A nurse is contributing to the plan of care for a child who has sickle cell crisis. Which of the following actions should the nurse recommend to include?

Apply cold compresses to the affected areas.

Implement pain management on a PRN basis.

Active range-of-motion (ROM) exercises daily.

Promote hydration with IV and oral fluids.

Answer and Explanation

The Correct Answer is D

A. Apply cold compresses to the affected areas. Cold can cause vasoconstriction, which may worsen the sickling and pain. Heat packs are generally recommended to promote circulation and relieve pain.
B. Implement pain management on a PRN basis. Pain management should be consistent and proactive rather than PRN (as needed). Regular pain control is essential in managing sickle cell crises.
C. Active range-of-motion (ROM) exercises daily. During a crisis, the child should rest and avoid physical activity to prevent further pain and complications. ROM exercises are more appropriate during non-crisis times for maintaining joint function.
D. Promote hydration with IV and oral fluids. Hydration is crucial during a sickle cell crisis as it helps to decrease blood viscosity, reducing the risk of further sickling and vaso-occlusive events.

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Correct Answer is D

Explanation

A. "I will report changes in breathing or signs of confusion." Correct action as changes in breathing or confusion can indicate diabetic ketoacidosis or other serious complications.
B. "I will encourage him to drink a half a cup of water or sugar-free fluid every 30 minutes."Ensuring adequate fluid intake helps prevent dehydration and helps manage blood sugar levels during illness.
C. "I will notify the doctor if his temperature is not controlled with acetaminophen." Correct action as fever may indicate an infection that needs further medical evaluation and treatment.
D. "I will continue to check his blood sugar two times every day." When a child with diabetes is ill, blood sugar should be monitored more frequently, typically every 3-4 hours, to manage the risk of hyperglycemia or hypoglycemia due to illness.

A. A barium enema B. IV fluids until the spasms subside C. Immediate surgery D. Gastric lavage

Correct Answer is A

Explanation

A. A barium enema: A barium enema is both diagnostic and therapeutic for intussusception in many cases. It helps to diagnose the condition by visualizing the telescoped intestine and can also often reduce the intussusception by hydrostatic pressure.
B. IV fluids until the spasms subside: IV fluids are important for managing dehydration and maintaining hydration but do not directly treat intussusception.
C. Immediate surgery: Surgery may be necessary if non-operative reduction methods fail or if there are complications like bowel necrosis or perforation. However, it is not the first-line treatment choice.
D. Gastric lavage: Gastric lavage (stomach pumping) is not indicated for the treatment of intussusception.

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A nurse is contributing to the plan of care for a child who has sickle cell crisis. Which of the following actions should the nurse recommend to include?

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