Exhibits

Complete the following sentence by using the lists of options.

The nurse should first address the child's

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• IV hydromorphone: This potent opioid analgesic is indicated for managing severe pain during vaso-occlusive crises in sickle cell disease, especially when pain reaches a level of 10/10 despite prior interventions. Rapid IV delivery ensures quicker pain relief.
• Pain: The child’s reported pain escalation from 7 to 10 out of 10, along with swelling and warmth of the knee, strongly indicates severe vaso-occlusive pain, which is a hallmark of sickle cell crisis requiring urgent analgesic management.

Rationale for Incorrect Choices:

• Oxygen at 2 L/min via nasal cannula: The child’s oxygen saturation remains normal at 96% on room air, indicating no current hypoxia. Supplemental oxygen is not necessary unless oxygen saturation drops or respiratory distress develops.
• Oral amoxicillin: There are no clinical signs or lab evidence of infection (e.g., normal WBC count, no fever), so antibiotics are not warranted. Prophylactic antibiotics may be used in certain sickle cell scenarios but are not indicated here.
• Hypoxia: The child maintains normal oxygenation, making hypoxia an unlikely contributing factor to the current presentation. Hypoxia would require both clinical signs (e.g., low SpO₂) and symptoms like shortness of breath.
• Signs of infection: The absence of fever, normal WBC count, and localized pain without erythema or drainage suggest that infection is not present at this time. Pain is due to vaso-occlusion, not infectious origin.

A. Perform a sterile dressing change 8 hr after the procedure: Dressing changes are typically done only if the dressing becomes wet, soiled, or loose. Routine dressing changes soon after the procedure can increase the risk of bleeding or infection and are generally avoided during the initial recovery period.

B. Keep the affected extremity straight for 4 hr: Keeping the affected leg straight helps prevent bleeding and hematoma formation at the catheter insertion site by minimizing movement and pressure on the femoral vein. This immobilization period is critical to allow proper healing and reduce complications.

C. Assess the pulses above the catheterization site: It is important to assess pulses distal to the insertion site (e.g., in the foot) to monitor for signs of impaired circulation or vascular compromise. Assessing pulses above the site does not provide information about distal blood flow or potential complications.

D. Maintain NPO status for 24 hr following the procedure: NPO status is usually required only for a few hours before the procedure to reduce aspiration risk. After the catheterization, the child is typically allowed to resume oral intake once fully awake and stable, making prolonged NPO unnecessary.