A nurse is teaching the parent of an infant about car seat safety. Which of the following instructions should the nurse include?

A. Oxygen saturation: An oxygen saturation of 95% is within the normal range for a school-age child and acceptable for a client with cystic fibrosis, who may have mild baseline respiratory compromise.

B. WBC count: A WBC count of 9,600/mm³ is within the normal pediatric range (5,000–10,000/mm³). It does not suggest acute infection or bone marrow suppression, so it is not a reportable finding.

C. HbA1c: An HbA1c of 8.5% is significantly elevated above the normal range (4%–5.9%). This indicates poor glycemic control, suggesting cystic fibrosis–related diabetes, a common complication. This requires provider notification for further evaluation and management.

D. Heart rate: A heart rate of 98/min is within the normal range for school-age children (75–118/min). It does not indicate acute distress or cardiac complications, so it does not warrant immediate reporting.

Rationale for correct choices:

• IV hydromorphone: The child is in a vaso-occlusive crisis, where severe pain is the hallmark finding. IV opioids such as hydromorphone are the treatment of choice for rapid pain relief when pain reaches severe levels unrelieved by oral medications.

• Pain: The child reports escalating pain from 7/10 to 10/10 localized in the right knee with swelling and warmth, consistent with vaso-occlusion. Pain control is the immediate priority because inadequate management can worsen stress and sickling.

Rationale for incorrect choices:

• Fresh frozen plasma transfusion: This is not indicated in sickle cell crisis, as there is no coagulopathy or clotting factor deficiency. Plasma transfusion does not treat anemia or vaso-occlusive pain.

• Factor VIII: This therapy is specific to hemophilia A, which involves a clotting factor deficiency. It has no role in the management of sickle cell disease or vaso-occlusive crisis.

• Platelets: The child’s platelet count is elevated at 450,000/mm³, which reflects a reactive process but not a deficiency. Thrombocytopenia is not present, so platelet replacement is unnecessary.