Sickle Cell Disease
The nurse instructed the parents of a child with sickle cell disease how to administer deferoxamine (Desferal), an iron chelating-drug. Which patient statement indicates a need for further teaching?
"I should continue the infusion if my child develops shortness of breath."
Which statement by the nurse explains the cause of pain in patients with sickle cell disease?
"The lack of oxygen that happens in organs and bones from clumped sickle cells causes intense pain."
Which statement by the nurse to the parents of a child with sickle cell disease accurately explains the reason for periodic blood transfusions?
"They have proven to decrease the incidence of strokes in children."
At which age should the nurse expect to prepare a patient with sickle cell disease for routine head ultrasonography in order to assess cerebral blood flow?
2 years
Which collaborative intervention should the nurse recognize as a potential cure for patients with sickle cell disease?
Bone marrow transplant (recurs in approximately 10% of transplant recipients
A nurse educator is teaching a group of parents how to prevent a sickle cell crisis in the child with sickle cell disease. What precipitating factors that could contribute to a sickle cell crisis should the nurse teach the parents? Select all that apply. Warm Temperatures Increased Fluid Intake Emotional or physical stress High altitudes Fever and infection
Emotional or physical stress High altitudes Fever and infection
The nurse is analyzing and synthesizing assessment data related to the care of the patient with sickle cell disease (SCD). Which nursing diagnosis represents the highest priority when planning nursing care for the patient with SCD? (NANDA-I © 2014)
Gas Exchange, Impaired
Which factor should the nurse suspect precipitated a sickle cell crisis in a patient?
Going snow skiing on Vacation
The patient with sickle cell disease reports mild pain of 2/10 to the nurse. Which intervention would be most appropriate for this pain level?
Massage
The nurse is giving an in-service about the assessment and care of children who are diagnosed with sickle cell disease (SCD). Which information should the nurse include?
Newborn blood testing for sickle cell disease usually involves obtaining a blood sample by way of a heelstick.
The nurse is assigned to care for a client with sickle cell disease who is being admitted with splenic sequestration crisis. Which room would be the most appropriate for this client?
Private room (away from other infectious patients)
The patient with sickle cell disease (SCD) is preparing to be discharged to home. Which topic is appropriate for the nurse to include when providing home care teaching?
Recognizing signs of splenic sequestration
What teaching is most important for the nurse to provide the patient with sickle cell disease to prevent hypoxemia?
Refrain from traveling to high altitudes
In which circumstance should the nurse anticipate a patient with sickle cell disease to undergo a splenectomy?
Sequestration of red blood cells
Which statement describes the effects of sickle cell disease (SCD) on red blood cells (RBCs)?
Sickling dramatically decreases the life span of affected RBCs.
A nurse is planning care for a client with sickle cell disease and chooses "Acute Pain" as the nursing diagnosis. Which intervention is inappropriate for the nurse to include in this plan of care? Place client in position of comfort. Support the client's joints and extremities with pillows. Use heat or cold packs as tolerated. Administer prescribed analgesic medications around the clock.
Use heat or cold packs as tolerated.
Which intervention should the nurse include when teaching the parents of a toddler with sickle cell disease (SCD) regarding ways to prevent dehydration?
Use popsicles and flavored drinks to increase oral intake.
The nurse has developed a plan of care for a patient with sickle cell disease (SCD) who weighs 200 pounds. Included is the goal for the patient to urinate 0.5 mL/kg/h. Which 24-hour urinary output indicates this goal has been met?
1500 mL
The nurse should understand that which statement is true regarding sickle cell disease (SCD) in children?
A high level of fetal hemoglobin in children inhibits sickling of RBCs.
The patient with sickle cell disease (SCD) asks the nurse to explain vaso-occlusive crisis. Which information is appropriate for the nurse to include in the explanation?
Dehydration increases the risk for developing vaso-occlusive crisis.
The nurse is assessing the patient with sickle cell disease (SCD) for signs and symptoms of acute chest syndrome. Which assessment finding reflects this manifestation?
