Identify the actions the nurse should take to manage this patient’s heart failure effectively. (Select all that apply)

Choice A reason: Pulmonary edema involves fluid in alveoli, often from heart failure, not directly linked to pancytopenia. Low blood cell counts don’t cause fluid overload; this complication arises from cardiac or renal dysfunction, making it less relevant to pancytopenia’s hematologic deficits.

Choice B reason: Bleeding risk increases with pancytopenia due to thrombocytopenia, reducing platelet counts below 150,000/µL. Impaired clotting leads to spontaneous hemorrhage, such as petechiae or mucosal bleeding, a direct and common consequence of bone marrow suppression in this condition.

Choice C reason: Neurogenic shock results from spinal injury or autonomic dysfunction, causing vasodilation and hypotension. Pancytopenia affects blood cells, not neural regulation, so this complication isn’t a primary risk unless unrelated trauma or systemic failure occurs.

Choice D reason: Infection risk rises with pancytopenia from leukopenia, lowering white blood cells below 4,000/µL. Neutropenia impairs immune defense, increasing susceptibility to bacterial, fungal, or viral infections, a frequent and severe complication requiring vigilant monitoring in these patients.

Choice E reason: Seizures stem from neurologic or metabolic disturbances, like hypoglycemia, not pancytopenia. Reduced blood cells don’t directly affect brain excitability or seizure threshold, making this an unlikely complication unless secondary to infection or bleeding.

Choice A reason: Ambulation in sickle cell crisis risks worsening pain and ischemia from exertion. Rest preserves oxygen, as sickle hemoglobin clogs vessels; encouraging movement contradicts physiology, delaying recovery in acute vaso-occlusion.

Choice B reason: Opioids relieve severe pain in sickle cell crisis from vaso-occlusion. Evaluating their effect ensures adequate control, as pain signals ongoing tissue hypoxia, guiding dose adjustments for comfort and healing.

Choice C reason: High-protein, high-calorie diets support chronic sickle cell needs, not acute crisis. Teaching this now is secondary, as pain and hydration take priority over nutrition education during active vaso-occlusive events.

Choice D reason: Limiting fluids worsens sickle cell crisis by increasing blood viscosity, promoting sickling. Hydration (IV/oral) dilutes hemoglobin S, improving flow, so restriction contradicts evidence-based crisis management principles.