle Cell Disease (SCD)
Prevent and Control Complications:
Prevent infections:
o Frequent handwashing is the best defense
o Food safety- no raw or unpasteurized food products, wash fruits and vegetables
o Reptiles- avoid turtle’s, snakes and lizards
o Vaccinations- get all recommended vaccines
SICKLE CELL DISEASE IN AFRICAN AMERICANS 31
o Prophylactic antibiotics for children 2 mo-5 years and high-risk adults
Coping with Pain:
o Collaborate with HCP to develop a pain management plan.
o Other alternative methods to help control pain include:
Heating pads
Warm baths
Massages
Physical therapy
Acupuncture
Distracting and/or relaxing activities, such as listening to music, talking
on the phone, or watching TV
Mental Health:
o Living with a chronic disease can be stressful and cause emotional problems
support services include:
Counseling
Psychiatrist
Support groups
Visit American Sickle Cell Anemia Association for support
groups near you at http://www.ascaa.org/support-groups.php
Pursue a Healthy Lifestyle:
o Eat a nourishing diet
o Get enough sleep
o Regular physical activity- avoid strenuous activities
o Hydration
Activity Level and Restrictions
Exercise
o Gradual mild to moderate exercise may reduce risk of crisis, decrease pain and
increase respiratory muscle strength
Moderate (50% of maximal aerobic power) exercise for 10-30 minutes 2-
3 times per week
strength training
endurance exercises
gymnastics
stationary bicycle riding
games
aquatic rehab
kinesiology
stretching
aerobics
relaxation (Yoga, Pilates)
Rest every 20min of exercise to avoid dehydration and lactic acid
accumulation
Drink water during and after exercising
SICKLE CELL DISEASE IN AFRICAN AMERICANS 32
Prevent cold or heat stress with outdoor activities
Avoid any strenuous activity
Nutritional needs
Drink at least 8-10 glasses of water daily
Eat a healthy balanced diet
o Whole fruits
fresh, frozen, dried, and canned options
o Varied Vegetables
dark-green vegetables, red and orange vegetables, legumes (beans and
peas), starchy vegetables, and other vegetables
o Whole grains
o Varied Proteins
animal (seafood, meat, poultry, and eggs) and plant sources (nuts, beans
and peas, seeds, and soy products)
o Dairy (low-fat or fat-free)
milk, yogurt, cheese, and calcium-fortified soy beverages (soymilk)
o Oils
Choose the right amount of oil to stay within your daily calorie needs
o Add extra green vegetables to help counter micronutrient deficiencies
vitamins A, B2, B6, B12, C, D, E, iron, calcium, magnesium and zinc
folic acid
Dark leafy greens
Asparagus
Broccoli
Citrus fruits
Beans, peas and lentils
Brussel sprouts
Criteria for notifying or following-up with physician
See a doctor right away if you have any of the following serious signs
o Severe uncontrolled pain
o Fever
o Stroke symptoms
Altered mentation and speech and facial droop
o Difficulty breathing
o Symptoms of spleen enlargement
Abdominal pain, increased fullness without eating or eating little
o Sudden vision loss
o Symptoms of severe anemia
Pale skin, weakness, fatigue, shortness of breath, dizziness, tingling or
crawling of the skin, coldness in hands or feet and chest pain
Ongoing Medical Care:
SICKLE CELL DISEASE IN AFRICAN AMERICANS 33
Maintain a good primary care and hematologist to get regular checkups
o Annual Physical
labs, immunizations, and counseling on preventive measures
Penicillin prophylaxis
prophylaxis for surgical procedures
o Adult health maintenance requires routine medicals evaluations every 2-6
months
Immunizations
Tetanus, influenza and hepatitis annually
Pneumococcal every 5years
HIV and Hepatitis testing annually
Routine Dental exams to prevent SCD complications
Follow up Appointments:
Hematology Oncology Associates: Call for an appointment within 1 week
Anderson, MD (505) 727-3040
715 Dr Martin Luther King Jr Ave NE #102, Albuquerque, NM 87102