A nurse is caring for a toddler who has a short leg cast. Which of the following findings should the nurse report to the provider?

5 appropriate interventions:

A. Administer folic acid as prescribed. Folic acid is important for patients with sickle cell disease because it helps produce new red blood cells. Chronic hemolysis (destruction of red blood cells) is a hallmark of sickle cell disease, and folic acid supplementation aids in counteracting the effects of anemia by promoting red blood cell production.

B. Monitor oxygen saturation continuously. Continuous monitoring of oxygen saturation is crucial because hypoxia (low oxygen levels) can exacerbate sickling of red blood cells, leading to increased pain and vaso-occlusive events. Ensuring adequate oxygenation helps prevent further complications and supports overall management of the crisis.

E. Instruct the parent to ensure the pneumococcal vaccine is current. Patients with sickle cell disease are at increased risk for infections, including pneumococcal infections, due to functional asplenia (reduced spleen function). Ensuring vaccinations are up to date is a preventive measure to protect against serious infections, which can trigger or worsen a vaso-occlusive crisis.

H. Give oral hydroxyurea. Hydroxyurea is a medication used in the long-term management of sickle cell disease. It increases fetal hemoglobin (HbF) production, which helps reduce the frequency of vaso-occlusive crises and other complications by decreasing the sickling of red blood cells. It is part of a comprehensive approach to managing sickle cell disease.

Interventions to avoid:

C. Apply cold compresses to the affected joints:

Cold can cause vasoconstriction, which may worsen pain and decrease blood flow to the affected area, exacerbating the vaso-occlusive crisis. Instead, warm compresses are typically recommended to promote vasodilation and blood flow.

D. Restrict oral intake:

Hydration is crucial in managing vaso-occlusive crises. Restricting oral intake could lead to dehydration, which can increase blood viscosity and worsen the crisis. Patients should be encouraged to maintain adequate fluid intake.

F. Place the client on strict bed rest.

While rest is important, strict bed rest is not generally recommended as it can increase the risk of complications such as deep vein thrombosis. Patients should be encouraged to engage in light activity as tolerated to maintain circulation.

A. Weight loss of 5%: A 5% weight loss is typically indicative of mild to moderate dehydration, not severe.

B. Sunken anterior fontanelle: A sunken anterior fontanel is a sign of severe dehydration in infants as it indicates significant fluid loss.

C. Produces tears when crying: Producing tears is a sign of adequate hydration. Absence of tears would be more concerning for dehydration.

D. Capillary refill time 3 seconds: A capillary refill time of 3 seconds is at the upper limit of normal for infants. In severe dehydration, capillary refill time would typically be longer than 3 seconds.