The nurse is caring for an infant admitted with dehydration, irritability, signs of extreme hunger, and a palpable olive-like mass in the upper right abdominal quadrant. When feeding the infant, the nurse should monitor for which development?

Choice A reason: Chest pain is a sign of acute chest syndrome, which is a life-threatening complication of sickle cell crisis. It occurs when the sickle-shaped red blood cells block the blood vessels in the lungs, causing inflammation, infection, and low oxygen levels. Chest pain may be accompanied by fever, cough, shortness of breath, and wheezes. The nurse should report chest pain to the health care provider immediately and monitor the child's vital signs, oxygen saturation, and respiratory status.

Choice B reason: Jaundice is a common finding in children with sickle cell disease, but it is not an urgent sign of sickle cell crisis. Jaundice occurs when the red blood cells break down faster than the liver can process them, resulting in a buildup of bilirubin in the blood and skin. Jaundice may cause yellowing of the skin, eyes, and mucous membranes, as well as itching and dark urine. The nurse should assess the child's liver function and hydration status, but jaundice does not require immediate intervention.

Choice C reason: Ulcers on the legs are a chronic complication of sickle cell disease, but they are not an acute sign of sickle cell crisis. Ulcers on the legs occur when the blood flow to the skin is impaired by the sickle-shaped red blood cells, causing tissue damage and infection. Ulcers on the legs may cause pain, swelling, and drainage, and they may take a long time to heal. The nurse should clean and dress the ulcers, apply topical antibiotics, and elevate the legs, but ulcers do not require immediate intervention.

Choice D reason: Swelling in the hands or feet is a common finding in children with sickle cell disease, especially in infants and toddlers, but it is not a critical sign of sickle cell crisis. Swelling in the hands or feet occurs when the sickle-shaped red blood cells block the blood vessels in the extremities, causing inflammation and fluid retention. Swelling in the hands or feet may cause pain, stiffness, and difficulty moving the joints. The nurse should apply warm compresses, massage the affected areas, and encourage the child to exercise the joints, but swelling does not require immediate intervention.

Choice A reason: Encouraging the parents to rest when possible is not the first intervention that the nurse should instruct the mother to implement. While it is important for the parents to take care of themselves, the priority is to address the child's needs and comfort.

Choice B reason: Making a list of foods that the child likes is not the first intervention that the nurse should instruct the mother to implement. While it is important to maintain the child's nutrition and hydration, the child may not have an appetite due to the fever and inflammation caused by Kawasaki disease.

Choice C reason: Placing the child in a quiet environment is the first intervention that the nurse should instruct the mother to implement. This is because Kawasaki disease causes irritability and sensitivity to light and sound in the child. A quiet environment can help reduce the child's stress and discomfort.

Choice D reason: Applying lotion to hands and feet is not the first intervention that the nurse should instruct the mother to implement. While it is important to moisturize the skin and prevent cracking and infection, the lotion may not relieve the child's pain and inflammation.