Five minutes after initiating a transfusion of packed red blood cells (PRBCs), a client complains of headache and chills. Which action should the nurse take first?

A.Baked chicken breast prepared without salt is a high-protein, low-sodium option that supports the nutritional needs of a client with liver impairment. It provides essential amino acids necessary for albumin synthesis while avoiding the hidden sodium found in processed meats. This choice helps manage the osmotic pressure needed to reduce ascites and peripheral edema without contributing to further fluid volume excess.

B.Spaghetti with tomato sauce, especially if the sauce is commercially prepared, often contains high levels of sodium used as a preservative and flavor enhancer. High sodium intake in clients with hepatic dysfunction triggers the renin-angiotensin-aldosterone system, leading to significant water retention and worsening of portal hypertension. The nurse should advise the client to choose fresh, unprocessed ingredients to maintain a strict low-sodium profile.

C.A bowl of ice cream contains significant amounts of sugar and saturated fats, which can exacerbate underlying metabolic issues or non-alcoholic fatty liver disease. While it may not be as high in sodium as canned goods, it does not provide the lean protein required for hepatic cellular repair and maintenance of oncotic pressure. The nurse should prioritize nutrient-dense meals that specifically address the sodium restriction and protein requirements.

D.Canned soup is one of the most concentrated sources of sodium in the modern diet, often exceeding 800 mg per serving. Consuming such high levels of salt would cause rapid fluid accumulation in a client with liver impairment, potentially leading to respiratory distress or severe abdominal tension from ascites. The nurse must educate the client to avoid canned or highly processed foods to prevent acute fluid overload.

A.Annual influenza vaccination is an important health maintenance strategy for all clients to prevent respiratory complications and secondary infections. While infection can trigger a sickle cell crisis, this generalized preventative measure is not the most specific or immediate strategy for preventing the vaso-occlusive events that define the disease. The nurse should include it in a broader teaching plan but prioritize more direct triggers.

B.Daily iron supplements are typically contraindicated for clients with sickle cell anemia unless a true iron deficiency is laboratory-confirmed. Because these clients undergo chronic hemolysis and may receive frequent blood transfusions, they are at a significant risk for iron overload and subsequent organ damage, a condition known as hemosiderosis. The nurse must educate the client to avoid over-the-counter iron preparations to prevent systemic toxicity.

C.Frequent handwashing is a fundamental infection control practice that reduces the risk of contracting communicable diseases which could stress the body and precipitate a crisis. While essential for overall health, it specifically targets the external environment rather than the internal physiological conditions that lead to the sickling of erythrocytes. It serves as a supportive measure rather than a primary intervention for preventing vaso-occlusion.

D.Maintaining adequate hydration is the most critical strategy because dehydration increases blood viscosity and promotes the sickling of hemoglobin S. Increased fluid intake helps to dilute the concentration of sickled cells and ensures smooth transit through the microvasculature, thereby preventing the pain and tissue ischemia associated with a crisis. The nurse must emphasize consistent oral fluid intake to maintain hemodynamic stability and prevent stasis.