What assessment should the nurse make before initiating an IV infusion of dextrose in normal saline solution with 20 mEq KCL per liter for a child hospitalized with dehydration?

Choice A reason:

Adequate oxygenation is important in managing vaso-occlusive sickle cell crisis, but the replacement of factor V is not relevant to this condition. Factor V is involved in the blood clotting process, and its replacement is typically associated with bleeding disorders such as hemophilia. Therefore, this choice is not appropriate for managing a vaso-occlusive crisis.

Choice B reason:

Adequate hydration and pain management are critical components of care for a child in vaso-occlusive sickle cell crisis. Hydration helps to reduce the viscosity of the blood, which can prevent further sickling of red blood cells and improve blood flow. Pain management is essential because vaso-occlusive crises are extremely painful and require prompt and effective pain relief, often with opioid analgesics. These measures help to alleviate symptoms and prevent complications.

Choice C reason:

Pain management is indeed a crucial aspect of care for vaso-occlusive sickle cell crisis, but the administration of heparin is not typically part of the treatment. Heparin is an anticoagulant used to prevent blood clots, and it is not indicated for managing vaso-occlusive crises. The focus should be on hydration and pain relief rather than anticoagulation.

Choice D reason:

Correction of acidosis may be necessary in some cases, but it is not the primary focus of care for vaso-occlusive sickle cell crisis. The main goals are to manage pain and ensure adequate hydration to improve blood flow and reduce the risk of further sickling of red blood cells. While addressing acidosis can be part of the overall management, it is not the primary intervention.

Choice A reason:

Assessing skin turgor underneath the cast is not feasible because the cast covers the skin, making it difficult to evaluate turgor directly. Skin turgor is typically assessed to determine hydration status, but it is not a primary concern when monitoring a child with a cast. The focus should be on assessing for signs of complications such as swelling, circulation issues, and pain.

Choice B reason:

Skin temperature is an important assessment when a child has a cast. Changes in skin temperature, such as increased warmth, can indicate infection or inflammation, while a cooler temperature may suggest compromised circulation. Regularly checking the skin temperature around the cast can help identify potential complications early.

Choice C reason:

Assessing pulses is crucial when a child has a cast. Checking the pulses distal to the cast (e.g., in the fingers or toes) helps ensure that there is adequate blood flow to the extremity. Diminished or absent pulses can indicate compromised circulation, which requires immediate medical attention to prevent tissue damage.

Choice D reason:

Pain assessment is essential for a child with a cast. Pain can be an indicator of complications such as pressure sores, infection, or compartment syndrome. Monitoring the child’s pain levels and addressing any complaints of pain promptly is important for their comfort and to prevent further issues.