A nurse is admitting an 8-year-old child to the pediatric unit.

Exhibits

For each potential condition, click to specify if the child's assessment findings are consistent with Hodgkin Lymphoma, Bacterial Meningitis, or Acute Lymphoblastic Leukemia (ALL). Each finding may support more than 1 diseases.

• IV hydromorphone: This potent opioid analgesic is indicated for managing severe pain during vaso-occlusive crises in sickle cell disease, especially when pain reaches a level of 10/10 despite prior interventions. Rapid IV delivery ensures quicker pain relief.
• Pain: The child’s reported pain escalation from 7 to 10 out of 10, along with swelling and warmth of the knee, strongly indicates severe vaso-occlusive pain, which is a hallmark of sickle cell crisis requiring urgent analgesic management.

Rationale for Incorrect Choices:

• Oxygen at 2 L/min via nasal cannula: The child’s oxygen saturation remains normal at 96% on room air, indicating no current hypoxia. Supplemental oxygen is not necessary unless oxygen saturation drops or respiratory distress develops.
• Oral amoxicillin: There are no clinical signs or lab evidence of infection (e.g., normal WBC count, no fever), so antibiotics are not warranted. Prophylactic antibiotics may be used in certain sickle cell scenarios but are not indicated here.
• Hypoxia: The child maintains normal oxygenation, making hypoxia an unlikely contributing factor to the current presentation. Hypoxia would require both clinical signs (e.g., low SpO₂) and symptoms like shortness of breath.
• Signs of infection: The absence of fever, normal WBC count, and localized pain without erythema or drainage suggest that infection is not present at this time. Pain is due to vaso-occlusion, not infectious origin.

A. "I will increase my intake of vitamin D.": People with cystic fibrosis have fat malabsorption, which affects absorption of fat-soluble vitamins like A, D, E, and K. Supplementing vitamin D is essential to support bone health and prevent deficiencies.

B. "I will limit my calcium intake to prevent kidney stones.": Limiting calcium is not recommended. In fact, individuals with cystic fibrosis are at risk for low bone mineral density and need adequate calcium intake along with vitamin D to support bone development and prevent osteoporosis.

C. "I will be excused from physical education class.": Physical activity is encouraged in individuals with cystic fibrosis. It helps improve lung function, clear mucus from the airways, and maintain overall physical health. Avoiding PE would be counterproductive.

D. "I will take fewer enzymes when I eat high-fat foods.": High-fat foods require more pancreatic enzyme replacement to aid digestion and absorption. Taking fewer enzymes would result in malabsorption and GI symptoms.