A nurse is planning postoperative care for an adolescent following scoliosis repair with spinal instrumentation. Which of the following actions should the nurse include in the plan of care?

A. The nurse should not encourage flexion and extension of the neck, as this could cause further injury or damage to the spinal cord.
B. The nurse should reposition the client using a turning sheet to prevent skin breakdown and maintain alignment of the spine.
C. The nurse should assess the pin sites for infection at least once a day, not every other day.
D. The nurse should not tighten the screws on the halo device, as this could cause pressure ulcers or nerve damage. Only a provider can adjust the screws on the halo device.

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.