Increased white blood cell count
A client in sickle cell crisis reports taking a recent skiing trip that caused a respiratory infection from the cold weather. The client reports a pain level of 8 on a pain scale from 1 to 10. Which nursing diagnosis is a priority for this client?
Acute Pain
A patient with a history of sickle cell disease presents with chest pain, dyspnea, and a fever. The nurse administers oxygen at a high flow rate via mask. What is the rationale for this intervention?
Acute manifestations occur due to tissue Hypoxia
A client is admitted to the emergency department in a sickle cell crisis. The nurse assesses the client and documents the following clinical findings: temperature 102degreesF, O2 saturation of 89%, and complaints of severe abdominal pain. Based on the assessment findings, which intervention is the greatest priority? Administer Tylenol 650 mg by mouth. Apply oxygen per nasal cannula at 3 L/minute. Assess and document peripheral pulses. Administer morphine sulfate 10 mg IM.
Apply oxygen per nasal cannula at 3 L/minute.
The nurse is caring for a client who was admitted to a medical-surgical unit in sickle cell crisis. Which medication should the nurse expect to administer to this client? Meperidine (Demerol) Ibuprofen (Advil) Acetaminophen (Tylenol) Hydroxyurea
Hydroxyurea
The patient with sickle cell disease (SCD) is ordered to receive hydroxyurea. To correctly explain the rationale for administering hydroxyurea to the patient, which statement should the nurse include in the teaching?
Hydroxyurea decreases the production of abnormal blood cells
The nurse is assessing the patient with sickle cell disease (SCD) for manifestations of shock. Which assessment finding is most reflective of a classic manifestation of shock?
Pallor
The nurse is creating a presentation about pharmacologic treatments used in the care of patients with sickle cell disease (SCD). Which information is appropriate to include in the presentation?
Patient-controlled analgesia (PCA) machines may be ordered for patients with sickle cell disease.
The nurse is providing care to a 3-year-old client who is receiving treatment for sickle cell disease. The client is at risk for infection. Which medication does the nurse expect to administer to this client?
Penicillin
The nurse is caring for a patient who presents in sickle cell crisis. Which clinical manifestation should lead the nurse to conclude the patient is developing splenic sequestration?
Persistent hypovolemia
A patient with sickle cell disease is hospitalized for the third time in 6 months in crisis with an infection. What should the nurse include in the assessment to determine the cause of the infections?
Ability to afford daily antibiotics
Which information is appropriate for the nurse to include when teaching a patient with sickle cell disease (SCD) about ways to prevent infection?
Take antibiotics as prescribed.
The nurse is teaching the patient with sickle cell disease (SCD) about hemosiderosis, which is a complication associated with frequent blood transfusions. Which statement is appropriate for the nurse to include in the patient teaching?
"Hemosiderosis is storage of iron in tissues and organs."
A patient and her husband both carry the genetic trait for sickle cell disease (SCD). The patient asks the nurse, "What is the risk that we will have a child with sickle cell disease?" Which response by the nurse is accurate?
"There is a 25% chance that any of your children will have SCD."
Parents of a newborn infant are concerned that their baby may have sickle cell disease. The nurse reviews the medical record and finds that both parents have the sickle cell trait. Which is the best response for the nurse to give the parents?
"We are required to test all babies for sickle cell disease
The nurse developing a plan of care for a patient in sickle cell crisis includes "administer oral and intravenous (IV) fluids as ordered" as an intervention. What is the rationale for this intervention?
IV fluids decrease blood viscosity and clumping of sickled red blood cells.
The nurse is planning care for a young child who is admitted with sickle cell crisis. The parents are with the child, and neither has much information about the disease. When planning care for this family, the nurse will set which goal with this family?
The child will drink adequate amounts of fluid each day
An emergency department nurse is caring for a child in sickle cell crisis. The nurse suspects the etiology of the crisis as being thrombotic in nature because of which clinical manifestations? Select all that apply. The client has profound pallor and fatigue The client has profound hypotension and shock The client has fever The client's chest CT reveals a pulmonary infarct The client is in extreme pain.
The client has fever The client is in extreme pain.
