You are working in a busy outpatient client and performing assessment on a new patient. The patient reports pain and morning stiffness in the bilateral hands. You see what looks like large nodules on the knuckles, swan-neck deformity of the fingers, and ulnar deviation of the fingers as well. What is your patient's MOST LIKELY diagnosis?

A. While taking a multivitamin can provide additional nutrients, it is generally not a cause for concern unless the multivitamin contains high doses of certain minerals that might interact negatively with iron absorption. However, this is less pressing compared to the interaction between antacids and iron.
B. Antacids can significantly interfere with the absorption of oral iron supplements, leading to inadequate treatment of iron deficiency anemia. This is the most concerning finding because it may negate the effectiveness of the iron supplementation, making it harder for the patient to improve their iron levels.
C. Black stools are a common and expected side effect of iron supplementation due to the presence of unabsorbed iron in the gastrointestinal tract. While the nurse should monitor for this, it is not inherently concerning as it indicates that the iron is being ingested.
D. Constipation is a common side effect of iron supplements. Although it can be uncomfortable, it is not as critical as the potential interference caused by taking antacids. Management strategies can often alleviate this side effect.

A. Morphine is a strong opioid analgesic that is effective for managing severe pain, especially in acute situations like a vaso-occlusive crisis. Administering it intravenously allows for rapid onset of pain relief, which is critical given the severity of the patient’s symptoms. Continuous dosing (ATC—around the clock) ensures that pain is managed effectively.
B. Fentanyl patches are typically used for chronic pain management and take time to reach effective levels in the bloodstream (up to 12 hours or longer). In the case of acute severe pain from a vaso- occlusive crisis, this option would not provide immediate relief.
C. While ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can help relieve mild to moderate pain, it is not adequate for severe pain management. Additionally, in the setting of sickle cell disease, patients may be at risk for renal issues, making high doses of NSAIDs potentially harmful.
D. Hydromorphone is also a strong opioid analgesic; however, administering it orally may not be effective for severe pain management in an acute situation. IV administration of opioids is preferred for immediate and potent pain relief during a vaso-occlusive crisis.