A home health care nurse is visiting an older adult client who tells the nurse that she is feeling tired, is unable to shop for groceries, and would like the nurse to shop for her. Shopping and performing personal errands for the client is prohibited in the nurse's job description. Which of the following is an appropriate nursing response?

A. Bradycardia, or a slow heart rate, is not a typical finding during a sickle cell crisis. In fact, during a crisis, the child may exhibit tachycardia (increased heart rate) due to pain, stress, and potential hypoxia.
B. While constipation can be a complication in children with sickle cell disease (often related to pain medications or dehydration), it is not a primary symptom of a sickle cell crisis itself. The immediate concerns in a crisis are related to pain and vaso-occlusive episodes.
C. High fever is not a direct symptom of a sickle cell crisis. Although children with sickle cell disease are at increased risk for infections, which can cause fever, a fever is not a typical finding specifically related to a sickle cell crisis. It is essential to assess for infection, especially if fever is present.
D. Pain is the hallmark symptom of a sickle cell crisis, often referred to as a vaso-occlusive crisis. The sickle-shaped red blood cells can block blood flow in small vessels, leading to severe pain in various parts of the body, such as the chest, abdomen, and joints.

A. While it is important to address concerns about impairment, confronting the nurse directly can be counterproductive and may escalate the situation. It is essential to approach the situation with caution and follow established protocols for dealing with suspected substance impairment.
B. While gathering observations from colleagues may seem reasonable, it can create a culture of gossip and may violate confidentiality. This approach can also lead to misinformation and should not be the first step in addressing a serious concern about a colleague's safety and well-being.
C. Documenting observations is important, but it should not be the sole action taken at this point. Communicating with the personnel department is part of the process if the situation escalates, but immediate action is necessary to ensure patient safety.
D. This option is the most appropriate initial action. By closely monitoring the nurse’s behavior, the manager can gather more information before taking further steps. This approach allows for the collection of objective data and ensures patient safety while avoiding premature accusations.