A nurse is caring for a 3-year-old child.

Exhibit 1

Exhibit 2 Nurses' Notes

0730:

Child presents to the emergency department (ED). Guardians report the child woke up coughing with a low-grade fever. Child appears alert and restless in guardian's arms.

Respirations easy, no cough noted.

0800:

Child became agitated. Hoarse cry noted with audible inspiratory stridor. Barking, nonproductive cough present.

For each of the following findings, click to specify if the finding is consistent with acute laryngotracheobronchitis or pneumonia. Each finding may support more than one disease process.

Assessment Findings: Acute laryngotracheobronchitis /Pneumonia

A. Administer IV fluids intake: Hydration is a key intervention during a vaso-occlusive crisis. IV fluids help reduce blood viscosity and promote better circulation, which decreases the risk of further sickling.

B. Give oral hydroxyurea: Hydroxyurea reduces the frequency of sickling episodes by increasing fetal hemoglobin levels. It is part of long-term therapy and may be continued during acute care.

C. Administer meperidine IV for pain: Meperidine is avoided because its metabolite, normeperidine, can cause neurotoxicity and seizures. Opioids such as morphine or hydromorphone are preferred.

D. Instructing the parent to ensure the pneumococcal vaccine is current: Children with sickle cell disease are functionally asplenic and at high risk for infection. Ensuring vaccines are up to date is an important component of overall care.

E. Place the client on strict bedrest: Limiting activity helps reduce oxygen demand and pain caused by movement during a crisis. Bedrest supports recovery and comfort.

F. Apply cold compresses to the affected joints: Cold therapy causes vasoconstriction, which can worsen sickling. Warm compresses are preferred to improve blood flow and relieve pain.

G. Monitor oxygen saturation continuously: Monitoring oxygen saturation allows for early detection of hypoxia, which can trigger or exacerbate sickling episodes. Prompt intervention helps prevent complications.

A. Stevens-Johnson syndrome is a severe, rare, and potentially life-threatening reaction that can occur as a hypersensitivity reaction to certain medications. However, it is not typically associated with morphine use.
B. Morphine is more commonly associated with hypotension rather than hypertension. Therefore, while monitoring for changes in blood pressure is important, hypertension is not a primary concern with morphine administration.
C. Morphine use is not typically associated with prolonged wound healing. However, it can cause respiratory depression, which can indirectly affect wound healing by reducing tissue oxygenation.
D. Morphine is a potent opioid analgesic that can cause respiratory depression, leading to bradypnea (slow breathing) or even respiratory arrest. Monitoring respiratory rate is crucial when administering morphine to detect signs of respiratory depression early and intervene promptly.