A nurse is assessing a preschool-age child who has celiac disease. Which of the following findings should the nurse expect?

A vaso-occlusive crisis in sickle cell disease occurs when sickled erythrocytes obstruct blood flow in small vessels, leading to ischemia, severe pain, and tissue hypoxia. Management prioritizes relieving pain, improving oxygenation, maintaining hydration, and preventing further sickling episodes. Pain control is a cornerstone of therapy because uncontrolled pain increases stress responses, which can worsen vaso-occlusion. Nursing care focuses on timely and consistent analgesia along with supportive measures.

Rationale:
A. Ambulating the child in the halls four times each day is inappropriate during an acute vaso-occlusive crisis because physical activity increases oxygen demand and can worsen tissue hypoxia and pain. During crisis, the child should be encouraged to rest to reduce metabolic demands and prevent further sickling of red blood cells.

B. Restricting the child’s fluid intake is contraindicated because dehydration increases blood viscosity and promotes sickling of red blood cells. Adequate hydration is essential to improve circulation and reduce vaso-occlusion. Fluid restriction would worsen the condition and increase pain and complications.

C. Applying cold compresses to painful extremities is inappropriate because cold causes vasoconstriction, which can further reduce blood flow and worsen ischemia in already compromised tissues. Warm compresses are generally preferred to promote vasodilation and improve circulation in affected areas.

D. Administering prescribed pain medication around the clock is correct because consistent analgesia is essential in managing vaso-occlusive crisis. Scheduled pain control prevents pain escalation, reduces physiologic stress, and helps minimize further sickling triggered by stress responses. Effective pain management is a priority intervention in sickle cell crisis care.

Acetylsalicylic acid (aspirin) overdose in children is a medical emergency that leads to a complex disturbance of the acid-base balance and interferes with normal clotting mechanisms. Aspirin inhibits the synthesis of vitamin K-dependent clotting factors and can induce a state of hypoprothrombinemia, significantly increasing the risk of spontaneous or internal hemorrhage. Nursing management involves stabilization, gastrointestinal decontamination, and the administration of specific agents to counteract the systemic effects of the salicylate toxicity.

Rationale:

A. Naloxone is a concentrated opioid antagonist used specifically to reverse respiratory depression and sedation caused by opioid overdose (such as morphine or fentanyl). It works by competing for opioid receptor sites in the brain. Because acetylsalicylic acid is a non-steroidal anti-inflammatory drug (NSAID) and not an opioid, naloxone would have no therapeutic effect in reversing the metabolic acidosis or the toxic effects associated with an aspirin overdose.

B. Phytonadione (Vitamin K) is administered in cases of aspirin overdose to manage the risk of bleeding. Large doses of salicylates can interfere with the liver's ability to produce prothrombin, leading to a prolonged prothrombin time (PT). By providing exogenous Vitamin K, the nurse helps restore the body’s ability to synthesize clotting factors, thereby reducing the risk of hemorrhagic complications while the body clears the toxic levels of salicylate from the system.

C. Midazolam is a benzodiazepine used for sedation, anxiety reduction, and the management of active seizures. A severe aspirin overdose can eventually lead to neurological symptoms or seizures in its terminal stages, but midazolam is not a corrective treatment for the overdose itself. Furthermore, it could potentially mask neurological changes that the nurse needs to monitor closely, such as the progression of salicylate-induced encephalopathy.

D. Flumazenil is a specific reversal agent used for benzodiazepine toxicity. It works by competitively inhibiting the activity at the benzodiazepine receptor site on the GABA receptor complex. It has no pharmacological interaction with salicylates and would be ineffective in treating a child who has ingested a toxic amount of acetylsalicylic acid, as the underlying pathology involves metabolic and hematologic dysfunction.