A nurse is uncharacteristically extroverted on today's shift, with an unsteady gait. The manager suspects that the nurse may be chemically Impaired. What is the manager's most appropriate action?

A. Bradycardia, or a slow heart rate, is not a typical finding during a sickle cell crisis. In fact, during a crisis, the child may exhibit tachycardia (increased heart rate) due to pain, stress, and potential hypoxia.
B. While constipation can be a complication in children with sickle cell disease (often related to pain medications or dehydration), it is not a primary symptom of a sickle cell crisis itself. The immediate concerns in a crisis are related to pain and vaso-occlusive episodes.
C. High fever is not a direct symptom of a sickle cell crisis. Although children with sickle cell disease are at increased risk for infections, which can cause fever, a fever is not a typical finding specifically related to a sickle cell crisis. It is essential to assess for infection, especially if fever is present.
D. Pain is the hallmark symptom of a sickle cell crisis, often referred to as a vaso-occlusive crisis. The sickle-shaped red blood cells can block blood flow in small vessels, leading to severe pain in various parts of the body, such as the chest, abdomen, and joints.

A. While this situation raises ethical considerations, particularly regarding adolescent confidentiality, the nurse is not justified in overriding the client's right to confidentiality solely based on the request. In many jurisdictions, minors may have the right to confidentiality about reproductive health issues, though this can vary.
B. The nurse is generally required to respect this client's confidentiality. Unless there is a specific safety concern (e.g., domestic violence), the nurse should honor the client's request to keep this information private. Confidentiality should be upheld unless there is a clear and immediate risk of harm.
C. In this situation, the nurse may be justified in overriding the client’s confidentiality due to the disclosure of potential abuse. Healthcare professionals are often mandated reporters in cases of suspected abuse or neglect, particularly involving vulnerable populations such as older adults. The nurse has a duty to report this situation to ensure the safety of the client.
D. A client's wish not to know their diagnostic results does not justify overriding their confidentiality. The nurse must respect the client’s autonomy and decision-making regarding their own health information. The nurse should provide support and discuss the implications of this decision but should not disclose the results without the client’s consent.